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Kentucky Medicaid Eligibility

Kentucky Medicaid is jointly funded by the federal government and the Kentucky state government. The program is designed to help low-income and medically needy Kentucky residents cover health care costs. Even though it is federally regulated, each state has some liberty to make decisions based on the state’s individual needs. That’s why each state Medicaid program is slightly different.

In September of 2018, the Kaiser Family Foundation released data which shows that 21% of the Kentucky population is covered by either Kentucky Medicaid or CHIP (the Children’s Health Insurance Program which falls under Medicaid). Kentucky Medicaid covers 1/6 adults, 2/5 children, 2/3 nursing home residents, 1/2 disabled people, and 1/5 Medicare beneficiaries in the state of Kentucky. Kentucky Medicaid Eligibility requirements change each year, so you may be eligible and not even know it!

What You Should Know about Kentucky Medicaid Includes:

Kentucky Medicaid Eligibility Requirements

The Kentucky government reviews Kentucky Medicaid eligibility requirements every spring, so your eligibility is subject to change. One way to qualify for KY Medicaid is to meet the income requirements, which are as follows for 2018 (but are subject to change every year).

Keep in mind that asset refers to cash, stocks, bonds, investments, credit union, savings, checking accounts, pension funds, and secondary real estate. Income includes cash from family and friends, Veteran benefits, alimony, pension, Social Security, stock dividends, IRA withdrawals, and of course employer income. 

    Kentucky Medicaid Eligibility Requirements

    Supplemental Social Security Income (SSI Kentucky)

    In most cases, those who receive Social Security Disability Insurance (SSDI) can receive Medicare, and those who receive SSI Kentucky can receive Medicaid. Speak to an advisor at your local SSI Kentucky office to find out if you meet the Kentucky Medicaid eligibility requirements!

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    Kentucky Medicaid Application (MAP-14 and Benefind)

    There are a few ways to apply for Kentucky Medicaid.

    The easiest place to start is Benefind. Through Benefind, you can apply for SNAP (food stamps), KTAP (Kentucky Transitional Assistance Program (KTAP), child care assistance, and Medicaid. You can start by performing a prescreening to find out if you may be eligible, and then you can complete your application. Applying is the best way to know for sure whether or not you are eligible.

    You can also visit the Department for Community Based Services (DCBS) office in your county to apply in person. If you need help completing your Kentucky Medicaid Application, call your local DCBS office.

    If you are not able to complete the application yourself for any reason, you can authorize another person to complete the form for you via the  MAP-14 Interested Party Authorization Form.

    How to Apply for Medicaid in Kentucky

    To apply for Medicaid in Kentucky, you will need your:

    • Social Security Number
    • Drivers license or other legal proof of identity
    • Birth certificate for proof of citizenship
    • Evidence of any other health insurance
    • Pregnancy verification and due date if applicable
    • Proof of income and resources

    What does Medicaid cover in Kentucky?

    Even though Medicaid is a federal program, each state is allowed to add additional benefits as they see fit. However, every Medicaid program must cover the same basic benefits, which include:

    • Inpatient and outpatient hospital services
    • Early and periodic screening, diagnostic, and treatment services
    • Nursing facilities
    • Home health
    • Physicians
    • Rural health clinics and federally qualified health centers
    • Labs and X-rays
    • Family planning, birth centers, and midwives
    • Pediatric and family nurse practitioners
    • Medical transportation
    • Tobacco counseling for pregnant women

    While the Kentucky Medicaid program is federally required to cover the above services, it adds coverage for:

    • Prescription drugs
    • Radiology
    • Specialized child services
    • Pediatric immunizations and screenings
    • Skilled nursing care
    • Rehabilitation
    • Durable medical equipment (wheelchairs, ventilators, kidney machines, etc.)
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    Cost and Coverage of Medicaid in Kentucky

    Most Medicaid beneficiaries won’t have to pay for their services. Some people with higher incomes may have to pay small copayments (typically no more than $5) for major services.

    KY Medicaid Dental Providers

    Dentaquest is the largest Medicaid dental benefits administrator. A good place to start in looking for KY Medicaid Dental Providers may be the Dentaquest website!

    The Kentucky Medicaid Dental Program has different coverage for adults and children. Adults can receive coverage for:

    • Oral exams
    • X-rays
    • Extractions
    • Fillings
    • Emergency visits

    Kids can get coverage for everything that adults can with the addition of:

    • Root canal therapy
    • Crowns and sealants
    • Braces in severe circumstances
    • Denture repair

    KY Medicaid Dental Providers and Healthy Smiles Kentucky

    In 2004, Kentucky’s seniors led the nation in missing teeth. About 27% of all Kentuckians had lost at least six teeth due to decay or gum disease. On the same token, 46.8% of kids ages 2-4 had untreated dental problems. As a result, the Healthy Smiles Kentucky initiative was born.

    Healthy Smiles Kentucky is coordinated by the Kentucky Oral Health Program and funded by both state dollars and Appalachian Regional Commission and Health Resources and Services Administration grants. The money is used for training KY Medicaid dental providers on child dentistry (called ABCD training) and for expanding access to dental services.

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    Mental Health

    In 2008, the Mental Health Parity and Addiction Equity Act of 2008 made it a requirement for Medicaid programs to treat mental health and substance abuse the same way they treat physical health problems. This means that on a federal level, Medicaid is required to cover any testing, hospitalization, doctor visits, and even medical transportation that relates to your mental health.

