Orlando Harmon
Medicaid is government-funded health coverage for people in certain situations. In Kentucky, you may qualify for income-based Medicaid if your family's income is at or under 138% of the Federal Poverty Guidelines (FPG) ($21,597 per year for an individual; $44,367 for a family of four). If you are under 18 years old, your family income limit is higher at 218% of FPG ($70,087 per year for a family of four). If you are pregnant, your family income can be up to 195% of FPG ($62,693 per year for a family of four), with the unborn baby counted as a family member. Additionally, if you receive Supplemental Security Income (SSI) or qualify under SSI's 1619(b) rule, you automatically get Medicaid coverage.
| Characteristics | Values |
|---|---|
| Qualifying factors | Income, disability, age, pregnancy status, citizenship, and existing insurance coverage |
| Income requirements | Family income at or under 138% of FPG ($21,597 per year for an individual; $44,367 for a family of four) |
| Disability considerations | Extra ways to qualify for individuals with disabilities |
| Age-specific criteria | Individuals 18 or younger may qualify for KCHIP with family income at or under 218% of FPG ($70,087 per year for a family of four) |
| Pregnancy and family status | Pregnant individuals with family income at or under 195% of FPG ($62,693 per year for a family of four) may qualify; unborn baby counted as a family member |
| Citizenship requirements | Available for U.S. citizens or eligible immigrants |
| Insurance coordination | Used alongside other coverage, such as employer-sponsored insurance or Medicare |
| Cost considerations | No premium; lower copayments compared to private plans; extra help with prescription drug costs |
| Application process | Online pre-screening, application through kynect, reporting changes to the Department for Community Based Services (DCBS) |
| Coverage options | Covers more services than most private plans; includes hospital and institutional care |
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What You'll Learn
Qualifying for Medicaid
To qualify for Medicaid in Kentucky, applicants must meet specific income and asset limits. The program is administered by the Kentucky Cabinet for Health and Family Services' Department for Medicaid Services and provides healthcare benefits for low-income individuals of all ages.
Income Requirements
Most income sources, including wages, pensions, and Social Security benefits, are counted toward Medicaid's income limits. For 2025, the maximum spousal income allowance is $3,948/month. Non-applicant spouses may retain income up to $2,555/month (Minimum Monthly Maintenance Needs Allowance, MMMNA) and additional allowances if housing costs exceed $766.50/month.
Asset Requirements
Countable assets include bank accounts, stocks, and non-residential real estate. Exempt assets include personal belongings, one automobile, household furnishings, and the primary home (up to $730,000 in equity). Non-applicant spouses can retain 50% of the couple's assets, up to $157,920, or $31,584 if total assets are below this threshold.
Qualified Income Trusts (QITs): Excess income can be deposited into a trust, making it non-countable.
Asset Spend Down: Allows conversion of countable assets into exempt ones by paying debts, prepaying funeral costs, or making home modifications.
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Medicaid as secondary insurance
Medicaid is a government-funded health coverage option for people in certain situations. It is available to those with low incomes, regardless of their resources or whether they have a disability. In most cases, there is no premium for Medicaid, and the copayments for services are lower than those required by private plans. Medicaid also covers more services than most private plans.
To qualify for Medicaid, your income must be at or under 138% of the Federal Poverty Guidelines (FPG). This equates to $21,597 per year for an individual and $44,367 for a family of four. If you are 18 or younger, your family's income must be at or under 218% of FPG ($70,087 per year for a family of four) to qualify for the Kentucky Children's Health Insurance Program (KCHIP). If you are pregnant, your family's income must be at or under 195% of FPG ($62,693 per year for a family of four), with the unborn baby counted as a family member.
You can also qualify for Medicaid if you receive Supplemental Security Income (SSI) or qualify for SSI's 1619(b) rule, which applies to those who used to get SSI. If you receive SSI, you automatically get Medicaid coverage and don't need to apply separately. Additionally, if you have a disability, low income, and limited resources, you may qualify for SSI.
To apply for Medicaid, you can visit the kynect website or your local Department for Community-Based Services (DCBS) office. There, you will be able to determine whether you qualify for Medicaid or another health coverage option.
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Medicaid copayments
Medicaid is low-cost or no-cost health insurance for eligible individuals. While Medicaid covers most of the cost of healthcare services, there may be some out-of-pocket expenses, such as copayments, that beneficiaries are responsible for. Copayments, or copays, are fees that you pay when you receive certain healthcare services or prescriptions. The amount of the copayment can vary depending on the state, income, and type of service.
