Question 1: What is KCHIP?
The Kentucky Children's Health Insurance Program (KCHIP) provides health coverage at little or no cost to uninsured children who qualify.
Question 2: Who is eligible for KCHIP?
Uninsured children under the age 19 who live in families with income at or below 200% of the federal poverty level (FPL). View the "Income Limit Chart."
Question 3: How Do I Apply for KCHIP?
The initial application process requires a face-to-face interview at your local Department for Community Based Services (DCBS) office. Appointments can be scheduled or walk-ins are accepted. To find where your local DCBS office is located, call 877-KCHIP-18 or click here.
Question 4: What do I need to take with me when I apply?
1. Proof of income.
- For wages, take copies of pay stubs for the last two months or a letter from your employer. The letter should include your wage, employer's name, address, phone number and original signature. For self-employment, bring a copy of your last income tax return.
- For unearned income, bring most recent award letter or other proof of amount. Examples of unearned income include: KTAP, disability, pension, child support, alimony, cash gifts, annuities, interest, Social Security, veteran's benefits, etc. For child support, include copies of checks, a statement from the non-custodial parent or a statement from the child support collection agency in your county.
2. Proof of expenses for childcare or disabled adult living in the home.
- Bring copies of receipts or a statement from the care provider.
3. Health insurance information.
If anyone in your family has health insurance that pays for doctor's office visits and hospital care, we need the following information:
- Name of the insurance company
- Group number and policy number
- Effective date
- Name of policy holder
- Names of people who are covered
4. Proof of Identity
- Identity confirmation and proof of citizenship
Question 5: What will happen during the face-to-face interview?
You will provide information to the worker who will complete the application. You will:
- Choose your child's primary care provider
- Talk with the worker about other benefits you might be eligible for
- Learn about healthcare benefits covered under KCHIP and Medicaid
- Learn about how to use your KCHIP or Medicaid healthcare card
- Ask questions about anything you do not understand
If you live in the Passport Region that includes Louisville and the 16 counties surrounding it, you will be contacted by Passport regarding your primary care provider.
Question 6: What medical services does KCHIP cover?
KCHIP covers health check-ups and screenings, prescription medicines, immunizations (shots), doctor visits,vision exams and eyeglasses, hearing services, dental care,hospital care, mental health, allergy injections, serum and much more. See Benefits for more information.
Question 7: Are there any out-of-pocket costs?
Prescription drugs have co-payments that must be paid to the pharmacy when a prescription is filled. The pharmacy co-payments range from $1.00 to $3.00, depending on the type of medicine you are getting. You do not have to pay for allergy shots, but there is a $2.00 co-payment for allergy testing. Emergency room visits might have a 5% co-payment if they are not true emergencies.
If you cannot pay the co-pay at the time of service, you still owe it.
Some children enrolled in the Kentucky Children's Health Insurance Program (KCHIP) are required to pay a monthly premium. A family can receive a 10 percent discount if premiums are paid in advance for three or six months.
Question 8: Who pays the premium?
Families with children in the KCHIP program who are above 150 percent of the Federal Poverty Level (FPL) will be required to pay premiums. View the "Income Limit Chart."
Question 9: When do families pay the premium?
Premiums must be paid by the fifth of each month to continue receiving health benefits for your child. You will receive a bill from the Premium Payment Center around the 22nd or 23rd of each month.
If your child is newly approved for KCHIP, you will receive a bill from the Premium Payment Center. You will have to pay your premium before you receive your child's card in the mail. A new applicant will need to pay two premium payments, one for the first full month of KCHIP coverage and one for the next month.
Premium payments are due by the fifth of each month and are paid in advance. If you have any questions or concerns about premium payments, call the Premium Payment Center at 866-9KY-CHIP (866-959-2447).
Question 10: What happens if a family does not pay the premium?
You will need to pay the premium or your child will lose health benefits. If you child loses health benefits, you will have to go to the local DCBS office to re-apply for health benefits. You will need to make up the missed premium payment for the months in which the child received KCHIP coverage and did not pay the premium before the child can be re-approved for the KCHIP program. If you believe that your child was discontinued unfairly, you have a right to request a hearing.
Question 11: Will premiums affect how I apply for KCHIP for my child?
No. The KCHIP application process has not changed. You will need to go to the local DCBS office in the county where you live to apply for KCHIP benefits. If the application is approved, you child's health care coverage starts on the date of application, but only after the premium is paid.
Question 12: Is there a limit to the amount of co-payments and premiums?
Yes, you have a yearly out-of-pocket maximum of $225.00 for pharmacy and $225.00 for Medical services for a total of $450.00 per year. Also, the total amount you pay in co-payments and premiums will not be more than 5% of your quarterly income. You may call 1-800-635-2570 to see if you have met your out-of-pocket maximum amount.
Question 13: Will there be retroactive coverage for new KCHIP applicants?
No. Children in KCHIP will no longer receive three months of retroactive coverage. If you child is approved, their health care coverage will begin on the date you applied for KCHIP at the local DCBS office in the county where you live.
You must pay the premium or your child will not receive a KCHIP card.
