Utah DHHS Will Impose Medicaid SUD EnrollmentMoratorium to Combat Fraud

SALT LAKE CITY —  The Utah Department of Health and Human Services (DHHS) has received federal approval to place a temporary moratorium on new Substance Use Disorder (SUD) and mental health rehabilitation provider enrollments in the Utah Medicaid program. This temporary measure, executed in close coordination with the Utah Attorney General’s Medicaid Fraud Control Unit (MFCU), is part of an ongoing state effort to protect taxpayer resources and maintain the highest standards of public trust.

The moratorium applies only to new enrollments, including provider enrollments in progress. Medicaid members currently receiving SUD treatment will see no disruption to their care, and compliant providers already in the network will continue operating normally. Utah Medicaid will coordinate with managed care organizations and local mental health authorities to monitor network adequacy throughout the pause. 

“Taxpayers trust us to manage Medicaid funds with rigorous oversight and integrity,” said Julie Ewing, State Medicaid Director. “We are taking a hard line against fraud, waste, and abuse to ensure every dollar is properly used to care for those in need.”

Escalating risk prompted action 

On May 1, 2026, Utah exercised its federal authority under 42 CFR §455.450(e) to elevate all SUD and Applied Behavior Analysis (ABA) providers to “High-Risk” status based on national fraud trends. Existing and new SUD providers will soon undergo multi-phased screening that includes mandatory fingerprint-based criminal background checks for all owners and operators with a 5% or greater interest, as well as unannounced site visits. 

Strengthening multi-agency enforcement

The temporary pause on new enrollments will allow Utah Medicaid, the Utah Office of Inspector General (UOIG), and the Attorney General’s Medicaid Fraud Control Unit (MFCU) to pool resources and focus directly on the strict revalidation and auditing of current billing entities.

“Our office is fully synchronized with DHHS and our federal partners to root out bad actors who view Medicaid as a paycheck rather than a public service,” said Kaye Lynn Wootton, Director of the Medicaid Fraud and Patient Abuse Division, Office of the Utah Attorney General. “By implementing this moratorium alongside DHHS, we can effectively freeze the playing field, investigate suspicious activity, and aggressively pursue civil or criminal recovery efforts against anyone exploiting behavioral health programs.”

National alignment 

This moratorium aligns with a nationwide initiative by the Centers for Medicare and Medicaid Services (CMS) to strengthen Medicaid program integrity. Utah recently submitted its formal Two-Year Provider Revalidation Strategy to CMS — a comprehensive plan to screen and verify 4,644 high-risk billing providers across the state by June 5, 2028. 

The moratorium will remain in effect for an initial period of six months while state agencies complete compliance reviews and risk assessments of existing providers.  An exception process for new providers will be available on a case-by-case basis to ensure Medicaid members have sufficient access to care.

To report suspected Medicaid fraud, waste, or abuse, contact the Utah Medicaid Fraud Control Unit at [email protected] or (801) 281-1259.