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Yes: 304 • No: 61
KentuckyHB 22026 Regular SessionHouseWALLET
AN ACT relating to Medicaid, making an appropriation therefor, and declaring an emergency.
Sponsored By: Ken Fleming (Republican)
Became Law
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Bill Overview
Analyzed Economic Effects
26 provisions identified: 11 benefits, 12 costs, 3 mixed.
Emergency slots reserved for waiver care
Kentucky must reserve capacity in every Medicaid waiver for people found to have emergency needs. The cabinet must develop emergency waitlist placement policies. By January 1, 2027, it must set emergency allocation criteria for waivers that lack them. The home and community based waiver must prioritize people assessed as needing skilled nursing services. The law specifies neither a number of reserved slots nor a guaranteed placement time.
Medicaid stops covering weight-loss prescriptions
Kentucky Medicaid and its managed care plans cannot cover drugs prescribed mainly for weight loss. The ban depends on the prescription’s main purpose, not just the drug’s name. The provision lists no exception or end date.
New work rules for Medicaid adults
Starting no later than January 1, 2027, some Medicaid expansion adults ages 19–64 must meet community engagement rules. The rule also covers adults in waivers offering equivalent coverage. Qualifying activities include 80 monthly hours of work, service, or a work program; half-time approved education; or qualifying combinations. Income at least equal to the state minimum wage times 80 hours also qualifies, with six-month averaging for seasonal workers. Applicants must show engagement for the month before applying; enrollees must show three months since their latest eligibility review. Exemptions cover specified caregivers, former foster youth, veterans, medically frail people, pregnant people, and recovery-program, incarceration, or hardship circumstances. People meeting specified SNAP or TANF work rules are also exempt. The cabinet needs legislative approval to seek an exemption, waiver, or delay. If federal requirements are reduced or repealed, Kentucky must seek federal approval before applying its fallback requirements.
Stricter applications for Medicaid waiver services
Waiver applicants need a complete application with a provider's service recommendation and confirmation of their primary diagnosis. The provider must be a Kentucky-licensed physician, physician assistant, advanced practice registered nurse, or psychologist. Without those materials, the state cannot approve services or add someone to a waitlist. People already waitlisted when the law takes effect have 12 months to comply or face removal. Where federal law permits, new enrollees generally must be U.S. citizens or qualified aliens. They also need one year of Kentucky residency when the waiver has a waitlist. These citizenship and residency requirements do not apply to previously enrolled people, service members, their spouses or dependents, or veterans.
Faster decisions on Medicaid treatment requests
Medicaid managed care plans must decide expedited treatment requests within 24 hours and standard requests within five calendar days. Substance-use-disorder treatment requests count as expedited. Expedited deadlines can extend up to 14 days when the enrollee requests it; standard deadlines can extend when the provider or enrollee requests it. Plans can also obtain either extension by justifying to the department why more information is needed and how the delay benefits the enrollee.
Medicaid covers more help quitting tobacco
Medicaid covers all FDA-approved tobacco-cessation medicines and recommended individual, group, and telephone counseling, including combinations of services. Plans cannot require counseling before medication or limit treatment duration or quit attempts. Cost sharing is barred unless federal law requires it, and utilization controls are generally prohibited. Prior approval is allowed for treatment beyond current federal clinical guidelines or services tied to more than two quit attempts within 12 months.
More Medicaid maternity and breastfeeding support
Medicaid covers lactation visits, breast pumps, two pump kits and accessories, maternity digital care, and in-home substance-use treatment for pregnant and postpartum women. Breastfeeding coverage lasts for each birth throughout breastfeeding, as the beneficiary defines it. Beneficiaries can request telehealth or group visits instead of individual in-person consultations, or a manual instead of double electric pump. Multi-user pump rentals require a licensed provider's recommendation. Equipment is due within 48 hours after a post-birth request. Before birth, it is due by the later of two weeks before the expected due date or 72 hours after requesting it. If equipment cannot be supplied on time, beneficiaries must receive reimbursement for all out-of-pocket expenses, including balance billing. Coverage generally has no cost sharing or utilization controls unless federal law requires them.
New tools guide Medicaid waiver care
By July 1, 2026, Kentucky must select a nationally recognized, age-appropriate assessment tool for each Medicaid waiver. These tools guide all care-level assessments and yearly reviews, including recommended service frequency, duration, and intensity. Existing recipients age 18 or younger keep their current tool until they reach age 18. The department must also encourage providers to develop programs that improve care quality and value while lowering program costs. The law does not guarantee increased services or set a savings target.
New copays for some Medicaid adults
Beginning October 1, 2028, Medicaid expansion enrollees with family income above 100% of the federal poverty line face copays. They pay $5 per covered care, item, or service and $1 per prescription, unless exempt. Primary care, mental health and substance-use services, and care at federally qualified health centers are exempt. Certified community behavioral health clinics, rural health clinics, and federally protected services are also exempt. Total family cost sharing cannot exceed 5% of family income each month or quarter, as the secretary decides. Federal law can change these requirements or exemptions.