    The state of Kentucky has 14 regional non-profit Boards for Mental Health or Individuals with an Intellectual Disability. These centers can help Kentuckians who face mental health or intellectual disabilities or substance abuse. Click here to find the center closest to you.

    Kentucky Medicaid Transportation

    Medicaid in Kentucky will only cover medically necessary transportation if you are going to a doctor’s appointment or another Medicaid-covered provider. Generally, pharmacy travel is not included.

    Kentucky Medicaid will cover emergency ambulance travel if you need to get to a hospital due to a sudden serious injury or illness that makes it impossible for you to use another method of transportation. KY Medicaid can cover non-emergency ambulance travel if you are confined to a bed and/or need to be moved by stretcher to avoid further injury. Your Medicaid-covered transportation must stay within your service area unless you have a special referral from your primary care physician.

    If you need to request non-emergency medical transportation, you can do that through the Kentucky Human Service Transportation Delivery program. They can send either a taxi, bus, or van depending on your needs.

    KCHIP (Kentucky Children's Health Insurance Program)

    KCHIP, or the Kentucky Children’s Insurance Program, is for Kentucky persons under the age of 19 who do not have another source of health insurance and live at or below 213% of the federal poverty level. Kids can qualify with the following income levels in 2018 based on family size (subject to change each year):

    • Individual child - Annual income below $26,465
    • Family of 2 - Annual income below $35,883
    • Family of 3 - Annual income below $45,300
    • Family of 4 - Annual income below $54,718
    • Family of 5 - Annual income below $64,135
    • Family of 6 - Annual income below $73,553
    • Family of 7 - Annual income below $82,971
    • Family of 8 - Annual income below $92,388
    • *Add $785 per month for each additional family member*

    The KCHIP Program covers:

    • Doctor visits and hospitalization (co-pays from $3-$50)
    • Dental, vision, and hearing services
    • Psychiatrists and mental health
    • Labs and x-rays
    • Physical and speech therapy
    • Prescription drugs and immunizations (Co-pays from $1-$8)

    To apply for KCHIP, you can fill out a KCHIP application at your local health department or download it below. You will need to renew this application every year. You’ll need proof of income, child expenses, citizenship, identity, and other health insurance. If you need help with your application, call 1-855-4kynect (1-855-459-6328).

    Click to download KCHIP Application

    Kinship Care Kentucky

    The Family Caregiver Support System, or Kinship Care Program in Kentucky,, is a national program that helps senior caregivers access services such as counseling, support groups, training, respite care, etc.

    The Kinship Care Kentucky program is primarily for grandparents who are primary caregivers for a grandchild who is under 18 and related by blood, marriage, or adoption. Some Kentucky Family Caregiver Program participants with an income of no more than 150% of the federal poverty level may be eligible for grants or vouchers for clothes, school supplies, medical services, etc.

    Your local Area Agency on Aging and Independent Living can provide more information for Family Caregiver Support System services and Kentucky Family Caregiver Programs in your area.

    Medically Needy Medicaid

    If you are over the limit for Kentucky Medicaid eligibility but still need help due to large medical bills, you may still have Medicaid-related options. If you’re technically over the limit but your excessive medical expenses leave you living as if you’re under the limit, you may qualify for the “Spend Down Program.” This will allow you to receive a form of temporary Medicaid benefits.

    You can also qualify for QITs, or Qualified Income Trusts (also called Miller Trusts). With a QIT, you’ll have money deposited into a trust that you can use for healthcare costs.

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    Medicaid Works

    Medicaid Works is for Kentuckians with disabilities who are employed but low-income. Through Medicaid Works, you’ll have to pay a monthly premium to “buy into” Kentucky Medicaid. To qualify, you must be between the ages of 16 and 64, legally disabled, and earning less than 200% of the federal poverty level. You must provide proof of employment. If you quit or lose your job, you can keep your benefits for six months. If you find a new job after six months, you can re-apply for the program. To apply, visit your local Department for Community Based Services (DCVS) Office.

    Kentucky Medicaid Expansion

    You may have heard of a program called Kentucky HEALTH. The Kentucky HEALTH (Kentucky Medicaid Expansion) program was due to go into effect on July 1, 2018. Due to a legal decision, the program has not yet gone into effect. The legislation has been submitted to CMS (Centers for Medicare and Medicaid Services) again, but nothing has been changed as of yet. If Kentucky HEALTH or another Kentucky Medicaid Expansion program is approved, you will receive a notice from the Commonwealth of Kentucky explaining any new Kentucky Medicaid eligibility requirements or coverage changes. For now, Kentucky Medicaid will resume as usual.

    Click to view the latest Kentucky HEALTH program status update (9/24/18).

    Dual Eligibile Medicare and Medicaid Plans in Kentucky

    Did you know that you can get both Medicare and Medicaid benefits at the same time? You can qualify for Medicare if you are age 65 or older or if you have a qualifying disability such as End-Stage Renal Disease or Lou Gehrig's Disease.

    If you aren’t sure whether or not you qualify for both Medicare and Medicaid, or to speak to a Medicare licensed agent about your options, either complete this form or call Medicare Plan Finder at 833-438-3676.

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    Have questions? Call a Licensed Agent!