Kentucky Health One is the state’s managed care program for Medicaid, designed to coordinate medical care for eligible low-income adults, children, pregnant people, and seniors across Kentucky. Through contracts with managed care organizations (MCOs), the program delivers a defined set of benefits while emphasizing preventive care and care management. This explainer outlines how the program works, who is eligible, and how to find or change plans in a way that remains useful over time.
What is Kentucky Health One
Kentucky Health One is the managed care framework for Medicaid in Kentucky. It organizes coverage through managed care organizations (MCOs) that provide member services, care coordination, and access to networks of doctors, hospitals, and community providers. Rather than fee-for-service arrangements for many enrollees, the program uses capitated payments to MCOs to deliver care in a coordinated way. Kentucky Health One aims to improve quality, control costs, and make it easier for members to navigate the system.
Eligibility and Enrollment
Eligibility for Kentucky Health One depends on category, income, age, and other factors. Coverage groups include Medicaid expansion adults, children in CHIP, pregnant individuals, and traditional Medicaid-eligible groups such as seniors and people with disabilities. Income thresholds vary by group and are tied to federal poverty level (FPL) percentages. People can apply year-round through Kynect, Kentucky’s health insurance marketplace, or by contacting local resources for help. Certain life events, such as moving or changes in household size, may trigger a special enrollment period.
Key Eligibility Factors at a Glance
| Group | Typical Income Guideposts | Notes |
|---|---|---|
| Medicaid Expansion Adults | Up to 138% FPL | Adults ages 19–64 without dependent children |
| Children and CHIP | Up to 200–300% FPL, varies by age | Coverage levels may differ by age |
| Pregnant Individuals | Higher FPL thresholds | Includes prenatal and postpartum services |
| Traditional Medicaid | Means-tested, varies by group | Includes seniors, people with disabilities |
Choosing and Using a Kentucky Health One Plan
Once eligible, members typically receive plan options based on their county of residence and qualifying category. Each MCO offers a network of providers, often with value-based care models and tools such as telehealth, care coordinators, and disease management programs. Members usually select a primary care provider within the plan network and may need referrals for certain services. Preventive care, screenings, and authorized behavioral health services are core features, with cost-sharing structured around premiums, copays, and deductibles where applicable.
What to Compare Across Plans
- Network size and whether your preferred doctors and hospitals are in-network
- Monthly premiums, deductibles, and copayments
- Benefits for prescription drugs, behavioral health, and chronic conditions
- Availability of care coordination and telehealth options
Costs, Premiums, and Financial Assistance
For people who qualify for Medicaid through expansion or traditional pathways, premiums are generally very low or zero for the member, with the program covering the majority of costs through federal and state funding. Cost-sharing such as copays may still apply for services. For CHIP and other qualifying groups, sliding-scale fees and subsidies help keep care affordable. Financial assistance is also available to help with related costs like transportation to care or medications, depending on the MCO and member circumstances.
How to Apply, Change, or Disenroll
Applicants can use Kynect, call regional Medicaid offices, or get help from local community organizations. During open enrollment, usually aligned with the federal or state calendar, members may review and switch between available MCOs. Special enrollment may be available after qualifying events such as changes in income or household composition. Disenrollment from a plan or from Medicaid can occur under specific conditions, such as when a member no longer meets eligibility requirements, and coverage changes are typically processed with advance notice to minimize gaps in care.
Frequently Asked Questions
- Do I need to choose a plan under Kentucky Health One if I am on Medicaid?
In most cases, yes. Medicaid in Kentucky is delivered through managed care, so selecting an MCO under Kentucky Health One is part of how coverage works.
- Can I keep seeing my current doctor after switching plans?
It depends on whether your current provider is in-network for the plan you choose. Check the plan’s network directory during enrollment or switching periods.
- What happens if my income changes?
Changes in income can affect eligibility and may trigger a reassessment. Report changes promptly to your local office or through Kynect to ensure accurate coverage.
Get Help and Compare Options
Kentucky offers multiple avenues for personalized help, including Kynect customer service, community navigators, and local nonprofits. These resources can help you compare plan options, understand benefits, and complete applications. If you are already enrolled, your MCO’s member services team can assist with claims, referrals, and finding in-network care. Using these supports can improve your understanding of your coverage and make care easier to manage over time.