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Kentucky Medicaid and Kentucky Children’s Health Insurance Program (KCHIP)
Health Topics, Public Benefits Topics
This content was last updated on 4/3/2023
- What is Kentucky Medicaid?
Kentucky Medicaid provides health care and long-term care coverage for Kentuckians, including children, parents and caretaker relatives; low-income adults; pregnant women; older adults; and people with disabilities. Medicaid does not send money directly to patients - it pays the people providing the health care.
- What is KCHIP?
KCHIP (Kentucky Children's Health Insurance Program) is free health insurance for children younger than 19 that do not have Medicaid or other health insurance.
- Who is eligible for Medicaid in Kentucky?
Qualifying for Medicaid depends on your household income, age, disability or family size. Figuring out if your annual income below a certain level is the first step. You may also need to have few financial assets, depending on your age and other factors.
- Who is eligible for KCHIP in Kentucky?
Children in families with incomes less than 213% of the federal poverty level are eligible.
You can see if your household may be eligible for KCHIP, Medicaid and other benefits by clicking on this link: https://kynect.ky.gov/benefits/s/?language=en_US
- How do I apply for Medicaid or KCHIP?
You can apply for Medicaid or KCHIP several different ways:
1. Apply online here: Start your Medicaid/KCHIP application today.
2. Contact a kynector. To find a kynector, click here: https://kynexy.ke.gov/benefits/s/auth-reps-assisters?language=en_US.
3. Apply by phone. Call 1-855-306-8959.
4. Fill out the application at home. Print out the Medicaid/KCHIP application and mail, fax, or hand deliver it to your local DCBS office.
b. Medicaid/KCHIP (One Person)
5. Apply in-person at your local DCBS office.
If you have any questions about applying for Medicaid/KCHIP, call DCBS at 1 (855) 306-8959.
- When I get Medicaid or KCHIP for my child, do I have to find a doctor?
When you get Medicaid or KCHIP, you will most likely get your health care through a managed care organization (MCO). An MCO is a group of doctors and other health care workers who work together to take care of you and your family’s health care needs. You can pick which MCO you want.
Your MCO will cover most of your health services, including doctor visits, behavioral health services, nursing facility services and “waiver” services for community-based long-term care.
- How many MCOs are there in Kentucky?
As of 2023, there are 6 MCOs that you can pick from for your health care. They are:
- Aetna Better Health of Kentucky
- Anthem Blue Cross Blue Shield
- Humana Healthy Horizons in Kentucky
- Passport Health Plan by Molina Healthcare
- UnitedHealthcare Community Plan
- WellCare of Kentucky
All MCOs must provide the same benefits and cost-sharing. However, some offer special programs in addition to normal Medicaid benefits. Choosing the MCO plan that best meets your needs is very important.
- What are some things I should think about when picking my MCO?
- Which plan has all or most of the doctors my family and I visit?
- Which plan has the hospitals my family and I like to use?
- Do I or any family have a health problem that needs a specific type of doctor or specialist?
- Which MCO offers special programs that may be of interest to me and my family?
Go here for a side-by-side comparison of each MCO’s extra benefits and services: https://www.chfs.ky.gov/agencies/dms/Documents/KY%202023_side%20by%20side_Final_V2%2011.16.22.pdf
- Can I change MCOs?
Read this to see when you can change MCOS.
- What services does KCHIP cover?
Children enrolled in KCHIP are covered for: doctors’ visits, well-child checkups, hospital stays and emergency services, mental health services, lab tests and X-rays, prescription drugs, immunizations, speech and physical therapy, dental, hearing and eye checkups , glasses and many other services.
- Do I have to renew Medicaid every year?
Yes. Because of the COVID pandemic, many people who receive Medicaid have not had to renew their eligibility. This is about to change.
Beginning April 2023, everyone in Kentucky will have to go through a process to renew their Medicaid. You can find out when you have to renew through your KYNECT account. Make sure your address and email address are up-to-date on the KYNECT website.
To log in to your KYNECT account, go here: https://kynect.ky.gov/benefits/s/?language=en_US, then sign in at the upper right hand corner of the webpage.
Go here to learn more about the renewal process: https://kyvoicesforhealth.org/kentuckys-2023-medicaid-renewals-explainer/
- Can Medicaid help me pay past medical bills?
If you qualify, Medicaid may go back three months from the month you apply to pay for past medical bills.
- If my application for Medicaid is denied, what will happen? If I have Medicaid or KCHIP and I get a letter than says these benefits will stop, what will happen?
If your application is denied, you should get a written notice telling you the reason for the denial. If you are getting benefits and a decision is made that your benefits should stop, you will get a written notice telling you the reason. If you think the decision to deny or stop your benefits was wrong, you have the right to appeal. The notice will explain how you appeal and how long you have to file the appeal. Read the notice carefully and follow the instructions.
Keep the notice until your appeal is over.
If you get a denial notice or a notice saying your benefits will stop, it is a good idea to contact your local legal aid office for help right away: https://www.kyjustice.org/help-near-you.
- What happens after I file my appeal?
Once the appeal is submitted, the Medicaid agency will set a hearing date. At the hearing, there will be a hearing officer who will decide your appeal. You can call witnesses to testify and you can submit evidence as to why your application should have been granted.
- How do I get ready for the hearing?
Before the hearing, you have the right to look at your file and all of the documents that the agency has relied on to deny your Medicaid. Write down the points you want to make to the hearing officer so that you don't forget them during the hearing. You also have the right to have your own witnesses testify at the hearing and the right to ask any of the agency's witnesses questions.
If something happens at the hearing where that you think it would help to get some additional information, you can ask the hearing officer to give you more time to get the information before making a decision.
- What happens after the hearing?
You will get the hearing officer's decision in writing. If you lose your hearing, the decision will explain how you file an appeal and how long your have to file that appeal. Read the decision very carefully and follow the instructions.
If you lose your hearing, it is a good idea to contact your local legal aid office for help right away: https://www.kyjustice.org/help-near-you.