Navigating Medicaid in Kentucky

Even before the Kentucky Department for Medicaid Services (KDMS) approves your application for Medicaid benefits, you may qualify to get Medicaid benefits in Kentucky. After a simplified eligibility review, KDMS will expedite an individual’s access to temporary coverage for Medicaid services. This review includes an individual’s:

• Name
• Household size
• Estimated monthly income

KDMS will assign “presumptively eligible” individuals to one of the managed care plans (like Humana Healthy Horizons^® in Kentucky) offering access to Medicaid coverage in Kentucky. Once enrolled in a health plan, “presumptively eligible” enrollees are encouraged to:

• Complete the full Medicaid application process before their presumptive eligibility ends
• Try out their health plan and make sure that it gives them the services and extras they want and need
• Pick a different plan, if the plan into which they were auto-assigned is not the right fit

KDMS does not force presumptively eligible enrollees to stay enrolled in the same managed care plan into which they are assigned. Instead, KDMS gives enrollees the opportunity to choose a different managed care plan.

After being approved for Medicaid coverage, enrollees can:

• Make sure the health plan into which they were enrolled is right for them
• Pick a different health plan than the plan selected for them

The state auto-assigns enrollees into managed care plans based on several criteria. The decision to stay in this health plan is 100% up to the individual. Switching plans is easy. An individual who wants to switch to a different health plan can

• Contact his or her local Department for Community-Based Services office
• Call Kentucky’s enrollment kynector at 855-306-8959 (TTY: 711).

The following groups of people can qualify for presumptive Medicaid eligibility, depending on household size and income:

• Adults ages 19 through 64 with family incomes at or less than 138% of federal poverty guidelines
• Pregnant women with family incomes at or less than 195% of federal poverty guidelines
  • Women in Kentucky who meet eligibility guidelines can be deemed presumptively eligible for Medicaid once per pregnancy
• Children under 1 with family incomes at or less than 195% of federal poverty guidelines
• Children between 1 and 5 with family incomes at or less than 159% of federal poverty guidelines
• Children between 6 and 18 with family incomes at or less than 159% of federal poverty guidelines
• Adults between 19 and 26 who received Medicaid due to being in foster care but have aged out of foster care with family incomes at or less than 138% of federal poverty guidelines
• Adults with Medicare with family incomes of less than 29% of federal poverty guidelines

KDMS will deny your application for Medicaid benefits if you:

• Already get Medicaid benefits
• Are an inmate of a public institution
• Are not a U.S. citizen or qualified alien
  • Pregnant women can still qualify for Medicaid if they are not a U.S. citizen or are a qualified alien
• Do not live in Kentucky

Coverage is effective immediately upon getting an enrollee ID card. Coverage for presumptively eligible Medicaid enrollees continues until:

• The individual completes a Medicaid application, and the application is approved or denied
• The last day of the second month after presumptive eligibility determination, if no Medicaid application is filed
  • For example, if an individual is deemed presumptively eligible for Medicaid and enrolled into a health plan on January 1, but does not complete and file an application for Medicaid coverage, coverage will end on February 28.

Learn more about presumptive eligibility and Medicaid in Kentucky