In January the federal Centers for Medicare and Medicaid Services (CMS) approved the Bevin Administration’s 1115 Medicaid Waiver to modify Kentucky’s Medicaid program for the next five years, known as Kentucky HEALTH. We at Kentucky Youth Advocates believe Kentucky HEALTH’s initial rollout and ongoing implementation must be family-centric. Parents’ health coverage is vitally important to children’s health coverage, and if parents are going to maintain coverage to improve health outcomes for themselves and their children, Kentucky HEALTH must be simple for families to understand, participate in, and utilize.
As child advocates, we are sharing information about Kentucky HEALTH eligibility, enrollment, and requirements so that families who may be impacted, and those who work with families who may be impacted are aware of the changes and have the necessary information to maintain health coverage.
Families and individuals affected by the changes to Medicaid should visit kentuckyhealth.ky.gov, where all of the below information can be found, to learn more about changes to their eligibility and requirements. If you have questions about coverage, find contact information for assistance here.
What is the Kentucky HEALTH Program?
Individuals who will be affected by these changes to Medicaid include able-bodied adults who are not eligible for employer-sponsored coverage. The health coverage of children, pregnant women, youth who’ve aged out of foster care will not change. Learn more about those included and not included in Kentucky HEALTH here.
Individuals on traditional Medicaid will not need to re-apply to be enrolled in Kentucky HEALTH. If you are currently on Medicaid and eligible for Kentucky HEALTH, your benefits will not change until the new program starts on July 1, 2018. Current Medicaid members will receive information in the mail before the program starts.
The Kentucky HEALTH coverage includes four components:
- Monthly cost sharing payments (i.e. – monthly premiums or co-payments)
- $1,000 deductible account
- PATH community engagement requirement
- My Rewards health care spending account
Deductible Account –
Kentucky HEALTH members will be provided with a deductible account to cover non-preventive and pharmacy service expenses. The state will pay for the first $1,000 of the deductible expenses. Preventive services will not go towards the deductible expenses. The Managed Care Organizations (MCOs) , such as Humana CareSource, Aetna Better Health, WellCare of Kentucky, Anthem Blue Cross and Blue Shield Medicaid, and Passport Health Plan, will maintain members’ deductible accounts, and once the deductible account is empty, the MCOs will cover all additional health care costs.
What to expect? Starting in July, Kentucky HEALTH members will receive monthly statements showing the balance in their deductible accounts, and their account expenditures from the previous month. Former foster youth up to age 26, parents/guardians, and low-income adults up to 138% of the Federal Poverty Level will have a deductible account. Children and pregnant women will not have deductible accounts.
Cost Sharing –
Kentucky HEALTH will require premium payments on a sliding scale ($1-$15 per month), though individuals at or below 100% of the Federal Poverty Level (FPL) may elect to not make their required premium payments and instead continue to be charged copayments for services.
Adults above the 100% poverty level who fail to pay premiums for 60 days or fail to report changes that may affect eligibility within 10 days will lose coverage and be locked out from re-enrollment for six months. They can re-enter early if they catch up on their premium costs and if they take a financial or health literacy course. Adults below the poverty level who fail to pay premiums will be required to make copayments. They will not lose coverage or be locked out, but their My Rewards Account will be suspended.
What to expect? Starting July, Kentucky HEALTH members will pay monthly premiums or co-payments based on the table below to the MCOs. Children, former foster youth up to age 26, and pregnant women will not pay co-payments or premiums.
Community Engagement –
Kentucky HEALTH adult members – except those who are pregnant, full-time students, chronically homeless, medically frail, or the primary caregiver of a dependent child or adult – are required to participate in 80 hours of work, education, training, or community service activities per month to maintain health coverage.
What to expect? This community engagement requirement, called PATH, will be phased in across the state. Campbell County will be the first Kentucky county to implement the rollout of the PATH community engagement on July 1st. Kentucky HEALTH members will receive a 90-day notice before the PATH requirement is implemented in their county. The map above illustrates a projected rollout timeline. Children, pregnant women, former foster youth up to age 26, chronically homeless, primary caregiver of a dependent adult or child, and full-time students are exempt from the PATH Community Engagement requirement. Individuals receiving and meeting the SNAP or K-TAP 20 hours per week requirement will also meet the PATH requirement. Kentucky HEALTH members will report monthly PATH Community Engagement hours through an online portal called Citizen Connect. Kentucky HEALTH member must have a Benefind login account to log into the Citizen Connect portal.
My Rewards Account –
Some Kentucky HEALTH members will have a health spending account called My Rewards. Kentucky HEALTH members can accumulate funds in their My Rewards account upon completion of specified health-related preventive activities, education courses, community engagement, or healthy behaviors activities to access benefits not otherwise covered, such as dental care, vision services, and over-the-counter medications.
What to expect? Before Kentucky HEALTH begins in July, Kentucky HEALTH adults can earn dollars by receiving preventive health services and completing online education training through the Citizen Connect portal. Children will not have access to a My Rewards account. Pregnant women, medically frail individuals, former foster youth up to age 26, and primary caregivers will have access to a My Rewards account. Medicaid Expansion parents and adults must pay premiums to have access their My Rewards account. Medicaid Expansion parents and adults can use their My Rewards Account for routine dental and vision services. Members will have to utilize the Citizen Connect portal to monitor the balance, earn dollars, and learn more about spending My Rewards dollars.
Families and individuals affected by the changes to Medicaid should visit kentuckyhealth.ky.gov, where all of the above information can be found, to learn more about changes to their eligibility and requirements. If you have questions about coverage, find contact information for assistance here.