Employer-Sponsored Insurance Program

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: The Employer-Sponsored Insurance program establishes a way for the state to help pay a Kentucky HEALTH beneficiary's premium if his/her job offers medical benefits, also known as an employer-sponsored insurance (ESI) plan. Some beneficiaries are required to check if their ESI qualifies for the Employer-Sponsored Insurance program. Beneficiaries who have been…

  1. Enrolled in Kentucky HEALTH for 12 total months and
  2. Employed with the same employer for 12 months in a row

…are required to enroll in the Employer-Sponsored Insurance program if the ESI coverage is cost-effective for the Commonwealth. The beneficiary pays the same Kentucky HEALTH premium amount, whether the beneficiary is on the Employer-Sponsored Insurance program or Kentucky HEALTH.

Timing: The Employer-Sponsored Insurance program through Kentucky HEALTH will be available to beneficiaries in 2019.

What's Changing?

  • Kentucky HEALTH will provide advance reimbursement to the employee for the full employee cost of the employer plan, minus the beneficiary's required Kentucky HEALTH premium amount.
  • There will be no other out-of-pocket costs for those covered on the plan. Medicaid will cover the cost for services that are covered by Kentucky HEALTH if they are not covered by the employer plan.

Who is Impacted?

Mandatory enrollment: Medicaid Expansion adults, parents, caretakers & those with Transitional Medical Assistance who have been enrolled in Kentucky HEALTH for 12 months and employed with the same employer for 12 months if the employer plan is deemed cost effective.

Who is Not Impacted?

Optional enrollment: Medically Frail, Former Foster Youth Up to Age 26, Pregnant Women & Children

Please visit the Resources page for more information.