What Health Care Programs Are There for Kentucky Families?

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Medicaid in Kentucky is called KyHealth Choices. It is available for aged, blind and disabled persons and also provides health and medical coverage to certain lower income families, children, children in foster care, and pregnant women in Kentucky. The goals of the program are to provide health care to children and families, and to help prevent health problems with early medical care and treatment.

Who benefits from Medicaid?
Your family may automatically qualify for Medicaid because your income is low and you receive K-TAP (Kentucky Transitional Assistance Program, formerly known as welfare). Your family or dependent children 18 years of age or younger may qualify for Medicaid even if your income is above the K-TAP limits. Depending on your income, you may have some premiums and co-payments.

If you are pregnant, you may qualify for Medicaid coverage of pre-natal care, pregnancy complications, delivery, and 60 days of care after delivery.

There is also a special program for women who are under 65 and have breast or cervical cancer. They can be eligible for medical coverage if they do not have other health insurance and if their income is less than 250% of the federal income poverty level.

The Kentucky Women's Cancer Screening Program provides low-cost mammograms and Pap tests through health departments in every county. View a list of local health departments [PDF file].

Three factors are used to determine eligibility for breast cancer screening:

  • age
  • income
  • uninsured (no private insurance, no Medicaid, no Medicare).

Women age 40-64 who meet guidelines are eligible for screenings every year.

Women younger than 40 are eligible to receive screening services if they have a family history of breast cancer.

Low-cost annual Pap tests are provided to uninsured women at or below 250% of the poverty level beginning three years after the onset of sexual activity or no later than 21 years of age.

Am I eligible for Medicaid (KyHealth Choices)?
To be eligible for one of the programs of Medicaid (KyHealth Choices), you must:

  1. Be a Kentucky resident;
  2. Over 65 years old, blind, or disabled; and
  3. Have limited resources
Call your county Department for Community Based Services, Cabinet for Health and Family Services to get more information or to get an application. Information is also available on-line at http://chfs.ky.gov/dms/apply.htm

I am a working parent. Will my children be eligible for Medicaid?
Possibly. Some programs are designed to help more children receive health services, even if their families earn too much money for the traditional Medicaid programs. Kentucky provides a program called Kentucky Children's Health Insurance Program (KCHIP) for uninsured children.

Who is eligible for the Kentucky Children's Health Insurance Program?
To be eligible for the Kentucky Children's Health Insurance Program, you must:

  1. Be under the age of 19;
  2. Be a Kentucky resident; and
  3. Be a member of family that has income of 200% of the federal income poverty level or less.
Eligibility is based on the federal income poverty level, and the level changes yearly. The monthly income limit for a family of 4 is $3,675 in the year 2009. You can access the income tables at http://kidshealth.ky.gov/en/kchip/eligibility.htm or call KCHIP Information at 877-524-4718.

What is covered under this program?
Kentucky Children's Health Insurance Program covers health check-ups and screenings, presciption medicine, immunizations (shots), doctor visits, vision exams and eyeglasses, hearing services, dental care, hospital care, mental health, allegy injections, serum and much more.

Where do I apply?
You apply at your county Department for Community Based Services, Cabinet for Health and Family Services. If you do not know where the Department is located, call 877 524-4718.

Do I choose my child's doctor?
Yes, but if you live in Louisville and the surrounding 16 counties (Jefferson, Oldham, Trimble, Carroll, Henry, Shelby, Spencer, Bullitt, Nelson, Washington, Marion, Larue, Hardin, Grayson, Meade, and Breckenridge), you will be part of a program called Passport Health Plan. After you apply for Kentucky Children's Health Insurance Program, Passport Health Plan will help you find a doctor. They will provide you with a list of doctors in your area to choose from. If you don’t choose, a doctor will be assigned to you and your family. Passport is set up to help your family find a doctor who will keep records of your child's progress so your child gets more consistent care.

What if I don't like the doctor I have chosen?
You can change your doctor after 12 months. You can change the doctor sooner than 12 months if there are special circumstances (such as you have moved).

What kind of health and medical care is offered?
Kentucky Children's Health Insurance Program covers a wide range of services. Basic services that are covered include:

  • Doctor or Nurse Practitioner care, including check-ups, immunizations, and well-baby/ well-child care.
  • Preventive services in Health Departments.
  • Hospital care, in-patient and out-patient, emergency care for true emergencies, laboratory services, diagnostic services.
  • Pharmacy Services, such as prescriptions drugs and some over-the-counter medications.
  • Dental care, including regular check-ups, fillings, and cleanings.
  • Vision care and eyeglasses
  • Hearing care
  • Therapy services, which include physical therapy, speech therapy, respiratory therapy and occupational therapy.
Other services that are covered under Kentucky Children's Health Insurance Program are mental health and substance abuse care, medical supplies and equipment, home health care, chiropractic care, early intervention for infants and toddlers with disabilities, services provided by school districts for children with disabilities, and transportation services. You can call 1-877-524-4718 if you have any questions about Kentucky Children's Health Insurance Program.

Do I have to pay for medical services in the Kentucky Children's Health Insurance Program?
There may be some fees for services. If you are in the Kentucky Children's Health Insurance Program and the family income is between 151% and 200% of the federal income poverty level you pay a $20 monthly premium. You may also pay $1 to $3 co-pay for prescriptions, $2 co-pay for allergy testing and 5% of emergency services if it is not a true emergency.

What if I am in the Kentucky Children's Health Insurance Program but I don’t pay the required premium?
If you are required to pay a premium, you will be billed. If you don’t pay the first premium, your application will be denied. If you miss a premium later, the health coverage will stop. Contact the premium payment center at 1-866-959-2447.

What if I disagree with a decision made by the program?
You can appeal if you are denied any of these services or if you disagree with a program decision. You will then have a hearing. There are time limits for appealing, so make sure you read the denial notice carefully to see how to appeal. You may also want to contact a private attorney or your local legal aid office for help.

Remember: If you are on Medicaid or Kentucky Children's Health Insurance Program and you change your address, let the Cabinet for Health and Family Services know so you don’t miss any important information.

Reviewed August 2009