Kentucky Medicaid covers a broad range of medical services, from doctor visits and hospital stays to prescriptions, dental care, mental health treatment, and transportation to appointments. Most members receive their benefits through a private managed care plan, but the core coverage is the same regardless of which plan you choose. Here’s what’s included and what to expect in terms of costs.
Doctor Visits and Hospital Care
All standard medical care is covered. That includes visits to your primary care doctor, specialist appointments, inpatient hospital stays, outpatient hospital services, and emergency room visits. Lab work, X-rays, and other diagnostic testing are also fully covered. If you need surgery or are admitted to the hospital, Medicaid pays for the stay, the procedure, and follow-up care.
Nurse practitioners and nurse midwives can serve as your providers, and visits to federally qualified health centers and rural health clinics are covered as well. If you need home health services, such as skilled nursing or therapy delivered in your home, those fall under Medicaid too.
Prescription Drugs
Kentucky Medicaid covers prescription medications through a Preferred Drug List, which groups commonly prescribed drugs into three tiers: preferred, preferred with prior authorization, and non-preferred. Your doctor can prescribe any covered medication, but choosing a preferred drug avoids the extra step of getting approval from your plan. If a non-preferred drug is medically necessary, your provider can request authorization.
The copayment for prescriptions is just $1 per fill. You can ask your doctor or pharmacist whether your medication is on the preferred list, and the full list is available through the Kentucky Medicaid online portal.
Dental and Vision
Adults on Kentucky Medicaid have limited but meaningful dental coverage. Covered services include oral exams, emergency dental visits, X-rays, tooth extractions, fillings, and dentures (dentures require prior authorization). This is notable because many state Medicaid programs offer little to no adult dental care.
Children enrolled in Medicaid or the Kentucky Children’s Health Insurance Program (KCHIP) receive more comprehensive dental and vision benefits through a federal requirement called Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). This ensures kids get regular checkups, screenings, and any treatment identified as medically necessary, including dental cleanings, vision exams, and eyeglasses.
Mental Health and Substance Use Treatment
Kentucky Medicaid covers a full range of behavioral health services. Individual, family, and group therapy are available on an outpatient basis, typically limited to three hours per day but expandable when medical necessity supports it. For children and adolescents, collateral services allow a therapist to meet with parents, guardians, or school personnel involved in the child’s care.
Substance use disorder treatment is a significant part of Kentucky’s Medicaid program. Coverage includes residential treatment for adults and children entering addiction recovery, providing intensive care in a structured environment. Medication-assisted treatment for opioid and alcohol use disorders is a federally required benefit, meaning Kentucky must cover it. Outpatient therapy for substance use disorders is also available.
Maternity and Children’s Coverage
Pregnant women qualify for Medicaid at higher income levels than other adults. Kentucky covers pregnant women and children up to 200% of the federal poverty level, and uninsured pregnant women and children can qualify at income levels up to 218% of the poverty level. For a family of four, that 218% threshold works out to about $70,092 per year.
Medicaid covers prenatal visits, labor and delivery, and postpartum care. Kentucky does not use the CHIP program to cover pregnant women separately; instead, pregnant women are enrolled directly in Medicaid.
KCHIP, Kentucky’s children’s health insurance program, has no premiums and no cost sharing. Children enrolled get the same comprehensive benefits as Medicaid, including the EPSDT screening benefit that covers everything from developmental assessments to immunizations to hearing and vision tests.
Home and Community Based Waivers
For people who need long-term support but want to remain at home rather than in a nursing facility, Kentucky operates several waiver programs. Each targets a specific population:
- Michelle P. Waiver and Supports for Community Living: serves individuals with intellectual and developmental disabilities
- Home and Community Based (HCB) Waiver: serves elderly individuals and adults with physical disabilities
- Acquired Brain Injury (ABI) Waivers: provides both acute and long-term care services for brain injury survivors
- Model II Waiver (MIIW): provides ventilator-dependent care in the home
- CHILD Waiver (Community Health for Improved Lives and Development): serves children with complex medical needs
These waivers can cover personal care assistance, respite care, home modifications, and other supports that standard Medicaid doesn’t include. Waiver programs often have waiting lists, so applying early matters.
Medical Transportation
Getting to your appointments is a covered benefit. Kentucky Medicaid provides non-emergency medical transportation for members who don’t have access to a free ride that meets their medical needs. The program runs through a regional brokerage system called the Human Service Transportation Delivery (HSTD) program. You contact your regional broker to schedule a ride to any Medicaid-covered service.
If you need transportation outside your usual service area or to a specialist, you’ll need a referral from your primary care doctor. For questions or complaints about the transportation program, you can call the Office of Transportation Delivery at (888) 941-7433.
Costs for Members
Kentucky Medicaid has very low out-of-pocket costs. Copayments are capped at $1 for prescriptions, $1 for non-emergency use of the emergency room, and $1 for non-emergency ambulance transport. Many members pay nothing at all, since several groups are exempt from cost sharing entirely.
Most Medicaid members pay no monthly premium. The exception is the Medicaid Works program, which covers working individuals at higher income levels. Monthly premiums for Medicaid Works are based on income: $35 if your income falls between 100% and 150% of the federal poverty level, $45 between 150% and 200%, and $55 between 200% and 250%. If your income is at or below 100% of the poverty level, you owe no premium.
How Benefits Are Delivered
Most Kentucky Medicaid members are enrolled in one of four managed care organizations that administer their benefits. The current options are Aetna Better Health of Kentucky, Humana Healthy Horizons, Passport Health Plan by Molina Healthcare, UnitedHealthcare Community Plan, and WellCare of Kentucky. (Anthem exited the program in January 2025.)
All plans are required to offer the same core benefits and cost sharing. Where they differ is in value-added extras, which are bonus services each plan offers to attract members. These might include gym memberships, extra dental visits, or wellness incentives. Kentucky publishes a side-by-side comparison of these extras each year to help members choose a plan. If you’re auto-assigned to a plan and want to switch, you can do so during an open enrollment period or within 90 days of your initial enrollment.