While not a coverage expansion, Kentucky has undertaken a redesign of its Medicaid program. In May 2006, Kentucky received state plan amendment approval from CMS to

move forward on plans to redesign its Medicaid program using DRA flexibility.

The new plan, KyHealth Choices, offers four different benefit packages tailored to specific populations, increases cost sharing, and expands access to community-based long-term care. The new targeted benefit plans replace the Medicaid benefit package with "Secretary-approved" coverage. The four plans are:

Global Choices: Global Choices is designed for pregnant women, working parents up to 68 percent FPL, foster children, medically fragile children, Supplemental Security Income-related groups, and women with breast and cervical cancer. Global Choices covers basic medical services with new benefit limits and increased cost sharing. Long-term care services are excluded.

Family Choices: Family Choices is designed for most children, including children enrolled in Kentucky 's SCHIP program. Family Choices offers the same benefit package as Global Choices except there are no prescription drug limits and there is a higher vision care maximum benefit.

Optimum Choices: For individuals with developmental disabilities and mental retardation in need of long-term care services, Optimum Choices covers all the benefits in Global Choices as well as three levels of long-term care services.

Comprehensive Choices: For the elderly and individuals with disabilities in need of nursing facility level care, Comprehensive Choices offers all the benefits of

Global Choices plus two levels of long-term care, including services offered through the state's current home and community-based services waivers.

Kentucky also implemented new cost sharing requirements in June 2006. There are no co-pays for preventive services, and pregnant women and mandatory children, are exempt from cost sharing. KyHealth Choices includes new benefit limits; however, services beyond the benefit limits may be approved through a prior authorization process. KyHealth Choices also includes an employer-sponsored insurance option.

Enrollees can choose to receive a subsidy for private plans that meet the state employee plan benchmark and certain "economy and efficiency" criteria, but there is no wrap-around coverage. Enrollees can move back to a Medicaid plan at any time. The program also includes "Get Healthy Benefits" that allow individual members with specific diseases to access additional benefits, such as vision, dental, smoking cessation, and nutrition visits, if they participate in a disease management program for one year. Enrollees have six months to use their new benefits. Benefits are lost after disenrollment from Medicaid.

High-Risk Pool  

Kentucky's high-risk pool, Kentucky Access, became operational in 2001 and is financed by program participant premiums, tobacco settlement funds, and assessments on insurers. The program's premium cap is set at 175 percent of market rate for comparable coverage but the program currently sets rates at 130 percent. As May 2006, approximately 3,700 persons were enrolled in the program.

Limited-Benefit Plan  

In 2005, the Kentucky legislature passed HB278, the Small Business Insurance Relief Act, which creates a state-established basic health benefit plan to make insurance more affordable by tailoring benefits to specific needs, creates a uniform system for physicians to receive credentials with insurers or hospitals, and establishes an advisory committee to help Kentucky provide patients with quality and cost information about their health care. The basic health benefit plan is available to individuals and employers with fewer than 50 employees.

Other

In 2006, the Kentucky legislature passed the Insurance Coverage, Affordability and Relief to Employers (ICARE) Act. ICARE will provide a subsidy to employees of small firms (2-25 employees) of $40 to $60 per employee per month. The subsidy is reduced by increments of between $10 and $15 each year. The program is available to small firms whose employers pay at least 50 percent of total premium, who are uninsured for 12 months or have one employee with a high-cost medical condition, and whose average employee wage is less than 300 percent FPL. All carriers who currently write in the Kentucky small group market are required to offer three ICARE benefit packages including: basic, enriched, and high deductible coupled with an account. The ICARE program is authorized for four years. The program began in November of 2006.

	Notes and Sources

Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile.