Proposed changes to Kentucky’s Medicaid system: comment till 7/22

The Governor has proposed changes to the Medicaid system, and those changes will affect our homeless clients as well as the formerly homeless and at-risk families who could become homeless without medical assistance.

Here’s a fact sheet prepared by Kentucky Voices for Health about the changes to the system.Until July 22, we are in the comment period for these changes. During this period, the state is required to take into consideration every comment and include their responses when they submit the plan to Centers for Medicare and Medicaid Services (CMS). CMS will then consider this plan before responding to Kentucky. If their response is positive, this plan will be implemented.

Here are some key thoughts regarding the plan for those who serve the homeless:

  • Most homeless people either receive cash benefits or have some employment income (even minimal). Nearly 60% of homeless Louisvillians work. When clients work for an organization with an employer provided plan, those homeless clients would be required to join that plan within a year, with some assistance to cover that cost through state reimbursements.


  • Homeless clients without employer provided plans who also make 138% of the poverty rate ($33,465 for a family of four) would be entered in a new Medicaid program with monthly premiums ranging from $15 to $37.50. Insurance does not start until the first premium is paid and if the client misses premiums, they are dropped from the program for six months. These plans will not have dental or vision (except children, pregnant women and the medically fragile).


  • Most of our homeless clients are below 100% of the poverty level ($11,770 per year for an individual or $24,250 for a family of four). A single person with an annual income of $2,942 would be required to pay $1 each month, and someone with an income of $11,770 would pay up to $8 per month. If they fail to make their monthly premiums, they will be moved to a co-pay program. If they are moved to this option due to non-payment, they will also lose the My Rewards account to pay for additional health benefits. 
  • Annual enrollment will be required. If a homeless client loses coverage and is then reinstated, their coverage is not retroactive and does not cover medical costs while they were uninsured (except for children and pregnant women).


  • All Medicaid recipients would be required to meet work requirements within three months of program entry. Exemptions are provided for children, pregnant women, primary caregivers, and the medically fragile. (Kentucky would develop a process by which individuals would be evaluated and assigned a risk score based on objective criteria, and individuals with qualifying conditions and scores would be determined to be medically frail.) The State has also said they will ensure that medically fragile individuals receive the most robust benefits available, including non-emergency transportation. Half of the homeless people identified in Louisville each year have a disability, so it would be important for service providers to find work opportunities or go through the process to receive an exemption to maintain Medicaid benefits.


To submit a comment, send an email to or write a letter to:

Commissioner Stephen Miller
Department for Medicaid Services
275 E. Main Street
Frankfort, KY 40621

Please note that the deadline for written and emailed comments is 5pm on Friday, 7/22. 

To read Kentucky Voices for Health’s talking points for submitting comments, click here. The full proposal can be read here.