Kentucky Medicaid Has Presumptive Eligibility

pregnant The Medicaid program in each state has a portion that covers the health care needs of women who are pregnant. In Kentucky, this program is called Presumptive Eligibility for Pregnant Women. The purpose is to ensure immediate access to prenatal care.

Medicaid is a public, or government run, health insurance program. It is designed to cover individuals and families who are low-income, and who cannot afford to pay for a health insurance plan from a private insurance company. Medicaid is funded by both the federal government and by the government of an individual state.

In Kentucky, Medicaid is administered by the Kentucky Cabinet for Health and Family Services. The main Medicaid program covers women who are pregnant. Eligibility requirements for Medicaid include an income limit of $217.00 and a resource limit of $2,000 for an individual. People who have an income that exceeds that amount might be eligible for the spenddown program.

Kentucky is one of the states that has adopted a Presumptive Eligibility (PE) for Pregnant Women program. The Kentucky website that talks about PE says:

“In Kentucky, 15 percent of pregnant women fail to receive critical prenatal care until after their first trimester. Regular prenatal care is proven to reduce many health risks to both mother and child. Early detection and management of potentially high-risk pregnancies can also make a significant impact on reducing the overall cost of delivering health care to the financially needy citizens of Kentucky.”

Presumptive Eligibility enables eligible pregnant women to receive prenatal care through Medicaid for up to 90 days while their eligibility for full Medicaid benefits is determined. In other words, it lets the woman receive prenatal care while she is waiting to be officially approved for Medicaid.

To be eligible for PE, a woman must be pregnant, and must be a resident of Kentucky. She must meet the income guidelines for the program. She also must not currently have a pending Medicaid application on file with the Department for Community Based Services, and must not be currently enrolled in Medicaid.

She cannot be an inmate of a public institution. She also cannot have been previously granted Presumptive Eligibility for her current pregnancy.

Coverage under Presumptive Eligibility begins on the date that a qualified provider determines that a woman is eligible for the program. It lasts for up to 90 days. It will end when the woman is granted full eligibility into the Medicaid program. Or, it will end on “the last day of the second month following the month in which a qualified provider made the Presumptive Eligibility determination.”

Image by Teza Harinaivo Ramiandrisoa on Flickr