Impacts for Eligibility Group

Based on a June 29, 2018 legal decision, changes to Medicaid under Kentucky HEALTH did not begin on July 1, 2018 as planned. Please click here for more resources and information about how this impacts Medicaid in Kentucky.

Learn more about which parts of Kentucky HEALTH may be required, optional, or not applicable to you by answering a few questions in the Kentucky HEALTH Eligibility Finder. Click here to use the Eligibility Finder:

Kentucky HEALTH Eligibility Finder

Income-eligible Adults

  • Alternative Benefits Plan: Your Medicaid benefit plan DOES change. You will have the Alternative Benefits Plan. You will have coverage for:

    • Primary and specialty care
    • Behavioral health services
    • Medications

Dental and vision services are covered through your My Rewards Account. Non-emergency medical transportation costs will NOT be covered by the Commonwealth

  • Cost Sharing: Premiums are REQUIRED. You will pay your Managed Care Organization (MCO) a monthly fee of $1-$15 based on household income.
     

  • My Rewards Account: You DO HAVE access to My Rewards Account if you pay your monthly premium. You may earn My Rewards dollars by doing healthy activities. You may use the My Rewards Account for extra benefits like vision and dental services.


  • PATH Community Engagement: You are REQUIRED to meet a new community engagement requirement of 80 hours per month (known as PATH). Qualifying activities include employment, volunteer activities, caregiving, job search, job training, education activities, and substance use treatment. If you are a full-time student or the primary caretaker of a dependent, PATH participation is optional.

  • Deductible Account: You DO HAVE a Deductible Account. The Deductible Account tracks the cost of your health services. The Commonwealth puts $1,000 in the account. If you use all the money in your account, your health plan will cover additional costs.


Income-eligible Parents/Guardians

  • State Benefit Plan: Your Medicaid benefits do NOT change. You will still have coverage for:
    • Primary and specialty care
    • Behavioral health services
    • Medications
    • Dental and vision services
    • Non-emergency medical transportation
       
  • Cost Sharing: Premiums are REQUIRED. You will pay your Managed Care Organization (MCO) a monthly fee of $1-$15 based on household income.
     
  • My Rewards Account: You MAY HAVE access to My Rewards Account if you pay your monthly premium. You may earn My Rewards dollars by doing healthy activities. You may use the My Rewards Account for extra benefits.
     
  • PATH Community Engagement: You are REQUIRED to meet a new community engagement requirement of 80 hours per month (known as PATH). Qualifying activities include employment, volunteer activities, caregiving, job search, job training, education activities, and substance use treatment. If you are a full-time student or the primary caretaker of a dependent, PATH participation is optional.
     
  • Deductible Account: You DO HAVE a Deductible Account. The Deductible Account tracks the cost of your health services. The Commonwealth puts $1,000 in the account. If you use all the money in your account, your health plan will cover additional costs.

Medically Frail Adults

  • State Benefit Plan: Your Medicaid benefits DO NOT change. You will still have coverage for:
    • Primary and specialty care
    • Behavioral health services
    • Medications
    • Dental and vision services
    • Non-emergency medical transportation.
  • Cost Sharing: Premiums are OPTIONAL. You may choose to pay premiums each month to your MCO if you want to use your My Rewards Account. If you do not pay premiums, you are placed in the No Cost Share plan and you do not have a My Rewards Account.

  • My Rewards Account: You MAY HAVE access to My Rewards Account if you pay your monthly premium. You may earn My Rewards dollars by doing healthy activities. You may use the My Rewards Account for extra benefits.

  • PATH Community Engagement: You are NOT REQUIRED to complete PATH Community Engagement activities. Participation in PATH is optional.

  • Deductible Account: You DO HAVE a Deductible Account. The Deductible Account tracks the cost of your health services. The Commonwealth puts $1,000 in the account. If you use all the money in your account, your health plan will cover additional costs.


Former Foster Youth up to age 26

  • State Benefit Plan: Your Medicaid benefits DO NOT change. You will still have coverage for:
    • Primary and specialty care
    • Behavioral health services
    • Medications
    • Dental and vision services
    • Non-emergency medical transportation.

  • Cost Sharing: Premiums are OPTIONAL. You may choose to pay premiums each month to your MCO if you want to use your My Rewards Account. If you do not pay premiums, you are placed in the No Cost Share plan and you do not have a My Rewards Account.

  • My Rewards Account: You MAY HAVE access to My Rewards Account if you pay your monthly premium. You may earn My Rewards dollars by doing healthy activities. You may use the My Rewards Account for extra benefits.

  • PATH Community Engagement: You are NOT REQUIRED to complete PATH Community Engagement activities. Participation in PATH is optional.

  • Deductible Account: You DO HAVE a Deductible Account. The Deductible Account tracks the cost of your health services. The Commonwealth puts $1,000 in the account. If you use all the money in your account, your health plan will cover additional costs.

Pregnant Women

  • State Benefit Plan: Your Medicaid benefits DO NOT change. You will still have coverage for:

    • Primary and specialty care
    • Behavioral health services
    • Medications
    • Dental and vision services
    • Non-emergency medical transportation.
  • My Rewards Account: You MAY HAVE access to your My Rewards Account. However, vision and dental services are covered by the Medicaid State Benefit Plan while you are in the Pregnant Women eligibility group.

  • PATH Community Engagement: You are NOT REQUIRED to complete PATH Community Engagement activities. Participation in PATH is optional.

  • Deductible Account: You do NOT have a Deductible Account.

Children

  • State Benefit Plan: Your Medicaid benefits DO NOT change. You will still have coverage for:
    • Primary and specialty care
    • Behavioral health services
    • Medications
    • Dental and vision services
    • Non-emergency medical transportation.

  • Cost Sharing: You do NOT have any monthly premiums. If you are in KCHIP, you may still have copays when you go to the doctor.

  • My Rewards Account: You do NOT have a My Rewards Account.
  • PATH Community Engagement: You are NOT REQUIRED to complete PATH Community Engagement activities.

  • Deductible Account: You do NOT have a Deductible Account.