Cost Sharing

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.

Timing: Cost sharing begins on July 1, 2018

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?

  • Adult group
  • Parent/caretaker relatives

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)