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Learn About Requirements for Medicaid in Kentucky

UPDATE: In 2020, the requirements and application steps for obtaining Medicaid insurance have undergone no significant changes.

Kentucky Medicaid is offered to qualified applicants all through the year. There are various categories of people that are eligible for the program. Kentucky Medicaid eligibility requirements are determined by the state and are reviewed every year in April. Applicants should find out how to qualify for Medicaid buy reviewing requirement before applying.

Kentucky Medicaid has a number of programs tailored for special groups of people. Among the programs is Medicaid Works, which targets disabled applicants. What are the requirements for Medicaid? The eligibility requirements for Medicaid in Kentucky depend on the category that an applicant falls under. Kentucky Medicaid eligibility benefits also vary depending on the category of an applicant.

What Are the Income-Based Medicaid Benefits Requirements in Kentucky?

What are the income requirements for Medicaid? The state has come up with specific income guidelines to be used to determine whether or not an applicant qualifies for Medicaid. In general, all beneficiaries must demonstrate financial need. The requirements for eligibility for Medicaid in Kentucky include:

  • Children aged 18 years or under with a family income of 159 percent of the Federal Poverty Level (FPL) or below
  • Children aged 1 year or younger with a family income of 195 percent of the FPL or below
  • Pregnant women with a family income of 195 percent of the FPL or below
  • Children whose family income is too high for Medicaid (up to 213 percent of the FPL) qualify for Kentucky Children’s Health Insurance Program (KCHIP)
  • Parent and other adults with incomes of up to 133 percent of the FPL

The above Kentucky Medicaid eligibility requirements do not apply to all applicants. People in specials categories such as the disabled and elderly have different requirements to meet.

What are the Medicaid application guidelines? Kentucky Medicaid eligibility benefits apply if your household meets the following income guidelines:

  • 1 person: less than $16,612
  • 2 people: less than $22,491
  • 3 people: less than $28,369
  • 4 people: less than $34,248
  • 5 people: less than $39,247
  • 6 people: less than $40,127
  • 7 people: less than $51,884
  • 8 people: less than $57,762

Children and pregnant women qualify for higher levels of income. Learn more about Medicaid requirements by downloading our comprehensive guide.

What Are the Non Income-Based Medicaid Benefits Requirements in Kentucky?

The Kentucky Medicaid eligibility requirements do not end with income. Applicants must also meet citizenship requirements. This means you must be a U.S. citizen or national. If you are not a U.S. citizen, you must meet the qualified status of an alien. You should also be a Kentucky resident to be approved for Medicaid coverage in Kentucky. Remember, Medicaid in Kentucky can only cover you if the medical services or items you need are provided in Kentucky. There are a few scenarios where getting medical care or items from providers in other states may be covered.

Another Kentucky Medicaid eligibility requirement is good citizenship. To be approved for coverage, you must not currently be in prison or held in custody by the state. This condition is only considered when you are applying for the coverage. Finally, you must provide proof of income.

Pregnant women in Kentucky also qualify for Medicaid through presumptive eligibility. The Kentucky Medicaid requirements for presumptive eligibility for women include:

  • Should be pregnant
  • Should not be currently enrolled in Medicaid
  • Should not be an inmate of public institutions
  • Should be a Kentucky resident
  • Should meet the income guidelines discussed above
  • Should not be currently having a pending Medicaid application

When a qualified health service provider, for example, a clinic or physician, determines a female applicant is pregnant, presumptive eligibility can begin. Women that enroll for Kentucky Medicaid program get benefits for 60 days postpartum. Kentucky Medicaid eligibility requirements for pregnant women are not related to income. Moreover, the requirements have remained fairly the same over the years.

Learn About Other Programs

Kentucky Medicaid has a number of programs tailored for special groups of people. One of the programs in Medicaid Works. The eligibility requirements of Kentucky Medicaid for this program are different from those required for other adults.

Medicaid Works is meant for qualified people with disabilities. This program is opened to disabled people who are between the ages of 16 and 64, work and earn an income that is less than 200 percent of the FPL. Members are required to make monthly premiums to buy into the Medicaid program.

Applicants should also meet the Social Security definition of disabled and their personal assets should not be more than $4000. Disabled applicants who meet the eligibility requirements and are qualified aliens can also apply for the program.

The Kentucky Medicaid Works Program takes into account the income of the disabled applicant. To qualify, an applicant may have up to $773 in unearned income. Examples of such incomes include Social Security benefits, workers compensation, veterans benefits, etc. Applicants with a retirement fund also qualify for the program. The retirement plan should be one that is approved by the Internal Revenue Code.

During the application process, applicants may have to prove that they are working. Some of the accepted items is a written verification from the employer indicating employment or pay stubs. Self-employed applicants have to provide records (for example, Schedule C forms) to prove employment. For independent contractors, verification can be required through form 1099 IRS to prove income and employment. Download our helpful guide to learn about the different requirements for Medicaid.