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
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)