Question 14: If my child has health insurance, can he get KCHIP?
No. If your child has health insurance, he cannot get KCHIP, but he may be eligible for Medicaid. For certain income levels, a child must not have other health insurance coverage for a period of six months before applying for KCHIP. There are exceptions if the child loses health insurance for reasons that cannot be controlled. Contact the local DCBS office to see if your child is eligible.
Question 15: If a parent voluntarily left a job or was fired, would their children be eligible immediately for KCHIP benefits?
Job loss is considered an involuntary reason for loss of health insurance; therefore, the children may be eligible for KCHIP.
Question 16: Is my child eligible for KCHIP if I have dropped health coverage?
Your child may be eligible. It depends on your income level. Contact your local DCBS office, or call 877-KCHIP-18 for more information.
Question 17: How long will it take for me to find out if my child is eligible?
The local DCBS office has 30 calendar days or less from the date of the face-to-face interview to determine eligibility. It may take longer if you don't have all the information needed to process the application when you first meet with the DCBS caseworker.
Question 18: What are the differences between the KCHIP Medicaid expansion and the KCHIP separate insurance program?
The KCHIP Medicaid expansion up to 150% FPL has the same benefits as traditional Medicaid and does not require a six-month waiting period without health insurance. The KCHIP separate insurance program from 151 to 200 percent FPL does not provide non-emergency transportation or EPSDT (Early Periodic Screening, Diagnosis and Treatment) Special Services and requires a six month waiting period if you voluntarily drop the child's health insurance. EPSDT Special Services are medically necessary services that are not covered in the benefit package and require prior approval from Medicaid such as a third pair of glasses. If your income increases, your benefits may change. Be sure to check with your caseworker when reporting income changes to see if your benefits are affected.
Question 19: Is the billing process different for the KCHIP Medicaid expansion and the KCHIP separate insurance program?
The billing process is the same. All claims must be completed as if they were a Medicaid claim. Passport Health Plan providers submit claims to their managed care plan.
Question 20: What do the healthcare cards look like?
Each KCHIP member will receive a white wallet sized plastic card. Click here to view card. You will keep this card as long as you receive KCHIP benefits.
Question 21: If my child has Passport, what does the card look like if I have KCHIP or Medicaid?
Children enrolled in the KCHIP Medicaid expansion who live in the 16 county Passport Health Plan region will also issue a wallet-sized plastic member card. Only the Passport plastic, wallet-sized card for the KCHIP separate insurance program has a purple stripe at the top.
Question 22: How do I use the KCHIP or Medicaid cards?
Always take your card with you when you get a health care service. If you don't, you may have to pay for the service. Also, don't ever let anyone else use your card. If you lose your card, contact your caseworker.
If you get health services through Passport, you will also receive a Passport card when you enroll. You must bring both your Passport and KY Health Card with you to receive services. Click here to learn more about Passport.
Question 23: How often do I renew KCHIP and Medicaid for my children?
If your child has KCHIP or Medicaid, you will receive a renewal form in the mail every 12 months. To renew (or re-certify) you must do the following:
- Complete, sign and return the renewal form, or complete a telephone interview.
- Send proof of income for the last two months.
- Send proof of unearned income.
- Send proof of expenses for childcare or disabled adult living in your home.
- Send health insurance information.
It is very important to send complete information about earned and unearned income and health insurance. Failure to provide complete information could result in loss of benefits or prosecution for fraud.
If you don't send back the renewal form by the date printed on your notice, your child's coverage will stop, and you will need to go to your local DCBS office to reapply
Question 24: Are immigrant children eligible to receive KCHIP benefits?
Immigrants who enter the Unites States on or after Aug. 22, 1996, are not eligible to receive Medicaid or KCHIP benefits for five years from the date they enter the country with a status as a "qualified alien." The clock on the five years begins to run from the date the immigrant obtains qualified alien status. The following qualified aliens are exempt from the five-year time period; refugees, asylees, Cuban and Haitian entrants, Victims of trafficking, aliens whose deportation is being withheld, Amerasian immigrants, legal permanent residents (LPR) who first entered the country under another exempt category and who later converted to LPR status, members of a federally recognized Indian tribe, as defined in 25 U.S.C 450b(e) or American Indians born in Canada to whom 289 of the Immigration and Nationality Act applies.
Also, other exemptions include qualified aliens who are honorably discharged U.S. military veterans, currently on active duty or the spouse (including a surviving spouse who has not remarried) or unmarried dependant child of an honorably discharged veteran or individual on active duty in the U. S. military. For more information concerning questions about immigration issues, click on this link:http://cms.hhs.gov/immigrants/default.asp.
Question 25: Is a parent's immigration status part of KCHIP eligibility?
No, unless the parent is applying for Medicaid coverage for himself. If a child of an immigrant is a United States citizen or has obtained "qualified alien status" as described in Question 23, then the parent can apply for KCHIP or Medicaid for the child only.
Question 26: What if I have questions about KCHIP?
You can call the toll free hotline at 877-KCHIP-18, or for the hearing impaired call 877-KCHIP-19. Spanish speakers may call 800-662-5397.