Based on a June 29, 2018 legal decision, changes to Medicaid under Kentucky HEALTH did
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
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.
Timing: Cost sharing begins when Kentucky HEALTH goes into effect
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?
Who is Not Impacted?
Medically frail individuals
Former foster youth up to age 26
Medicaid beneficiaries not in Kentucky HEALTH (for example, individuals who are disabled or over age 65)