Updated February 3, 2021
January 1st marked the start of new Medicaid plans for 2021. This year, there are several changes and updates to the Managed Care Organizations (MCOs) providing health, oral health, and behavioral health coverage for Kentuckians.
A new MCO, United Healthcare, has been approved and began providing coverage in 2021. Any new Medicaid members who did not select an MCO have been automatically assigned to United Healthcare. United Healthcare has also been designated as the primary provider for those who are Presumptive Eligibility Medicaid members. However, this coverage is temporary and will expire on March 31, 2021. To maintain coverage, Presumptive Eligibility Medicaid members are encouraged to complete a full Medicaid application in the Kynect portal. Presumptive Eligibility Medicaid members will have the option to change their MCO after completing and receiving approval of a full Medicaid application.
Aetna Better Health of Kentucky has begun administering the Supporting Kentucky Youth (SKY) program. This means that children and youth in foster care, in out-of-home care (OOHC), children receiving adoption assistance, dually involved youth, and former foster care youth will be enrolled with Aetna for their Medicaid coverage. SKY participants will remain covered by Aetna and do not have the option to change their MCO.
As a reminder, there are six MCOs providing Medicaid coverage in Kentucky:
- Aetna Better Health of Kentucky
- Anthem Blue Cross Blue Shield
- Humana Healthy Horizons in Kentucky
- Passport Health Plan by Molina Healthcare
- United Healthcare Community Plan
- WellCare of Kentucky
Any Medicaid recipient who did not select their MCO during the open enrollment period has until March 15th to change their MCO.
Also, beginning on January 1st, the Department for Medicaid Services (DMS) has transitioned to a Single Preferred Drug List (PDL) for Kentucky Medicaid Fee-For-Service (FFS) and the Managed Care Organizations (MCO). All MCOs will follow the FFS PDL. The transition to a Single PDL will simplify pharmacy coverage for patients as well as prescribers. Medicaid members can learn more with this FAQ document.
Lastly, DMS has issued guidance removing all prior authorization (PA) requests for inpatient Medicaid services provided by Kentucky Medicaid-enrolled inpatient hospitals, as well as all Medicaid covered substance use and behavioral health services. Removing PA requests will make it easier for families and children to access needed mental health, substance use treatment, and behavioral health services. PA requests will also be lifted for certain prescription drugs including most anticonvulsants, antipsychotics, and stimulants. For more information about PA requests on prescription drugs contact DMS Pharmacy Department at 800-432-7005. These changes are in effect as of February 1, 2021.
If you would like to share any personal stories, positive or negative, about Kentucky’s Medicaid Managed Care process and your experience, please do so through this FORM.
Kentucky Youth Advocates (KYA) is a statewide nonprofit, we are not part of the Cabinet for Health and Family Services or affiliated with any MCO, but we monitor implementation of the Medicaid program by MCOs within the Commonwealth.