Changes Coming to Medicaid and Marketplace Coverage

The federal government makes rules that Kentucky Medicaid must follow when providing health care coverage. A federal law passed in July 2025 is changing the rules about who can get Medicaid and what they must do to keep it. The new rules do not apply to all Kentucky Medicaid members. The information below can help you understand when the new rules start and whether they affect you.

October 1, 2026 Immigrant or Noncitizen Eligibility

Federal law only allows Medicaid to cover U.S. citizens and certain qualified legally present immigrants or noncitizens. Starting October 1, 2026, changes to federal law will limit the types of lawfully present immigrants or noncitizens who can 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 a pregnant woman 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.

Time-Limited 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.

January 1, 2027: Marketplace Changes -- Advance Premium Tax Credit (APTC):

You may still be eligible for APTC if you are:

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.

You will no longer qualify for APTC if you are:

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.

Full-Priced Qualified Health Plans will be available, and Catastrophic and other plans may be an option for some.

January 1, 2027: Work or Community Engagement Requirement for Adults Age 19-64

Starting January 1, 2027, 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 are based on what you were already doing before you applied for or renewed your coverage. This means you must be working or doing community engagement activities for at least 80 hours per month when you apply for or renew your Medicaid coverage.

What is the Requirement?

To qualify, you must work or complete community engagement activities for at least 80 hours per month.
If you are applying for Medicaid, you must show you met the work or community engagement activities in the month before you apply.
If you are a current Medicaid member, you must show you met the work or community engagement requirement for at least three of the six months before you renew your coverage.

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.

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.

Medicaid Applicants

If you apply for Medicaid on or after January 1, 2027, and must report work or community engagement activities, you must work or do community engagement in the month before you apply.

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.

What are the Short-Term Hardship Exceptions?

If you meet the Medicaid community engagement requirement, you may be able to get a short-term exception in certain situations. A short-term hardship exception means you do not have to meet the community engagement requirement for a month if you have a temporary hardship in that month. You may qualify if:

You are staying in a hospital or nursing facility.
You or your dependent must travel away from home for medical care that is not available in your community because of a serious or complex medical condition.
You live in an area with very high unemployment.
You live in an area affected by a federally declared emergency or disaster, such as a major flood, tornado, or other natural disaster.

A short-term hardship exception is temporary. When the hardship ends, you may need to meet the community engagement requirement again if it still applies to you. When it is time to renew your Medicaid coverage or when you apply for Medicaid, you will receive instructions on how to request a short-term hardship exception if you think you qualify.

You can meet the requirement by doing one of the following activities:

Completing at least 80 hours per month of:

Work.
Job training or a work program.
Volunteering or community service.
Going to school part-time.
Any combination of the activities above that adds up to 80 hours.

Going to school at least half-time, including high school, college, or career and technical education.
Earning $580 a month, or if your work is seasonal, earning an average of $580 over the last 6 months.

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. If you need help determining if you meet the requirement or not, a kynector can help. You can call 1-855-459-6328 or visit thekynect website and select "Get Local Help" from the top of the page.

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.

It is important to respond within 30 days. If you do not respond, your Medicaid application may be denied, or you may lose Medicaid Coverage.

You have the right to appeal any eligibility decision. Appeal instructions will be included in your Notice of Eligibility. You may also reapply for coverage at any time.

When you apply or renew your Medicaid, we will let you know whether you must meet the work or community engagement requirement.

We will share more information on how to meet the requirements or request an exemption soon.

What Kentucky Medicaid Members Should Do Now

While you will be notified if these Medicaid changes apply to you, there are steps you can take now to help you keep your coverage.

Update your address, phone number, and email address with Kentucky Medicaid. You can do this by:

Logging into the Self-Service Portal
Calling kynect at 1-855-459-6328 Monday through Friday 8 a.m. to 7 p.m. ET
Calling the Department for Community Based Services (DCBS) at 1-855-306-8959 Monday through Friday 8 a.m. to 5 p.m.
Calling or visiting a kynector - Search for a kynector
Visiting a DCBS office - Find a DCBS office

Check your mail, email, and texts. If you receive mail, an email, or a text from Kentucky Medicaid, be sure to follow the directions it gives you and respond quickly.
Know your renewal date. Kentucky Medicaid will send you letters, emails and texts when your renewal date is coming up.
Track your activities. Keep a record of any work, volunteer, job training, or school hours you complete each month. If you start now, you will be ready to show Kentucky Medicaid that you meet the requirements when it’s time for your renewal.
Gather documents. Begin gathering important medical or legal documents so you are ready if you need to show Kentucky Medicaid that you qualify for an exemption.
Follow up with Kentucky Medicaid. You can call us at 1-855-459-5328 Monday through Friday from 8 a.m. to 7 p.m. ET to find out what you need to do to keep your coverage.
Stay updated on what's happening at Kentucky Medicaid by registering for or watching the Medicaid Monthly Forum or following us on social media.

January 1, 2027: More Frequent Medicaid Renewals for Adults Aged 19 to 64

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

Starting January 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.

If you enroll on or after January 1, 2027, you will renew your Medicaid every six months.

If you were already enrolled before January 1, 2027, you will keep your current 2027 renewal month. After your eligibility is renewed, you will move to the six-month renewal.

All other Medicaid members will continue to have their Medicaid renewal once per year.

January 1, 2027: Limits on Backdated Medicaid Coverage

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.

October 1, 2028: Cost Sharing for Members

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.

Some services, such as primary care or mental health and substance use disorder services, will be exempt from cost sharing.

Kentucky Medicaid is still reviewing how to meet federal cost-sharing rules and will share more information as it becomes available.

Important Information for Kentucky Medicaid Members

You will be notified if these Medicaid changes apply to you.
Please keep your information up to date with Kentucky Medicaid. You can update it by:

Logging into the Self-Service Portal
Calling kynect at 1-855-459-6328 Monday through Friday 8 a.m. to 7 p.m. ET
Calling the Department for Community Based Services (DCBS) at 1-855-306-8959 Monday through Friday 8 a.m. to 5 p.m.
Calling or visiting a kynector - Search for a kynector
Visiting a DCBS office - Find a DCBS office

If you receive mail, an email, or a text from Kentucky Medicaid, be sure to follow the directions it gives you and respond quickly.
Check your renewal date so you know when to watch for mail, emails or texts.
Stay updated on what's happening at Kentucky Medicaid by registering for or watching the Medicaid Monthly Forum or following us on social media.

Federal Law Changes Sample Outreach Notice

Federal law (H.R. 1) requires states to have community engagement requirements for some adults ages 19 to 64 enrolled who qualify for Medicaid based solely on their income. Kentucky Medicaid is sharing this sample notice so members, providers, and the public can see the information that will be sent to households who may be affected.

Medicaid Community Engagement (MACE) Sample Outreach Notice

Medicaid Community Engagement (MACE) Exemption Fact Sheet

Medicaid Community Engagement (MACE) What to Do Now

Medicaid Community Engagement (MACE) How to Meet Requirements

The sample notice explains who the requirement may apply to, what members may need to do, possible exemptions, and where to get help. Kentucky Medicaid will begin mailing these notices to current members on July 1, 2026. Members may also receive a text message or an email about the community engagement requirement.

You do not need to report anything at this time. Members who are required to meet the community engagement requirement will receive additional notices starting 120 days prior to their annual renewal in 2027.