Initially, that program will be limited to those with pulmonary disease, diabetes, and cardiac conditions, but may be expanded. Those benefits will include additional dental and vision services, or counseling for nutrition or smoking cessation.
Also, unlike the West Virginia program, Kentucky Medicaid patients are not required to sign a contract, said Judith Solomon, a senior fellow at the CBPP. Kentucky officials say they are trying to control Medicaid costs while boosting healthier behavior. For example, Kentucky's plan requires patients to share in the cost of many services, but patients also receive full coverage of preventive services such as vaccines.
Kentucky is using its newfound federal flexibility to create a “tiered” approach, sorting enrollees into different groups with benefits targeted to their needs. A May 2 document from the state's Department of Medicaid Services (DMS) stated that packages “may contain service-specific coverage limits … None of the visit or dollar cost limits are 'hard' limits but rather are 'soft' limits,” which can be bypassed “if medical necessity is demonstrated by [a physician] through a prior authorization process.”
A better integrated system is the goal—for example, mental and physical health services will be better coordinated, according to the DMS.
The state also plans to transform the Kentucky Children's Health Insurance Program “from a Medicaid-administered program to a program potentially operated by a managed care organization,” according to the DMS.
This move will increase access to pediatricians and pediatric specialists, the DMS stated.