Population Demographics

 

Geographically, Utah is the thirteenth largest state consisting of primarily rural and frontier land. Utah has 5 urban, 11 rural, and 13 frontier counties (figure 1). In 2020, Utah's average population density was 39.7 persons per square mile, compared to 93.8 persons per square mile nationally. While geographically the state is largely rural and frontier, 89.8% of the population lives in the five urban counties that make up the Wasatch Front, with 36% residing in Salt Lake County. Sixty-three percent of Utah’s lands are under federal ownership, with 24% privately owned, 8.5% by the State and 4.5% by tribal governments. According to the U.S. Census Office, Utah’s population increased to 3,271,616 in 2020, an 18.4% increase since 2010, making Utah the fastest-growing state in the nation.

 

Figure 1. Classification of Utah’s Counties as Urban, Rural, and Frontier

 

According to the report “Diversity in Utah, Race, Ethnicity and Sex”, Utah ranks as the 34th most racially/ethnically diverse state in the nation with 22.3% of the population being of non-White race or Hispanic ethnicity. Utah’s younger population is more diverse than older age groups.

 

The 2020 Census results showed that while Utah’s population increased by 18.4%, growth was concentrated among racial and ethnic minorities. Utah’s Native Hawaiian/Pacific Islander population grew the most between 2010 and 2020 at 50.4%, followed by Asians (45.5%), Black/African Americans (36.8%), Hispanic/Latinos (37.6%), American Indian/Alaska Natives (26.5%), and Whites (8.1%).

 

Data on religious affiliation in Utah comes from the 2021 Behavioral Risk Factor Surveillance Survey (BRFSS), which reports that 49.5% of Utahns are members of the Church of Jesus Christ of Latter-day Saints (LDS). Utah is home to the world headquarters for the LDS church. Other Christian faiths (Protestant and Catholic) make up 10.7% of Utah’s population. Thirty-nine percent of Utahns identify as some other religion and less than 1% report no religion.

 

There are eight sovereign tribal governments within Utah: Confederated Tribes of the Goshute Reservation, Navajo Nation, Northwestern Band of Shoshone Nation, Paiute Indian Tribe of Utah, San Juan Southern Paiute, Skull Valley Band of Goshute, Ute Mountain Ute Tribe, and Ute Indian Tribe. Census data shows the largest tribal communities indigenous to Utah are the Navajo Nation, Ute Indian Tribe, and Paiute Indian Tribe of Utah. Figure 2 provides a map of Utah Tribal lands.

 

Figure 2. Map of Utah Tribal Lands

 

 

 

Utah has resettled over 22,561 refugees since 1998 and ranks 24th in refugee arrivals. Of those arrivals in 2021, 45.6% were female. Children under 18 years old comprise 46.7% of the refugees arriving in Utah since 2015. While refugees in Utah arrive from countries all over the world, since 2016 most have arrived from African countries (47%), followed by South and Central Asian countries (23%), the Near East (North Africa and Middle Eastern countries) (12%), and East Asian/Pacific Island and Latin American countries (11% and 7%, respectively).

 

In 2020, life expectancy at birth was 77.1 years for males and 80.9 years for females in Utah, compared to 74.5 for U.S. males and 80.2 U.S. females. Utahns under the age of 25 make up 39.8% of Utah’s population, compared to 31.7% of the U.S. overall. The younger age structure of the Utah population results in the lowest median age in the nation at 31.8 years, compared to 38.8 years for the entire US. Median ages by county are shown below in figure 3. Graph 1 illustrates the Utah population by age and sex based 2020 Census data.

 

Figure 3. Median Age by County, 2020.

 

 First Insights - 2020 Census Demographic and Housing Characteristic File, Kem Gardner Policy Institute, 2023

 

Graph 1. Utah Population by Age and Sex, 2021-2022

 

Kem Gardner Policy Institute, 2023

 

 

 

 

Table 1.  State of Utah Selected Age Groups by Race and Hispanic or Latino Origin, July 1, 2022

Note: Share is of total race or ethnic population. Individuals claiming Hispanic, Latino, or Spanish origin are categorized as Hispanic and can be of any race. Non-Hispanic persons can be classified as a single race alone—White, Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander—or as two or more races. This table presents the non-Hispanic, single-race alone categories. Source: U.S. Census Bureau, Population Division, Kem Gardner Policy Institute, 2023

 

Utah’s Births

 

Utah’s 2021 general fertility rate ranked fifth highest in the nation. Utah’s 2021 general fertility rate was 63.2 live births per 1,000 women in 2020 compared to 56.3 nationally. Utah continues to have the highest birth rate in the U.S. (13.9 Utah vs.11.0 U.S.). For the first time in six years, the number of live births to Utah residents rose from 45,724 to 46,719 in 2021. Graph 2 illustrates the 2021 Utah births by race and ethnicity.

