Cost Sharing

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. 

Description: Qualifying Kentucky HEALTH beneficiaries pay premiums or copayments (copays) as a way of investing in personal health. Kentucky HEALTH beneficiaries have monthly household premiums that range from $1 to $15, depending on household income. This payment is made to their Managed Care Organization (MCO) each month. If all Kentucky HEALTH beneficiaries in a household are enrolled in the same MCO, they pay one premium each month to the MCO. Cost sharing is limited to 5% of family income on a quarterly basis, which includes all family copayments and premiums.


Premiums and Copayments
  • Some Kentucky HEALTH recipients will contribute to the cost of their healthcare by making monthly payments, known as premiums. These will pay for all of their Medicaid-covered visits that month. There will be no additional fees.

  • If they choose not to pay a once-a-month premium, they may have to pay a fee every time they receive a medical service. This is called a copayment. Kentucky HEALTH recipients can choose the copayment option only if their income is under 100% of the Federal Poverty Level (FPL).  If their income is over 100% FPL, they must pay monthly premiums.

  • Failure to pay the monthly premiums could result in the loss of Kentucky HEALTH benefits for up to six months. Benefits may be restored sooner if the recipient pays the missed premiums and takes an online training course.

  • Monthly premiums are optional for Medically Frail Adults and Former Foster Youth up to age 26. Kentucky HEALTH recipients who choose to pay monthly premiums will have access to a My Rewards Account that enables them to earn rewards for healthy activities. Those funds can then be used to pay for services not covered by Medicaid.

Timing: Cost sharing begins when Kentucky HEALTH goes into effect

What's Changing?

Beneficiaries will pay monthly premiums (Beneficiaries will not have copayments when monthly premiums are paid). Non-payment penalties depend on a household's Federal Poverty Level (FPL). Adults in a household with income over 100% Federal Poverty Level (FPL) will have their benefits suspended if they do not pay their premiums. Adults in households with income at or below 100% FPL will be required to make copayments if they do not pay their premiums.

Who is Impacted?

  • Income-eligible Adults
  • Income-eligible Parents/Guardians

Who is Not Impacted?

  • Children
    • Note: Children under the age of 19 do not have any cost sharing requirements (premiums or copays). Even if their parents are disenrolled, the children will remain enrolled in Medicaid. 
  • Medically frail individuals
  • Former foster youth up to age 26
  • Pregnant women
  • Medicaid beneficiaries not in Kentucky HEALTH (for example, individuals who are disabled or over age 65)