Orlando Harmon
If you're looking to change your Medicaid insurance in Kentucky, there are a few things you should know. Firstly, understand that you have options. During the COVID-19 pandemic, the federal government suspended the annual eligibility test, but with the resumption of these tests, many people are losing their Medicaid coverage. However, some may have obtained other health insurance, and there are low-cost health plans available with federal subsidies. You can visit the kynect site, meet with a kynector, or consult a local insurance agent to explore these options. When you first enroll in a Medicaid managed care plan, you have 90 days to try it out, and during this period, you can switch to a new plan for any reason. After the 90-day period, you'll have to wait until the next open enrollment period unless you experience a qualifying event.
| Characteristics | Values |
|---|---|
| Options to look for other insurance plans | Visit the kynect site, meet with a kynector or local insurance agent |
| Health plans available | Low-cost health plans with federal subsidies |
| Medicaid eligibility | Low-income adults and children |
| Documentation required | Proof of income or address |
| Children's health insurance program | CHIP, a Medicaid program for children whose parents earn too much to qualify but are still considered low-income |
| Humana Healthy Horizons | A managed care plan option for Medicaid enrollees in Kentucky |
| Switching plans | Possible within the first 90 days of enrollment; after 90 days, switching is possible during the yearly open enrollment period or after an event that allows a change |
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What You'll Learn
Enrolling in Humana Healthy Horizons
To enroll in Humana Healthy Horizons, you must be a resident of a state where the program is offered. Currently, Humana Healthy Horizons is offered in Ohio and Florida.
In Ohio, Humana Healthy Horizons is a Medicaid product of Humana Health Plan of Ohio, Inc. It provides healthcare services to eligible Ohio residents. All pharmacy services are covered by Gainwell, Ohio Medicaid's SPBM. This includes all Medicaid-covered, medically necessary prescription and over-the-counter (OTC) medications.
In Florida, Humana Healthy Horizons is provided in partnership with the Florida Agency for Health Care Administration (AHCA). This is done through managed medical assistance (MMA) plans.
Once you have enrolled in Humana Healthy Horizons, you can create a MyHumana account. To do this, you will need to enter your email address, create a username and password, and choose a security question. After setting up your account, you will receive a confirmation email with instructions to verify your email address. With a MyHumana account, you can access your health plan information 24/7, as well as connect with Member Services. You can also use your MyHumana username and password with Go365 for Humana Healthy Horizons, a wellness program that offers rewards for taking healthy actions.
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Switching to a new plan
When you first enroll in a Medicaid managed care plan in Kentucky, you have a 90-day trial period during which you can switch to a new plan for any reason. After this 90-day period, you will not be able to change health plans until the next yearly open enrollment period, unless you experience a qualifying life event. The yearly open enrollment period allows mandatory enrollees to change plans for any reason.
If you want to switch to Humana Healthy Horizons, a Medicaid product of Humana Health Plan Inc., you can call the Kentucky Department for Medicaid Services (KDMS) at 855-446-1245, Monday through Friday from 8 a.m. to 5 p.m. Eastern time. Any changes you make to your health plan enrollment will take effect on January 1 of the following year. For example, changes made in November 2022 will take effect on January 1, 2023. Your current health plan will remain in effect until this date.
If you are unsure whether you can change plans, you can call Kentucky's designated enrollment kynector at 855-306-8959 (TTY: 711). A kynector can help you enroll or disenroll from a plan and answer any questions you may have. You can also visit the kynect website or meet with a local insurance agent to explore other options, including low-cost health plans with federal subsidies.
Remember that maintaining Medicaid coverage requires yearly recertification, which was temporarily suspended during the COVID-19 pandemic. Failure to respond to notices and provide the necessary documentation, such as proof of income or address, may result in the loss of coverage.
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Losing Medicaid coverage
In Kentucky, the primary reason for losing Medicaid coverage appears to be the resumption of yearly eligibility tests after the COVID-19 emergency. During the COVID-19 pandemic, the federal government suspended the annual requirement for individuals to prove their eligibility for Medicaid, which is largely based on income. Now that the emergency has ended, many people are losing their Medicaid coverage as they are no longer eligible under the income requirements. Additionally, some people may lose coverage if they move out of Kentucky, as Kentucky Medicaid coverage is typically not valid in other states.
On a broader scale, there are concerns about potential Medicaid cuts at the federal level. With the advancement of a budget resolution by the GOP-led House, key committees are tasked with finding ways to reduce spending, and Medicaid is expected to be a target. The resolution instructs the House Energy and Commerce Committee, which oversees Medicaid, to cut $880 billion in spending over the next decade. As Medicaid accounts for a significant portion of the committee's funding, experts anticipate substantial changes and cuts to the program. While House Republicans have vowed to protect benefits, they are considering work requirements for Medicaid, which could result in thousands of people losing coverage.
If you are facing the loss of Medicaid coverage in Kentucky, there are a few steps you can take. First, visit the kynect website or consult with a kynector or local insurance agent to explore other options. There are low-cost health plans available with federal subsidies to make them more affordable. Additionally, you can contact the Kentucky Department for Medicaid Services or your MCO (Managed Care Organization) to inquire about specific eligibility and coverage details. They can provide accurate information and help you understand your options.
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Obtaining other health insurance
If you have lost your Medicaid coverage in Kentucky, you may be eligible for other low-cost health insurance plans. Firstly, you can visit the kynect website or meet with a kynector or local insurance agent to discuss other options. Kynect is Kentucky's online health insurance exchange, and it offers a range of low-cost health plans with federal subsidies to make them more affordable. These plans are available to those whose income has increased, making them no longer eligible for Medicaid.
You can also consider enrolling in a Medicaid managed care plan, such as Humana Healthy Horizons, which is a Medicaid product of Humana Health Plan Inc. When you first enroll in a Medicaid managed care plan, you have 90 days to try the plan. During this 90-day period, you can switch to a new plan for any reason. After the 90-day period ends, you will have to wait until the next open enrollment period to change plans, unless you have a qualifying event. The yearly open enrollment period allows mandatory enrollees to change plans for any reason.
If you are a child, you may be eligible for health coverage through the Children's Health Insurance Program (CHIP), a Medicaid program for children whose parents earn too much to qualify for Medicaid but are still considered low-income.
Remember that maintaining health insurance coverage is important, and there are resources available to help you find a plan that meets your needs and financial situation.
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Medicaid recertification
Medicaid is a federal-state health plan for low-income adults and children. During the COVID-19 pandemic, the recertification process was waived for Medicaid recipients. However, in May 2023, the process resumed after the U.S. national emergency formally ended in April. This change took many people by surprise, as they had not been required to respond to notices regarding their coverage for the past three years.
To maintain Medicaid coverage in Kentucky, individuals must now go through the recertification process annually to prove their eligibility. This typically involves providing documentation such as proof of income or address. It is important to respond promptly to notifications from the Department for Medicaid Services to avoid losing coverage.
Those who have lost their Medicaid coverage may be able to obtain other health insurance plans. Low-cost, federally-subsidized private plans are available through kynect, Kentucky's online health insurance exchange. Additionally, Kentucky's managed care Medicaid program offers comprehensive free or low-cost health care to eligible adults, families, people with disabilities, children under 19, children in foster care, and pregnant women.
To be considered a Kentucky resident and qualify for Kentucky Medicaid, individuals must provide proof of residency. This can include owning or renting a home in the state, or having a physical location in Kentucky where they are staying. Dependent children attending school out of state may still be considered residents if they return to Kentucky during breaks and their primary residence is in the state.
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