 

Graph 2. Utah Births by Race/Ethnicity, 2021

 

 

Utah’s birth outcomes are generally favorable, yet disparities emerge when examined by race and ethnicity (table 2):

 

 

Table 2. Birth Outcomes by Race/Ethnicity, 2021
 

 

The proportion of Utah births that occur in an out-of-hospital setting are increasing (graph 3). Over the past five years, planned home births increased by 46% and freestanding birth center deliveries increased by 47%.

 

Graph 3. Planned Out of Hospital Births in Utah, 2017-2021

 

Utah's Economy

 

The Office of Labor Statistics noted that the 2022 unemployment rate in Utah was 2.2 compared to 3.5 nationally. The 2017-2021 American Community Survey (ACS) estimates for median household income put Utah's $79,133 above the U.S. at $69,021. As Utah’s households are large, there is a significantly lower per capita income in Utah ($33,378) compared to the U.S. ($37,638). There is also a large variation in median income when broken out by race and ethnicity as shown in graph 4.

 

Graph 4. Median Household Income by Race and Ethnicity, American Community Survey, 2017-2021
 

According to the 2017-2021 ACS 5-Year estimates, the percentage of individuals with income below the federal poverty level (FPL) is 8.7% in Utah vs. 12.8% in the U.S. Poverty rates range widely across counties of residence. In 2020, poverty rates were lowest in Morgan County (4.5%) and highest in San Juan County (26.8%), with a statewide mean of 10.2%. The 2020-2021 National Survey of Children’s Health finds that 9.2% of families had a household income below 100% FPL, compared to 18.4% nationally.

 

Health Insurance

 

In 2021, BRFSS data estimated that 8.7% of adult Utahns were uninsured, continuing a decreasing trend over the past several years (graph 5). However, there is variation in insurance status by race and ethnicity. Graph 7 illustrates Asian adults being the least likely to be uninsured (3.8%) followed by White adults (6.4%). Pacific Islander, Black, American Indian/Alaska Native, and Hispanic adults all have higher uninsured rates compared to the Utah average. Uninsured rates for Utah children ages 0-17 have been gradually increasing since 2016 (graph 6) and are slightly higher than the national average.

Graph 5. Percentage of Adult Utahns without Health Insurance, BRFSS 2013-2021

 

 

Graph 6. Percentage of Children (ages 0-17) without Health Insurance, Utah vs. U.S. NSCH 2016-2021

Graph 7. Utah Uninsured Rates for Adults by Race and Ethnicity, BRFSS 2021

 

Note: Health insurance is defined as including private coverage, Medicaid, Medicare, and other government programs. Age-adjusted. No comparable U.S. average is provided.
 

*Use caution when interpreting. Estimates have a coefficient of variation greater than 30% and less than or equal to 50% and are therefore deemed unreliable by Utah Department of Health standards.
 

Source: Utah Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health and Human Services. Retrieved Wed. 7 June 2023 from the Utah Department of Health and Human Services, Indicator-Based Information System for Public Health Web site: http://ibis.health.utah.gov, Kem Gardner Policy Institute, 2023

 

Education

 

Based on the 2017-2021 ACS, Utah had a higher percentage of residents with a high school diploma (93.1%) compared to what is seen nationally (88.9%) among those aged 25 years and older. A higher percentage of Utah’s age 25 and older population obtained a Bachelor's degree (35.4%) compared to the U.S. (33.7%), though the proportion of Utahns with a graduate degree (12.7%) is similar to the U.S. (11.7%). According to the 2022 Kids Count report, Utah has a higher percentage of children ages 3-4 who are not in school compared to the nation (57% vs 53%). However, the proportion of fourth graders not proficient in reading is lower in Utah (60%) as compared to the national average (66%). The June 2022 National Education Association Report lists Utah as having the lowest per-student expenditure at $8,968, compared to the national average of $14,360.

 

Household and Family

 

Utah has the largest household size in the country at 2.9 persons per household compared to 2.5 nationally. Utah’s average family size is also larger than the U.S. (3.51 vs 3.15). The percentage of family households with one or more persons under the age of 18 is higher in Utah (38.3%) than nationally (29.5%).

Children and Adolescents

 

Table 3 uses National Survey of Children’s Health (NSCH) data from 2020-2021 to illustrate many areas where Utah’s children differ from the national average:

 

Table 3. Demographic Characteristics of Children Ages 0-17, Utah and U.S., NSCH 2020-2021

 

	Utah	U.S.
Race / Ethnicity
Hispanic	18.2	25.7
White Non-Hispanic	75.5	50.1
Black Non-Hispanic	1.0*	13.3
Asian Non-Hispanic	1.1	4.6
Other Non-Hispanic	4.1	6.4
Primary Language Spoken in the Home
English	92.2	84.7
Non-English	7.8	15.3
Highest Education in Household
Less than High School	4.6	9.6
High School	12.4	19.5
Some College	22.2	20
College Graduate	60.7	50.9
Family Structure
Two Parent, Currently Married	80	64
Two Parent, Not Currently Married	2.8	7.3
Single Parent	15.5	23.7
Grandparent Household	1.3*	3.4
Other Family Type	0.5*	1.6
Not Insured at Time of Survey	9.1	7.1
Current Insurance Not Adequate	30.0	25.6
2 or More Adverse Childhood Events	14.0	17.2

 

*Interpret with caution - estimate may be unreliable due to small sample size

 

The 2021 Youth Risk Behavior Survey (YRBS) illustrates differences between Utah high school youth and those in the nation. Compared to national estimates, Utah youth were significantly more likely to report texting or emailing while driving (47.0% vs. 36.1%), but less likely to report driving after drinking alcohol (1.0% vs 4.6%). Utah youth were also more likely to report having carried a weapon onto school property (8.0% vs. 3.1%). Utah youth were also significantly more likely to report having experienced sexual violence (14.8% vs. 11.0%). Utah youth were less likely than their U.S. peers to report any form of tobacco (9.5% vs. 18.7%), alcohol use (8.1% vs. 22.7%), or to ever misuse prescription pain medication (8.2% vs. 12.2%).

 

Children with Special Health Care Needs (CSHCN)

 

Data from the 2020-2021 NSCH found 23.3% of Utah children have one or more functional difficulties and 15.8% of Utah children have special health care needs. Utah’s percentage of children with special health care needs ranks seventh lowest in the nation. The 2020-2021 NSCH data provides important information on Utah’s CSHCN population and their parents in table 4.

Compared to their non-CSHCN counterparts, CSHCN in Utah were more likely to experience one or more current or lifelong health conditions (CSHCN 84.9% vs. non-CSHCN 23.9%) and to not have received needed health care (CSHCN 9.1% vs. non-CSHCN 3.9%). Their families were also more likely to have problems paying for medical bills and health care in the past 12 months (CSHCN 20.5% vs. non-CSHCN 7.9%). Families of CHSCN were also likely to report cutting back on hours or stopping working due to the child’s health (CSHCN 12.6% vs. non-CSHCN 4.0%), and to report food insecurity (CSHCN 7.5% vs 2.2%). These findings reflect broader U.S. conditions for CSHCN and their families.

Table 4. Comparison of Utah and U.S. Child Demographics and Other Select Characteristics by CSHCN and Non-CSHCN, NSCH 2020-2021

 