Residency notices can end Medicaid coverage
Where federal law allows, Kentucky checks federal matching records at least quarterly for possible dual-state enrollment or lost Kentucky residency. The state must notify identified people within 30 days and give them 30 days to prove Kentucky residency. Without a response, the state moves them from managed care to fee-for-service coverage and stops payments to their managed care plan. A second notice must follow within 45 days of the first. Failure to provide proof within 30 days of that second notice results in removal from Kentucky Medicaid.
Returned mail can end Medicaid enrollment
Returned first-class Medicaid mail triggers a search for the beneficiary's current address. The department must ask the health plan, check records, and try at least two of telephone, text, and email. It must continue those efforts for at least 30 days after asking the plan and resend mail when an address is found. If no correct address is found within 30 days, the department must end enrollment where federal law permits. Federal appeal rights still apply.
Tighter Medicaid and SNAP eligibility checks
Beginning January 1, 2027, Kentucky reviews Medicaid eligibility every six months for the federally specified groups, excluding federally exempt people. New information affecting eligibility triggers an additional full Medicaid review or a SNAP case review. Medicaid must use personal statements about income, residency, age, household, caretaker status, and other coverage only as a last resort. An exception covers assisted-living, long-term-care, and hospital residents using those statements for temporary presumptive eligibility. Unless federal law requires otherwise, the cabinet cannot seek permission to skip periodic income-data checks. Agencies check lottery and gaming records and death records monthly, and unemployment and out-of-state benefit records quarterly. Medicaid also checks vehicle and address-change records quarterly, tax records annually, corrections records monthly, and child-support records regularly. When Medicaid records conflict and one indicates ineligibility, the cabinet must issue an appealable initial ineligibility finding where federal law allows. That finding rule remains subject to the exception in Section 9(11).
State takes over Medicaid dental claims
Beginning January 1, 2029, an administrative services organization must manage all covered Medicaid dental services instead of managed care plans. Kentucky remains responsible for dental claims; the administrator cannot take financial or insurance risk for them. The department must hire a full-time licensed Medicaid dental director beginning July 1, 2028, and contract with the administrator. The provision does not specify changes to covered dental care, beneficiary costs, or claim amounts.
Coaching helps Medicaid adults meet work rules
Kentucky must provide Volunteers of America $5 million each fiscal year of the 2026–2028 budget period. The money funds a community engagement pilot run by that organization or its direct successor. Medicaid enrollees in pilot areas who face federal engagement requirements receive individual coaching, navigation, and support. Services must begin no later than January 1, 2027.
Hospitals must help finish Medicaid applications
Qualified hospitals must help people they find temporarily eligible for Medicaid complete and submit a full application. That help must occur before the temporary presumptive eligibility period ends. Application assistance does not guarantee ongoing Medicaid eligibility.
Medicaid plan fines fund payment recommendations
Plans face at least $500 per prohibited claim-resubmission request or incentive, $1,000 per specified contact-penalty or death-reporting violation, and $5,000 per marketing violation. Improperly counting an inactive provider in network analysis carries a $10,000 penalty per provider. Collections go into a restricted Medicaid compliance fund; unused balances and interest carry forward. Only the General Assembly can authorize spending from the fund. By November 1, 2027, and each later odd-numbered year, the cabinet must recommend uses that increase Medicaid provider payment rates. No rate increase or direct household payment is guaranteed.
More payment protections for Medicaid providers
Providers now have 120 days, up from 60, after confirmed receipt to appeal reduced or denied Medicaid claims. Plans must decide provider grievances and appeals within 30 days or face possible contract penalties. When an appeal finds money owed, plans must pay providers in full within 30 days. Providers receive at least 30 calendar days to supply audit records, and audits generally must finish within 180 calendar days. That audit deadline does not apply when providers delay access to records. Plans cannot recover payments until the audit and appeals end; amounts must reflect actual payment errors unless providers agree to settle. Provider websites must list relevant contacts and explain internal appeals and independent reviews plainly, with updates within 30 days of changes.
Stronger safeguards for Medicaid health plans
New, renewed, or extended Medicaid contracts must require compliance with the law's listed rules, insurance laws, and contract duties. Plans and contractors cannot induce claim resubmissions to raise plan risk scores or punish providers for unsuccessful good-faith member contact. Marketing is limited to identifying the plan's Medicaid participation. Network counts cannot include providers with no Medicaid encounter or payment claim to that plan during the prior 12 months. Plans must report an enrollee's death to Medicaid and the appropriate Social Security office within five business days of learning about it. The department must use all available contract remedies when it finds covered contract or legal violations.
Stronger tracking for Medicaid ride brokers
Regional ride brokers must pay for GPS devices that track vehicles while they provide covered Medicaid rides. Brokers have 2% of their payments withheld, earnable back through trip completion, delay, scheduling, and rider-satisfaction measures. Minimum medical loss ratios are 85% for the fiscal year starting July 1, 2026, and 87% starting July 1, 2027. They rise to 89% starting July 1, 2028, and 90% starting July 1, 2029, and thereafter. Brokers missing the applicable ratio must return excess payments to the state. These rules do not charge riders.
