Utah performs well on early work requirement activity, MCO presence, private coverage retention, per-enrollee cost growth, Medicaid budget exposure, improper payment performance, existing APCD infrastructure, CON law status, provider flexibility, and IMLC participation. That said, Utah’s overall score is held back by Medicaid expansion, weak redetermination performance, rapid Medicaid spending growth, weak MFCU enforcement activity, and low primary care provider supply.