Comparison of Utah And U.S. Child Demographics by CSHCN and Non-CSHCN
	Utah Overall (%)	Utah CSHCN (%)	U.S. Overall (%)	U.S. CSHCN (%)
Race/Ethnicity
Hispanic	18.2	19.2	25.7	23.0
White Non-Hispanic	75.5	73.5	50.1	51.8
Black Non-Hispanic	1.0*	2.1*	13.3	16.0
Other Non-Hispanic	5.3	5.2*	10.9	9.2
Household Income
0-99% FPL	9.2	19.0	18.4	20.6
100-199% FPL	21.5	12.7	21.2	20.6
200-399% FPL	39.2	16.6	29.0	19.4
400% or greater FPL	30.1	19.7	31.5	18.2
One of More Current or Lifelong Health Indicators	84.9	23.9	92.0	24.3
Current Insurance not Adequate	37.0	28.5	32.7	23.8
Did not Receive Needed Health Care	9.1	3.9	8.8	3.8
Child Has Coordinated, Ongoing, and Comprehensive Care in a Medical Home	55.7	54.4	42.0	47.7
Problems Paying for Child's Medical or Health Care Bills in Past 12 Months	20.5	7.9	14.3	6.8
Family Member Cut Back Hours, stopped Working, or Both Due to Child's Health	12.6	4.0	17.1	3.9
Sometimes or Often Could not Afford to Eat	7.5*	2.2	7.4	3.6
** Indicates the total number of respondents is less than the criteria set by MCHB
* Please interpret with caution: estimate has a 95% confidence interval width exceeding 20 percentage points or 1.2 times the estimate and may not be reliable

 

Autism Spectrum Disorders (ASD) Prevalence Estimates Statewide

The Utah Registry of Autism and Developmental Disabilities (URADD) uses a passive, population-based system to identify persons with Autism Spectrum Disorder (ASD) based on a community medical diagnosis of ASD and/or an autism special education eligibility. As previously reported, early identification of ASD in Utah continues to be lower than expected.

In Utah, 1 in 40 8-year-olds in Salt Lake, Davis, and Tooele counties was identified with ASD. Only about 1 in 79 4-year-olds in the same counties were identified¹. For every two children identified with ASD who were age 4, there was one child who was suspected but not confirmed to have ASD. This is lower than national estimates, indicating that fewer Utah children are being diagnosed early.

To further explore these trends, URADD investigated longitudinal data for two previously studied birth cohorts from 2006 and 2008 at ages 4 and 12, and 4 and 10, respectively. These data demonstrate that 4-year-old children with ASD are not diagnosed until later in life (table 4).

Table 5. Utah Registry of Autism and Developmental Disabilities (URADD) 4-year-old follow up

Utah Registry of Autism and Developmental Disabilities (URADD) 4-year-old follow up
2006 birth cohort*		2008 Birth cohort*
4-year-olds	1.2%²	4-year-olds	1.3%²
12-year-olds	3.3%³	10-year-olds	2.7%³
*Salt Lake and Tooele Counties
Data Sources:  Maenner MJ, Warren Z, Williams AR, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveill Summ 2023;72(No. SS-2):1–14. DOI: http://dx.doi.org/10.15585/mmwr.ss7202a1 Christensen DL, Maenner MJ, Bilder D, Constantino JN, Daniels J, Durkin MS, Fitzgerald RT, Kurzius-Spencer M, Pettygrove SD, Robinson C, Shenouda J, White T, Zahorodny W, Pazol K, Dietz P. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 4 Years - Early Autism and Developmental Disabilities Monitoring Network, Seven Sites, United States, 2010, 2012, and 2014. MMWR Surveill Summ. 2019 Apr 12;68(2):1-19. doi: 10.15585/mmwr.ss6802a1. PMID: 30973853; PMCID: PMC6476327. The Utah Registry of Autism and Developmental Disabilities and the DHHS Public Health Indicator Based Information System (IBIS)

As an essential first step, the Autism Systems Development Program (ASDP) developed marketing and educational materials to encourage earlier diagnosis and worked with Help Me Grow Utah (HMG) and early intervention programs to implement the M-CHAT and STAT screeners. In 2022, HMG screened 176 children for ASD and referred 233 children to appropriate services.

Moving forward, additional steps need to be taken in working with diagnosis partners to help diagnose children at a younger age.

Utah Title V Capacity

 

The Department of Health and Human Services’ and Utah's Title V unified vision is “The Department of Health and Human Services will advocate for, support, and serve all individuals and communities in Utah. We will ensure all Utahns have fair and equitable opportunities to live safe and healthy lives. We will achieve this through effective policy and a seamless system of services and programs.''

