Blocked from starting new Medicaid plan, state comes up with a question-and-answer sheet to help providers and their patients

By Melissa Patrick
Kentucky Health News

As the Cabinet for Health and Family Services scrambles to deal with the fall-out from a court ruling that vacated the state’s new Medicaid plan, which was set to go into place Sunday, July 1, its call centers and front-line staff are using a new question-and-answer document to help health-care providers advise their Medicaid clients.

The document says Kentucky HEALTH (for “Helping to Engage and Achieve Long Term Health”) hasn’t been cancelled, but instead has been “halted for further review” by the federal government.

The state and federal governments are expected to appeal the decision of U.S. District Judge James Boasberg of Washington, D.C. Gov. Matt Bevin has said the issue will ultimately be decided by the Supreme Court.

The state has also posted a Kentucky HEALTH update on its website, and the question-and-answer document says the state will be sending additional information about the changes this week.

In the meantime, most of the 1.4 million Medicaid members’ benefits will stay about the same as they have been for now — no premiums, no deductibles, no reporting requirements and no requirements for work or other “community engagement.” The Q&A says managed-care organizations that deal with Medicaid patients and providers will be charging co-payments for services.

The exceptions are the 460,000 members covered by expanded Medicaid, who had been moved to a My Rewards Account and have lost their dental and vision benefits.

“When Kentucky HEALTH was invalidated by the court, the My Rewards program was eliminated, and there is no longer a funding mechanism in place to pay for dental and vision services,” the health cabinet said in a statement.

The Q&A says that while members cannot use the benefits that may have already earned in their My Rewards accounts, they can still continue to earn these “virtual” dollars for qualifying activities if they so choose.

The Q&A offers answers about many topics and concerns, including questions about whether a person on Medicaid can still go to the doctor; what to do about premiums and co-payments; and the status if the “community engagement” or work requirements that were struck down.

The answer to the questions of “Will I be reimbursed if I’ve already made a premium payment: Will you be sending a refund?” is that the state and manged-care firms are working on how to manage this, and hope to have an update soon to share with these members. At this time, no premiums are due.

The Q&A also says all managed-care firms will be required to charge a co-payment for medical services, saying, “The requirement to make co-payments was a state change that was separate from Kentucky HEALTH.”

The document has a list of 18 services that require co-payments. A few examples include $3 for office visits, $1 for generic drugs, $4 for preferred brand-name drugs that don’t have a generic equivalent; and $8 for emergency-room visits.

The cabinet continues to stress in this document that the supports and resources in Kentucky HEALTH to help Kentuckians improve their income and health are still available and that members can still log on to to take free online courses about health, life and work skills. It also encourages interested Kentuckians to visit find their local career center.

County totals of people on Medicaid, the expansion and other categories are at

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