Kentucky Medicaid

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Medicaid is a program that provides elgible low-income families with health coverage. Guidlines and income standards vary by state. This should not be confused with medicare, another government program that provides health care to the elderly.

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In 2009, there were 748,301 Kentuckians elgible for Medicaid. [1]

Who Qualifies?

Individuals must meet certain qualifications in order to be elgible for Medicaid. For each person, the monthly income limit is $217 and the resource limit is $2,000. [2]

Individuals or Families with Dependent Children

To be elgible, individuals or families with dependent children must meet the following requirements:

  • A pregnant woman
  • A dependent child younger than 19. (The child does not have to live with a parent or close relative to receive Medicaid)
  • Parent(s) (one or both) of the dependent child if one parent has left the home, cannot work due to sickness or disability, or has died
  • Parents (both) living with the dependent child, if the parent is unemployed or underemployed [3]

In addition, individuals must also meet income standards. For complete information about these guidelines, click here.

Health Care Reform and Medicaid

President Barrack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law on March 23, 2010. The bill first passed in the House of Representatives on October 8, 2009, and then in the Senate on December 24, 2009. On March 21, 2010, the House of Representatives voted to accept the changes by the Senate, and on March 23, 2010, the bill became law. The 2,700-page bill is a massive overhaul of our current American health care system.

Under the new law, Medicard will be expanded to:

  • Cover all individuals under 65 up to 133% of the federal poverty level
  • Provide 100% coverage for newly eligible Medicaid recipients from 2014-2016 [4]

According to a study by the Heritage Foundation[5], PPACA will have the following effect on Kentucky's Medicaid program:

  • Medicaid/CHIP (Children’s Health Insurance Program) enrollment will increase by 31.4% from 938, 237 to 1,232,609 in 2014
  • It will cost $324.7 million in benefits and $183 million in administration costs, more than $507 million total to expand Medicaid
  • Kentucky taxpayers will evantually foot the bill to pay for “Doc Fix” (exported cost to the state to reimburse primary care physicians for Medicaid)

KCHIP (Kentucky Children's Health Insurance Program)

KCHIP is free or low-cost health insurance for children under the age of 19 who do not have health insurance and whose family income is below 200 percent of the federal poverty level. The program is funded jointly by the state and federal government. The federal government pays for 80 cents out of every dollar used for KCHIP, and the state government pays the remaining 20 cents. In 2009, there were 60,778 children enrolled in KCHIP, up from 45,063 in 2000. [6] The program covers:

  • Doctor visits
  • Dental care
  • Hospitalization
  • Outpatient hospital services
  • Psychiatrists
  • Laboratory tests and X-rays
  • Vision exams
  • Hearing services
  • Mental health services
  • Prescription medicines [7],

In addition, kids who qualify for KCHIP may also get glasses, immunizations, well-child checkups, physical therapy and speech therapy. Co-payments are capped at $450 per year.

If a parent voluntarily leaves a job, his or her child may be elgible for KCHIP because job loss is viewed as an involuntary loss of health insurance. Also, if a parent drops their health coverage, the child may still be elgible depending on the parent's income.

In 2008, Gov. Steve Beshear launched a program to get elgible kids enrolled in KCHIP. At the time, there were an estimated 67,000 elgible kids in Kentucky not enrolled in KCHIP or Medicaid. If goals were met, the plan was expected to cost $6 million in 2009 and an additional $25 million in 2010. [8] In August 2010, he announced the elimination of KCHIP premiums, which previously cost some enrolled familes $20 a month.

Fraud

The Office of Inspector General, Division of Audit and Investigations, is the branch of the Cabinet for Health and Family Services responsible for investigating possible Medicaid fraud by both providers and recipients. To report Medicaid fraud, call (800) 372-2970 at any time. Investigators are available Monday through Friday from 8 a.m. until 4:30 p.m. You may also mail the complaint to:

275 E. Main St., 5E-D

Frankfort, Kentucky 40621[9]

Igenix

In Oct. 2010 it was announced that Kentucky hired a company name Igenix to monitor waste, fraud and abuse within the state's Medicaid program. [10]

“In a program the size of Kentucky’s Medicaid program, which continues to grow both in costs and people served, having the most vigilant waste, fraud and abuse detection system in place is critical,” said Gov. Beshear. “This contract represents a multi-faceted and technologically sophisticated approach to detecting and remedying any unnecessary expenditures, and that is good news for Kentucky taxpayers.”[11]

According to the press release, the new system will identify an estimated $27 million per year in wasteful spending.[12]

See Also

References

  1. Medicaid Statistics retrieved Dec. 9, 2010
  2. Kentucky Cabinet for Health and Family Services website retrieved Dec. 9, 2010
  3. Ibid. retrieved Dec. 9, 2010
  4. Kaiser Family Foundation Health Reform Source retrieved Dec. 15, 2010
  5. Obamacare: Impact on States - The Heritage Foundation retrieved Dec. 15, 2010
  6. 2010 Kentucky KIDS COUNT Data Book retrieved Dec. 9, 2010
  7. KCHIP website retrieved Dec. 9, 2010
  8. The Beshear Plan retrieved Dec. 10, 2010
  9. Division of Audit and Investigations retrieved Dec. 10, 2010
  10. Igenix Press Release retrieved Dec. 13, 2010
  11. Ibid. retrieved Dec. 13, 2010
  12. Ibid. retrieved Dec. 13, 2010
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