Lawmakers control more Medicaid benefit changes
The cabinet generally needs specific legislative approval to establish a basic health program or change Medicaid eligibility, coverage, or benefits. The approval requirement also covers providing Medicaid benefits or spending state general funds on benefits. Exceptions cover federally required actions, reimbursement rates, fee-for-service schedules, the preferred drug list, and qualifying payment programs initially federally approved before March 27, 2025. Changes responding to presidential national emergencies, federal disasters, or the Governor's state emergencies are also allowed. Emergency changes must end when the related declaration ends.
New duty to report Medicaid waiver violations
People who know or have reasonable cause to suspect a Medicaid 1915(c) waiver law or policy violation must report it. Reports must go to the Office of Medicaid Fraud and Abuse Control or the Medicaid Fraud and Abuse hotline. The duty also covers suspected caregiver hiring, employment, or pay fraud in programs that let participants directly employ caregivers. This rule does not require people to investigate violations.
Transportation brokers must certify Medicaid reports
Regional Medicaid transportation brokers must have an officer certify data and reports sent to state transportation oversight or administration agencies. The officer must confirm that submissions are truthful, accurate, and complete to the best of their knowledge. This applies to nonemergency medical transportation. Medicaid members have no new reporting duty under this rule.
Medicaid plans must earn withheld payments
Medicaid plans must work with the department on a payment model that withholds 2% of each plan's capitation payment. Plans can earn back some or all of that amount by meeting care measures. Measures include readmissions, screenings, well-care visits, maternity care, emergency visits, behavioral health, and recovery services. This changes payments to plans, not recipients' copays or benefit amounts.
Tighter checks on Medicaid enrollment records
Kentucky Medicaid plans must make reasonable efforts at least monthly to find members also covered in another state. This check covers the same plan, its parent company, or a subsidiary; plans must promptly notify the cabinet about matches. Plans must report their efforts monthly and face $1,000 per violation, with each noncompliant month counting separately. Penalties go to the Medicaid managed care organization compliance fund. When federal law permits, Kentucky Medicaid must arrange to receive Social Security’s full death-information file and updates at least quarterly, then remove enrollees reported as deceased.
New arrangements for Medicaid medical rides
Kentucky must decide eligibility for covered nonemergency rides during Medicaid applications and eligibility reviews. It must also check transportation records, including vehicle registrations, at least quarterly when they may show eligibility changes. Regional brokers arrange rides not covered by managed care plans; plan-covered rides, including stretcher rides, remain outside these regional rules. An actuary sets separate regional payments using local factors and the number of eligible riders. Hospitals and skilled nursing facilities can transport their own patients or residents for covered trips. Brokers must pay facilities the same mileage rate as contracted drivers; facilities need not transport other people. The law also repeals the former facility transportation statute, KRS 311A.172.
Current Medicaid contracts extended through 2028
Kentucky must extend Medicaid managed care contracts in effect when the law takes effect through December 31, 2028. The department cannot begin seeking new managed care contracts before January 1, 2028. The extension and procurement restriction expire after March 15, 2029, unless lawmakers extend them. The law also repeals KRS 205.515, the former Medicaid delivery-system statute. The supplied provision does not explain the repeal's separate effect on services or costs.
Sponsors & Cosponsors
Sponsor
Ken Fleming
Republican • House
Cosponsors
David W. Osborne
Republican • House
John Hodgson
Republican • House
Tony Hampton
Republican • House
Vanessa Grossl
Republican • House
Roll Call Votes
Senate vote • 4/14/2026
passed
Yes: 32 • No: 6
House vote • 4/14/2026
passed
Yes: 80 • No: 18
House vote • 4/1/2026
passed
Yes: 83 • No: 11
Senate vote • 4/1/2026
passed
Yes: 32 • No: 5
House vote • 2/27/2026
passed
Yes: 77 • No: 21
Actions Timeline
delivered to Secretary of State (Acts Ch. 179)
4/14/2026enrolled, signed by President of the Senate
4/14/2026Houseenrolled, signed by Speaker of the House
4/14/2026Housereceived in House
4/14/2026Housepassed 32-6
4/14/2026Senatevetoes overridden
4/14/2026Senateposted for passage for consideration of Governor's line vetoes
4/14/2026to Rules (S)
4/14/2026Senatereceived in Senate
4/14/2026Senatepassed 80-18
4/14/2026Housevetoes overridden
4/14/2026Houseposted for consideration of Governor's line vetoes
4/14/2026taken from Rules
4/14/2026Houseto Rules (H)
4/14/2026Housereceived in House
4/14/2026Houseline items vetoed
4/13/2026delivered to Governor
4/1/2026enrolled, signed by President of the Senate
4/1/2026Houseenrolled, signed by Speaker of the House
4/1/2026Housepassed 83-11
4/1/2026HouseFree Conference Committee report adopted in House
4/1/2026Houseposted for passage for consideration of Free Conference Committee Report
4/1/2026Housetaken from Rules
4/1/2026Houseto Rules (H)
4/1/2026Housereceived in House
4/1/2026House
Bill Text
Current
4/14/2026
Introduced
2/27/2026
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