With the merger into the Utah Department of Health and Human Services, Utah statute was recodified in the 2023 legislative session. Statutes supporting Title V efforts are now woven into the new section 26B, Health and Human Services Code, Chapters 4 (Health Care - Delivery and Access) and 7 (Public Health and Prevention). Offices within the Division of Family Health (DFH) - Maternal and Child Health (MCH), Children with Special Health Care Needs (CSHCN), and the Office of Early Childhood- collaborate to serve mothers, infants, teens, children and children with special health care needs. Other DHHS programs that collaborate and contribute to the Title V work include the Office of Health Promotion and Prevention in the Division of Population Health and the Oral Health Program in the Office of Primary Care and Rural Health.

 

Title V staff work to identify the needs of underserved women, children, and children with special health care needs to prioritize allocation of resources. Staff weigh factors that limit access to, or availability of, services across the state in partnership with community organizations and other interested parties. Staff develop plans and interventions to support health needs. Division staff review and analyze MCH/CSHCN data and educate the public through marketing and educational sessions, as well as producing reports, fact sheets, abstracts, and articles in peer reviewed journals with DHHS staff as authors.

 

In 2019-2020, MCH/CSHCN staff, in partnership with the University of Utah Division of Public Health, conducted a comprehensive statewide needs assessment to determine the priority focus for the upcoming five years. A copy of the entire Needs Assessment Report can be found here: 2020 Utah MCH_CSHCN Needs Assessment.pdf.

 

Using results from a detailed review of Utah data and the statewide Needs Assessment, Domain Leaders met and identified priority areas, associated National and State Performance measures (NPM/SPM), and Evidence Based Strategy Measures (ESM). For this annual report, state priorities have not changed based on community needs. Designated MCH/CSHCN program staff are assigned responsibility for one or more National/State Performance measures. Additional goals and objectives are developed by each program as issues arise. Regular meetings are held to evaluate, reassess, and change strategies and/or amend program plans as needed. The Block Grant annual report and application process provides an opportunity for each program to review its accomplishments and to amend plans as needed based on its achievement of the assigned measures. For a more comprehensive description of Title V programs, please see Appendix A.

 

Data capacity is strong and focused around the Division of Data, Systems and Evaluation (DSE), which serves as the central point for state health data. DSE includes four Offices: Vital Records and Statistics, Informatics and Data Systems, Information Privacy and Security, and Research and Evaluation. The DSE oversees the Internet-based query system for health data (http://ibis.health.utah.gov/), providing access to more than 100 different indicators, as well as to data sets such as birth and death files, BRFSS, Pregnancy Risk Assessment Monitoring System (PRAMS), Youth Risk Behavior Surveillance System, hospital and emergency department data, hospital performance data, population estimates, and the Utah Cancer Registry. The DSE also conducts the Behavioral Risk Factor Surveillance System. The DSE is responsible for health plan surveys and reporting plan performance annually, as well as inpatient, ambulatory, and emergency room data. The DFH has strong working relationships with the DSE. The MCH/CSHCN Offices collaborate across the Department to ensure integrated use of data and population assessment.

 

Utah’s Strengths and Challenges

 

Strengths

 

Utah’s Title V programs have many attributes that contribute to enhancing communities' health and wellness statewide. Utah has strong collaboration efforts with stakeholders and values and incorporates the advice of our partners to develop, implement, and evaluate programs for women, children, and families. The State of Utah maintains a hybrid work model which includes both telework and in-person options. Utah continues to find success by conducting our MCH/CSHCN work with stakeholders, the public, and the populations we serve through both in-person and virtual meetings and service provision.

Challenges

The geographic distribution of the State's population continues to present significant challenges for those delivering and accessing health care services, particularly in rural and frontier areas. Long travel distances and a shortage of nearby hospital facilities and providers, particularly specialists, means many residents must travel hundreds of miles for care. Many may be reluctant, if not unwilling, to utilize certain services in their communities, such as family planning, mental health, and telehealth, because of concern for confidentiality and anonymity, as well as holding cultural beliefs that impact seeking these services.

Addressing the Needs of a Diverse Population

 

The Department has endeavored to include data on subpopulations in an attempt to better quantify the issues faced by various groups. The Office of Health Equity (OHE) works to document and address existing and emerging health disparities among historically and systematically disadvantaged populations. The OHE produced the Health Equity Framework that outlines how structural and social determinants of health impact health equity and quality of life in Utah. It guides the vision that Utah’s public health, health care, and social systems should be adequate and accessible for all Utahns. The OHE assists the Department in identifying priorities and needs of specific key populations in the state through quantitative and qualitative data reporting, assessing the adequacy of race/ethnicity data from common public health data sources and recommending improvements and guidelines, informing communities about efforts and activities, and developing tools and guidance to promote cultural and linguistic appropriateness for programs.