States have the option to impose copayments on most Medicaid-covered benefits, including both inpatient and outpatient services. However, there are certain services that are exempt from copayments, including emergency services, family planning services, pregnancy-related services, and preventive services for children. Additionally, certain vulnerable groups, such as children, pregnant women, and individuals residing in an institution, are typically exempt from most out-of-pocket costs, including copayments.
The amount of copayments for prescription drugs can also vary depending on the state and the type of drug. States may establish different copayments for generic versus brand-name drugs or for drugs included on a preferred drug list. For individuals with incomes above 150% of the federal poverty level (FPL), copayments for non-preferred drugs may be as high as 20% of the cost of the drug. On the other hand, for people with incomes at or below 150% FPL, copayments are limited to nominal amounts.
It is important to note that states have the option to establish alternative out-of-pocket costs for certain groups of Medicaid enrollees with incomes above 100% of the federal poverty level. These alternative costs may be higher than nominal charges, depending on the type of service, but they are subject to a cap of not more than 5% of family income. In addition, Medicaid enrollees may be denied services if they fail to pay alternative copayments. However, services cannot be withheld from individuals who are unable to pay regular copayments, but enrollees may be held liable for unpaid copayments.
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Medicaid and Medicare
Medicaid is a joint federal and state program that helps cover medical costs for certain individuals and groups with limited income and resources, including low-income families and children, pregnant women, the elderly, and people with disabilities. Each state has its own eligibility rules, and requirements vary from state to state. Generally, eligibility is determined by income, resources, and residency. Some states allow individuals to “spend down” their income to qualify for Medicaid. This is done by paying non-covered medical expenses until their income meets the state's Medicaid limit.
Medicaid offers benefits that are not typically covered by Medicare, such as nursing home care and personal care services. For those with both Medicare and full Medicaid coverage, known as "dually eligible," Medicare pays first for Medicare-covered services, while Medicaid pays last, after any other insurance. In this scenario, the state may cover Medicare Part B monthly premiums, deductibles, coinsurance, and copayments. Additionally, dually eligible individuals will automatically receive extra help with drug costs and may be enrolled in a Medicare drug plan.
Medicaid may still cover some drugs that Medicare does not. To understand the specific benefits and coverage options, it is recommended to contact the State Medical Assistance (Medicaid) office, as they can provide detailed information on the level of Medicaid coverage one may qualify for and how it coordinates with Medicare. This is especially important for individuals with both Medicare and Medicaid, as the benefits and payment processes can vary based on eligibility and the specific situation.
It is important to note that while the federal government sets general rules for state Medicaid programs, each state runs its own program. Therefore, it is always advisable to check with the specific state's Medicaid program to understand the eligibility requirements, benefits, and coordination with Medicare in that state. The website Medicaid.gov is a recommended resource for further information on this topic.
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Applying for Medicaid
To apply for Medicaid in Kentucky, you must first ensure you qualify for the program. Enrollment is open all year, and you can apply at any time. Once your application is approved, you will receive a welcome packet in the mail.
To start the application process, you will need to gather the following information:
- Employer and income information: Household monthly income, pay stubs, and W-2 forms
- Social Security numbers or document numbers for each household member applying
- Date of birth for each household member applying for coverage
- Immigration information, if applicable (some noncitizens may qualify, depending on state rules)
After you have gathered the necessary information, you can begin your application on the kynect benefits site. The application will take around 30 minutes to complete. Once you have submitted your application, the Department for Community-Based Services (DCBS) will review it and determine your eligibility for Medicaid benefits. If you are eligible, you may be enrolled in a managed care organization (MCO). Some people are required to take part in the Kentucky Medicaid Managed Care Program.
If you are already enrolled in Kentucky Medicaid, you can switch your health care plan to Aetna Better Health of Kentucky by calling Member Services at 1-855-300-5528 (TTY: 711).
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Frequently asked questions
You can check if you qualify for Medicaid by answering questions on the DB101 Kentucky website. You may qualify for income-based Medicaid if your family income is at or under 138% of the Federal Poverty Guidelines (FPG) ($21,597 per year for an individual; $44,367 for a family of four).
Medicaid usually doesn't have a premium, and the copayments for services are generally lower than those of private plans. Medicaid also covers more services than most private plans.
Yes, you can use Medicaid as secondary insurance to Medicare. You may also get help paying for prescription drugs.
Report your change in income to kynect. You may qualify for Medicaid or have the government increase how much it pays for your current insurance.
If you have a disability, low income, and limited resources, you may qualify for Supplemental Security Income (SSI). If you receive SSI, you automatically get Medicaid coverage and don't need to apply separately.
