Medicaid Changes (Enacted July 2025)

Starting Oct. 1, 2026, only certain lawfully present immigrants or noncitizens will qualify for Medicaid. 

You will only be able to get or keep Medicaid if you are one of the following: 
•    A Lawful Permanent Resident (LPR) after a five-year waiting period, unless you are exempt from the waiting period.
•    A Cuban-Haitian Entrant.
•    A Compacts of Free Association (COFA) Entrant.
•    A Lawfully present child or and pregnant women regardless of immigration status. 

You will no longer qualify for Medicaid if you are one of the following:
•    A refugee.
•    An asylee.
•    Paroled for at least one year.
•    A conditional Entrant.
•    Granted withholding of deportation.
•    Granted conditional entry prior to April 1, 1980.
•    Amerasian.
•    A survivor of domestic violence or human trafficking, and you have a pending status.

Emergency Medicaid will still be available to cover life-threatening medical conditions, regardless of immigration status, if you meet income requirements and reside in Kentucky.
If you are enrolled in Medicaid and affected by changes to eligibility due to your immigration or noncitizen status, you will be contacted.   

Some adults ages 19 to 64 will need to meet a new work or community engagement requirement to apply for or keep their Medicaid coverage. This applies to those enrolled in Medicaid based only on their income, also known as Medicaid Expansion. 

The Medicaid work or community engagement requirements look backwards. This means you must be working or doing community engagement activities when you apply for or renew your Medicaid coverage. 

Current Medicaid Members
You will be asked to report the work or community engagement activities you did when you renew your coverage in 2027. 

• It is important to know your renewal date. You can check your renewal date in kynect benefits.
• You must work or complete community engagement activities for three of the six months before your renewal date.
• For example, if your renewal is due in February 2027, you must work or do community engagement activities for at least three of the months between August 2026 and February 2027.

Who Must Meet the Requirement? 
 You may need to meet the requirement if all the following apply to you:

• You are age 19 to 64.
• You qualify for Medicaid based only on income.
• You are not exempt.

Who Qualifies for an Exemption to the Requirement?
You do not have to meet the requirement if we can document that you are one of the following:

• 18 or younger.
• 65 or older.
• Former foster care youth up to age 26.
• Member of a federally recognized tribe (American Indian or Alaska Native).
• A Parent, guardian, or caregiver and actively involved in the care of:
• A child 13 or younger; or
• A person of any age with a disability.
• Veteran with a total disability rating.
• Receiving Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), or Social Security Retirement (SSR) due to disability.
• Entitled or enrolled in Medicare Part A or enrolled in Part B.
• Medically frail or have a serious or complex medical condition, including a disability, mental health condition, or substance use disorder, that impacts your ability to complete community engagement requirements.
• Enrolled in a 1915(c) Home and Community Based Waiver or the Program of All-Inclusive Care for the Elderly.
• Meeting the Temporary Assistance for Needy Families (TANF) program work requirements.
• Live in a household that is meeting and not exempt from the Supplemental Nutrition Assistance Program (SNAP) work requirements.
• In a treatment program for mental health or substance use disorder.
• An inmate of a public institution now or was incarcerated in the past three months.
• Pregnant or in the 12-month postpartum period.
  
  

Starting in 2027, Medicaid will check available information to see if you meet the requirements or qualify for an exemption. You will be contacted if more information is needed. 

What Happens If You Don't Meet the Requirement?
If you do not meet the requirements or qualify for an exemption:

• You will receive a noncompliance notice.
• You will have 30 days to provide information.
• If you are currently enrolled in Medicaid, your coverage will continue for those 30 days. 

When you are enrolled in Medicaid, you must have your eligibility rechecked every year. This is called a "Medicaid renewal"

Starting Jan. 1, 2027, some Medicaid members will have a Medicaid renewal every six months instead of once per year.

You must have a Medicaid renewal every six months if you are aged 19-64 and qualify for Medicaid based only on your income.

Right now, Medicaid may go back and cover your health care costs for up to three months before someone applies for coverage.

Starting Jan. 1, 2027, Medicaid will be limited in how far back we can cover health care.

• People ages 19-64 who qualify for Medicaid based on their income may have health care costs covered for up to one month before they applied.
• All other applicants may have health care costs covered for up to two months before they applied.

Cost sharing means you pay for part of your Medicaid services.

Starting Oct. 1, 2028, this means you might have to make a co-payment when you visit a specialty provider, or when you get some services. 

Cost sharing will apply to Medicaid members who are aged 19-64 and qualify for Medicaid based on their income.