The OHE works to build Utah’s public health infrastructure to advance health equity at the state and local level. It supports the establishment of health equity offices across Utah’s LHDs and provides training to Department and LHD staff on health equity practices and equity, diversity, inclusion, and access. The OHE also works closely with community health workers (CHWs) to create programs and systems, like the COVID Community Partnership (CCP) project, to integrate CHWs into Department efforts. Efforts also include building internal and external infrastructures to support and expand the capacities of the CHW workforce. The OHE developed the It Takes a Village: Giving our babies the best chance (ITAV) project. ITAV is a community education and engagement series to raise awareness about maternal and infant health. It uses a thorough anthropological approach with a cultural framework, which mirrors the Pacific way of life and borrows from traditional Pacific systems for resolving community problems. Additionally, The Embrace Project Study (Embrace) is a community-based participatory research study extending ITAV practices and principles to improve maternal mortality and morbidity and diabetes and gestational diabetes health disparities among Native Hawaiian/Pacific Islander women. The Title V programs and the OHE work together to identify opportunities to collaborate to address MCH needs among diverse populations.

The Department works with the Office of American Indian/Alaska Natives Health and Family Services (AI/AN). This Office facilitates meetings with the Utah Indian Health Advisory Board​ (UIHAB). The purpose of this Board is to reaffirm the unique legal status of Tribal governments through the formal 'government to government' relationship and Tribal Consultation. The board provides leadership to develop collaborative efforts between and among Tribes, Tribal organizations, the Urban Indian Organization, the Indian Health Services (IHS), the Department, and other public and private agencies addressing the health and public health of AI/AN living on and off the reservation. In addition to these roles, the Board works with Utah's Executive and Legislative leadership to promote strategies to improve health outcomes.​ The mission of this Office is to raise the health status of Utah's AI/AN population to that of Utah's general population.

 

Public Health System

 

MCH/CSHCN services are provided in various settings, including medical homes/private providers, LHDs, community health centers that serve the unhoused and migrant workers, and a number of free clinics. There remains a great need for CSHCN services around the state. The CSHCN Office, in collaboration with its stakeholders, continues to research resources, establish community connections, refer to services, and brainstorm ideas for a more comprehensive and accessible service delivery system. During the past year, service needs have grown and the CSHCN Office and stakeholders continue to discuss strategies to meet the current health needs of this population.

 

Utah's public health system comprises the Department and 13 LHDs (figure 4). The DHHS and four LHDs are accredited by the Public Health Accreditation Board. Approximately half of the LHDs are multi-county districts covering large geographic areas. Many include both rural and frontier areas within their service region.

 

Figure 4. Map/Table of Utah Counties to Local Health Departments

 

Contracts with the LHDs include developing SMART objectives for Title V measures. The specific objectives vary by district and include postpartum depression education/screening, breastfeeding, family planning, home visiting, oral health/sealants, vision/hearing screening for children. All 13 LHDs have the same developmental screening objective. Four rural LHDs are receiving funding for a CSHCN Care Coordinator and coordinate with the Integrated Services Program.

 

Systems of Care

 

To meet the needs of underserved populations, there are many systems that collaborate to increase seamless services for Utah’s population. One such system is the Community Health Centers (CHCs) throughout the state and the Wasatch Homeless Clinic in Salt Lake City that provides primary care to underinsured and uninsured MCH populations. Utah has fourteen CHCs that operate 60 clinics throughout the state. In 2021, these health centers served 118,906 adults and 48,009 children. The Association for Utah Community Health (AUCH), the state's primary care association, works to promote the development of new or expansion of existing community health centers in Utah. Figure 5 provides a map of CHCs and clinics across the state.

 

Figure 5. Map of Utah Community Health Centers and Clinics

 

 

The Office of Primary Care and Rural Health maintains publicly available listings of Utah’s primary care safety net sites, dental safety net sites, and mental health safety net sites.

 

The Department provided primary care through the Health Clinic of Utah (HCU), which was located in Salt Lake City. This clinic closed in May 2023. The clinic location now houses the University of Utah Population Health Clinic. This new clinic will provide primary care services through a student-run primary care clinic (physicals, immunizations, diabetes care, cancer screenings, etc.). The New American Clinic for refugees will provide health screenings and medical care for newly arrived refugees, and an intensive outpatient clinic will provide long-term medical and mental health care tailored to the individual needs of patients.

 

The Indian Health System in Utah consists of one IHS outpatient facility, four Tribal and Tribal Organization operated facilities, and one Urban Indian Organization located in Salt Lake City. Not all reservation communities have a health care facility nearby. While some Tribal programs operate health care facilities, travel time for services can be 3-4 hours each way. When accessing this system, appointments are not always the norm; it is first come first serve. This can be problematic if an individual lives a significant distance or arrives later in the day, running the risk of not being seen and potentially asked to return the next day. The Indian Health System is primarily dependent on federal funding. Each year, Congress appropriates funding for the IHS. This system is chronically underfunded, operating below the level of need. Most of the Indian Health System facilities do not provide specialty care or dialysis and will refer patients to specialists outside of the system or to the closest IHS Area Office or IHS hospital, which can be located in a different state.

 

Hospital Systems in Utah

 

The hospital healthcare system for MCH/CSHCN populations is well developed in Utah, with several large Maternal-Fetal Medicine Centers, 10 self-designated Level III NICUs, and two tertiary children's hospitals (Primary Children's Hospital and Shriners Hospital). Utah currently has 46 delivering hospitals across the state, four hospital systems, one University medical school/facility and one college of osteopathic medicine. All but 12 hospitals are part of the four hospital systems, which provides Utah a unique opportunity to build strong collaborations. Of Utah's hospital systems, the largest is Intermountain Healthcare. Intermountain has a national reputation for excellent quality improvement efforts and is a valuable resource for the state. The University of Utah Hospital is a teaching medical school providing tertiary care and services. Other hospitals are owned by several different hospital systems such as MountainStar, Steward and LifePoint, or are independently owned. Utah’s five Steward hospitals will be acquired by Centura Health (CommonSpirit Health) in 2023. One urban Utah hospital ended labor and delivery services in 2022.

 

As shown in figure 6, Utah has 13 Critical Access Hospitals throughout the state:

 

Figure 6. Map of Utah’s Critical Access Hospitals

 

 

Telehealth Capacity

 

Telehealth capacity is expanding in Utah. The 2022 America’s Health Rankings Report notes 95.2% of Utah households have high-speed internet, the highest in the nation. Utah has a small number of infant-pediatric audiologists, all of whom reside on the Wasatch Front or in the St. George area. Oftentimes, these babies become lost-to-follow-up due to lack of access to specialists, travel costs, inability to take time off from work, costs of testing, etc. To reduce barriers to early diagnosis after failing newborn hearing screening, the Utah Early Hearing Detection and Intervention (EHDI) program purchased auditory brainstem response equipment to provide infant diagnostic tele-audiology services for rural/frontier communities.  There are now seven tele-audiology sites across Utah.

 

Tele-audiology services are hosted at the CSHCN Office with three pediatric audiologists on staff and a nurse or trained facilitator at the remote sites. The facilitator provides direct face-to-face contact with the family and infant. The nurse connects the electrodes to the infant and stays with the family throughout the evaluation, while the audiologist remotely accesses the computer to conduct the testing. If the testing reveals that the infant is deaf or hard of hearing, the CSHCN Office helps the family with the next steps in the EHDI process, including referrals to early intervention, parent-to-parent support, and offers medical providers.

 

The Department allocates funds to the University of Utah (UofU) for perinatal mental health screening and counseling via telehealth. The project is now working with five of Utah’s rural LHDs to screen women for postpartum depression symptoms using the Edinburgh Postnatal Depression Scale tool, refer women who need support, and provide online support groups and counseling using telehealth.

 

Clinical Workforce Availability

 

The ratio of physicians to persons in a population is an indication of the adequacy of the health system and the access to care for persons in that population. According to the United Health Foundation’s 2022 Annual Report on America’s Health Rankings, Utah ranks 49th in the number of Primary Care providers, with 208.8 providers per 100,000 population (compared to 265.3 nationally). The ratio of dental care (56.7 per 100,000) and mental health care (382.5 per 100,000) providers for Utah ranks 27th and 14th, respectively. The Utah Office of Primary Care & Rural Health 2021 Health Needs Assessment report found that the distribution of providers who practice in rural communities is disproportionate to where the population resides.

 

Table 6. Population and Provider Distribution between Urban and Rural Areas

 

	Urban	Rural
Population Distribution	78.5%	21.5%
Primary Care Provider Distribution	89.0%	11.0%
Dental Provider Distribution	84.0%	16.0%
Mental Health Provider Distribution	91.0%	9.0%

 

The Integrated Services Program (ISP) contracts with four rural LHDs within the State to provide care coordination and clinical coordination for direct care services to the CSHCN population residing within their service delivery areas. This model creates a regional “hub” or main point of contact for local families of CSHCN through which they may be referred to for support, specialists, and services that may benefit their child, which quite frequently are not readily available in their local communities, as the CSHCN specialty and subspecialty pediatric providers, including the state's tertiary pediatric care centers, are mostly located along the Wasatch Front. There is one comprehensive women and children’s health center located in the southern part of the state, serving a five-county rural area. Many rural counties have no pediatricians or sub-specialists, meaning families must drive long distances to access care for their children. In most cases, there is limited additional itinerant coverage from the private sector for these large geographic areas. In rural counties, health care is often provided to children through family practice physicians, LHDs, or community health centers.

 

Families continue to face formidable barriers in accessing services and coordinating care for their children with special health care needs. Access to pediatric specialists and subspecialists is adequate if you live along the Wasatch Front, although long waiting lists exist to see practitioners; but for those living in rural/frontier areas of the state, families must drive long distances to access the same services. In 2022-2023, ISP provided services through a hybrid model that includes both virtual and in-person services. ISP has found this modality allows ISP providers to be more flexible on appointment times, with the ability to meet with families in the evening after the workday. Additionally, it has cut travel time and costs, subsequently allowing for more service time.

 

Utah’s Public Behavioral Health System

 

Utah's public behavioral health systems have a similar structure to public health agencies. Contracts are created with local county governments who are designated as local mental health and substance abuse authorities to provide prevention, treatment, and recovery services. There are 13 local authorities that deliver services throughout the state, and several are co-located with the LHD.

 

Utah Medicaid

 

Utah’s Medicaid program is administered through the Department. The Medicaid program provides vital support to MCH/CSHCN populations throughout the State. Utah Medicaid contracts with managed care entities to provide medical services to Medicaid members. Utah Medicaid has two types of managed care entities that are accountable to provide physical health benefits: Accountable Care Organizations (ACO) and Utah Medicaid Integrated Care (UMIC). Members enrolled through Adult Expansion living in Davis, Salt Lake, Utah, Washington, or Weber counties must choose a UMIC plan. Non-expansion members living in Box Elder, Cache, Davis, Iron, Morgan, Rich, Salt Lake, Summit, Tooele, Utah, Wasatch, Washington, or Weber counties must choose an ACO. Members that live in other counties have the option to choose an ACO or the Fee for Service Network.

Each ACO or UMIC plan is responsible for covering all medically necessary services for their enrolled Medicaid members. Medicaid pays a monthly capitated rate for each Medicaid member enrolled in an ACO or UMIC plan. Each ACO or UMIC plan is allowed to offer more benefits and potentially fewer restrictions than Utah’s State Plan benefits, however they are not allowed to provide fewer benefits. The ACO or UMIC plan must specify services which require prior authorization and the conditions for authorization.

Members enrolled in an ACO or UMIC plan must receive all services through a provider in that plan’s network. The provider is paid by the managed care entity. Members enrolled in the Fee for Service Network may use any willing Utah Medicaid provider; Fee for Service providers are paid directly by the State.
 

Overview/Conclusion

 

The directors of Title V/MCH and CSHCN work with employees at the state and local levels, as well as with strategic partners, to implement programs and services of the Title V Block Grants three federally defined populations: women, children (including those with special health care needs), and families. The Title V/MCH and CSHCN Directors and staff use data, needs assessments, capacity surveys and historical experience to make determinations for program capacity, development, and funding with the goals to improve access and services throughout Utah.