Medicaid is a government health insurance program that helps people with low income get health care services at a lower cost. In Kentucky, there is a main Medicaid program and other programs covering different services for different people. This includes adults who are age 65+, blind, or living with a disability.

What does Kentucky Medicaid cover?

Medicaid pays for routine and acute health care services. This includes:

• Visits to health care providers (including physicians and nurse practitioners)
• Inpatient and outpatient hospital services
• Early and periodic screening, diagnostic, and treatment services
• Preventive care (e.g., vaccinations)
• Lab tests and X-rays
• Dialysis services
• Mental health services
• Substance use treatment
• Rural health clinic services
• Medical transportation
• Long-term care (e.g., nursing facility care, home health services)

Most Medicaid programs also cover optional services such as:

• Physical, respiratory, and occupational therapy
• Home- and community-based care
• Case management
• Prescription drugs
• Dental and vision care

Since the program serves those with limited income and resources, people with Medicaid pay few to no out-of-pocket costs. To get coverage once you are enrolled, you must go to health care providers that take part in the Medicaid program.

Medicaid is administered by the Kentucky Department for Medicaid Services (DMS), which is part of the Kentucky Cabinet for Health and Family Services (CHFS). Call the Kentucky Healthcare Customer Service line at 1-855-459-6328 to learn more about the coverages provided.

How do I know if I qualify for Kentucky Medicaid?

In general, to be eligible, you must:

• Be a Kentucky resident
• Be a U.S. citizen or a qualified non-citizen
• Meet the income and (if applicable) resource limits for your coverage group

If you need help with your health care coverage and costs, you should apply for Medicaid even if you think you are over the income limit. This is because:

• Not all types of income are counted toward the income limit.
• You may qualify for a different form of health care assistance.
• If you are over the income limit, but you have very high medical costs, you may be able to qualify through the Medically Needy Program.

What are the different Medicaid programs in Kentucky?

You may be able to get health coverage if you fall into one of the following categories:

Aged, Blind, and Disabled (ABD) Medicaid

In Kentucky, Medicaid for low-income adults who are older (age 65+), blind, or living with a disability is called Aged, Blind, and Disabled.

Medicaid Works

If you are a worker who has a disability and limited income/resources, Kentucky Medicaid Works can provide you with access to health care benefits. In some situations, working and earning money could prevent you from getting public benefit programs such as Medicaid. Medicaid Works lets you work, keep money in savings, and still get health care coverage. You may have to pay a monthly premium.

Home and Community-Based Waiver Program

This Kentucky Medicaid program gives you daily health care and support services so you can stay in your own home and avoid moving into a nursing home. It provides services such as case management, personal care, meal preparation and delivery, and housekeeping. You can get help from this program if you are age 65 or older or you have a disability at any age. Like other Medicaid programs, you must also have limited income and resources.

Medicaid Nursing Facility Services

This Kentucky Medicaid program covers health care and support in a nursing home or other medical facility. In addition to room and board, it may cover services such as nursing care, social services, and rehabilitation. You can get help from this program if you have limited income and resources. You must also have a medical condition that requires the skills of a licensed nurse on a regular basis.

Medically Needy Medicaid (Spend-Down Program)

If your income is too high to qualify for Medicaid, but you have high medical expenses, you may be able to qualify through the Medically Needy Program (also called the Spend-Down Program). This option works by letting you spend down your income so that you meet the program’s income limits. The spend-down amount is the amount of income that is over the Medicaid limit. This amount is different for each person.

To get Medicaid benefits, you must submit current paid or unpaid medical bills equal to or greater than your monthly spend-down amount. Once your medical bills reach this amount, you will get coverage for the rest of the calendar month. While using Medicaid to pay for your medical expenses, you should use a health care provider who accepts Medicaid.

Some examples of medical expenses you can use to spend down your income include:

• Unpaid medical bills (that have not been used to spend down your income before)
• Health insurance premiums
• Medical bills you paid within the last three months
• Medical bills that will not be paid by health insurance (or any other source)
• Co-pays for medical bills
• Medical services prescribed by your doctor
• Transportation by ambulance, bus, or taxi to get health care services

How do Medicare and Medicaid work together?

Medicaid pays for some services not covered by Medicare. If you get Medicare, you may also be able to get help from Medicaid. Millions of Americans have both Medicare and Medicaid coverage. This is called being "dual eligible."

If you have Medicare and qualify for full Medicaid coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums. Depending on the Medicaid program you qualify for, the state might also pay for:

• Your share of Medicare costs, like deductibles, coinsurance, and copayments
• Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage

If you have both Medicare and Medicaid, you should show both cards to your health care provider each time you receive services.

In addition, if you are dual-eligible for Medicare and Medicaid:

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.
• You can get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, visit the Medicare website or call 1-800-633-4227 or 1-877-486-2048(TTY).

How do I prepare to apply for Kentucky Medicaid?

When you apply for Medicaid, you’ll be asked for important information to help determine if you qualify for benefits. Before you start, gather some basic information to make your application process easier: 

• A document that shows your age, such as your birth certificate or driver’s license
• Your Social Security card
• Pay stubs for anyone in your household who has earned income
• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)
• Information about your financial assets, such as bank account or investment account statements

How do I apply for Medicaid in Kentucky?

There are a couple of different ways you can apply for Medicaid. Read below to learn more about which option might be right for you.

The quickest and easiest way to apply for Medicaid is online through the Kynect benefits portal. All your personal information is kept 100% confidential and protected by special security technology. 

Apply through Kynect Benefits Portal

To apply in person or by fax, you must first obtain an application. Download, print, and complete the application here: 

• Application for Medicaid (English)

Once you have completed the application, you can drop it off at your local county office or fax it to the Centralized Mail Room at 1-502-573-2005 or 1-502-573-2007.

To apply for Medicaid over the phone, call the Kentucky Healthcare Customer Service line toll-free at 1-855-459-6328.

How can I get help with my application?

• Call the Kentucky Healthcare Customer Service line at 1-855-459-6328.
• Find a local Kynector to assist you.
• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.
• NCOA also has a HelpLine you can call to get free support. To get started today, call 1-800-794-6559.