The following is for information purposes only. Not all services listed are available to all members. To determine what services are available to you, contact the Member Services Call Center at (800) 635-2570, 8 a.m. to 5 p.m., Monday through Friday.
Acute Care Hospital
An acute care hospital facility provides both inpatient and outpatient services, including emergency room services.
Acquired Brain Injury (ABI) Waiver Services
The ABI services program provides rehabilitative home- and community-based services to individuals with brain injuries as an alternative to nursing home facility services and to support individuals' efforts to return to a community setting with existing resources.
Acquired Brain Injury Long Term Care Waiver
The Acquired Brain Injury Long Term Care Waiver program provides an alternative to institutional care for individuals who have reached a plateau in their rehabilitation level and require maintenance services to avoid institutionalization and live safely in the community.
Advanced Registered Nurse Practitioner (ARNP) Services
Coverage is available for services provided by participating advanced registered nurse practitioners including nurse anesthetists and nurse midwives.
Ambulatory Surgical Center Services
Medicaid covers medically necessary services related to outpatient surgical procedures.
Breast and Cervical Cancer Treatment Program
Women screened by a local health department for breast or cervical cancer and found to need treatment for breast or cervical cancer can receive services through Kentucky Medicaid.
Child Advocacy Centers
The Department for Medicaid Services and Department for Community Based Services partner to administer programs for child Medicaid members.
Chiropractor Services
Coverage for chiropractic services is based on medical necessity and provided by Medicaid-approved providers.
Commission for Children with Special Health Care Needs (CCSHCN)
DMS also partners with CCSHCN to provide a broad array of services and service referrals to multiple health care providers for specific diagnoses or conditions.
Comprehensive Out-patient Rehabilitation Facilities (CORF)
CORF is limited to Medicare-deductible and coinsurance payments for Qualified Medicare Beneficiary (QMB) members. A facility enrolls as a CORF provider to bill separately for deductible and coinsurance amounts applicable to QMB members receiving services under the CORF program.
Community Mental Health (CMH) Centers
Publicly funded community services for individuals with mental health, mental retardation and substance abuse problems are provided through Kentucky's 14 regional MH/MR boards.
Consumer Directed Option
Consumer Directed Option is offered for Kentucky Medicaid waiver members currently receiving or eligible to receive home and community based waiver services.
Critical Access Hospital Program
An acute care facility may qualify as a critical access hospital if the facility meets other state and federal criteria.
Dental Services
Limitations and specified conditions apply to coverage for dental services including oral exams, emergency visits, X-rays, extractions and fillings.
Disproportionate Share Hospital (DSH) Program
Prior to billing a patient and submitting hospital service expenses to Medicaid as uncompensated, a hospital uses the Indigent Care Eligibility form to determine if the patient meets DSH guidelines.
Durable Medical Equipment (DME)
Medicaid covers durable medical equipment such as wheelchairs, hospital beds, orthotic appliances (braces) and prosthetic devices (artificial limbs) and medically necessary disposable medical equipment ordered by an accepted prescriber and suitable for use in the home.
Early Periodic Screening, Diagnosis and Treatment Services (EPSDT) Program
- EPSDT - Screenings
The EPSDT Screening Program provides routine physicals or well-child check ups for Medicaid-eligible children at specified ages
- EPSDT - Special Services
The EPSDT Special Services Program allows coverage for medically necessary items or services not covered somewhere else in Medicaid. It is considered treatment.
Family Planning Services
Services include complete medical history, physical examination, laboratory and clinical tests supplies, educational material, counseling and prescribed birth control methods best suited to the patient's needs.
Health Access Nurturing Development Services (HANDS)
HANDS is a voluntary, intensive home visitation program for first-time parents that provides services from pregnancy to the child's third birthday.
Hearing Services
Hearing and hearing aid evaluations performed by audiologists and hearing aids dispensed by hearing aid dealers are covered for persons younger than 21.
Home and Community Based (HCB) Waiver
The HCB Waiver program provides Medicaid coverage and services to older and disabled individuals to help them avoid admission to a nursing facility.
Home Health Services
Covered services include part-time nursing services, physical therapy, speech therapy, occupational therapy, medical social services, disposable medical supplies, light housekeeping service and home health aide services when necessary to help the patient continue to live at home.
Hospice Services
Medicaid covers hospice services for terminally ill members. Hospice care provides pain control and relief; supportive services and assistance to families adjusting to a loved one's terminal illness and death.
Hospital Services
Most medically necessary inpatient hospital services are covered, along with some hospital outpatient and emergency room services.
IMPACT Plus
Community-based services provided to children younger than 21 with complex mental health needs and at risk for institutionalization.
Independent Laboratory Services
A laboratory provider may perform Medicaid laboratory services for Medicaid recipients only to the extent authorized by the provider's CLIA certificate.
In-patient Psychiatric Hospitals
DMS funds mental health and mental retardation services in conjunction with the Department for Mental Health, Developmental Disabilities and Addiction Services and operates several in-patient facilities that provide psychiatric, rehabilitative and nursing care services.
Intermediate Care Facility Services for Individuals with Mentally Retarded or Developmentally Disabled (ICF/MR/DD)
Medicaid covers services to individuals with mental retardation and developmental disabilities who require a planned program of active treatment on an inpatient basis and who meet patient status criteria of ICF/MR/DD participating in the Medicaid program.
Kentucky Patient Access and Care (KenPAC)
KenPAC is a primary care case management program for enrollees.
Medical Transportation
Medicaid covers only medically necessary transportation to and from a Medicaid-covered service.
Michelle P. Waiver Services
A waiver that offers individuals with intellectual disability or other
developmental disabilities nonresidential services.
Model Waiver II Services
Model Waiver II services are community-based in-home ventilator services provided to members dependent on a ventilator and who otherwise would require care in a nursing facility.
Nursing Facility Services
Medicaid covers nursing facility services for eligible Medicaid members residing in a licensed Medicaid-certified facility.
Organ Transplant Services
Medically necessary organ transplants performed in a DMS-approved acute care facility are covered and paid up to $75,000 per transplant.
Pharmacy Services
Out-patient drugs are covered for Medicaid members, including members in nursing homes and personal care homes. Some drugs require prior authorization or have limits and exclusions.
Physician Services
Medicaid will pay for medically necessary services performed in the office, hospital or home.
Podiatry Services
Coverage includes a wide range of podiatry services; however, routine foot care is covered only for certain medical conditions which require professional supervision.
Presumptive Eligibility
A program for pregnant women who have not yet applied for Medicaid. Coverage includes out-patient prenatal care.
Preventive Services
Medicaid partners with the Department of Public Health to provide medically-necessary preventive services.
Primary Care Center Services
Medicaid will pay for covered services provided at licensed primary care centers. Primary care centers provide evaluation, management and out-patient services.
Psychiatric Residential Treatment Facility Services
In-patient psychiatric services are covered for residents ages 6 to 21 who require treatment on a continuous basis as a result of a severe mental or psychiatric illness.
Qualified Medicare Beneficiary (QMB) Coverage
QMB coverage is available to individuals enrolled and receiving Medicare Part A benefits. Coverage provides for payment of the Medicare Part A and B premiums, coinsurance and deductibles (hospital and physician).
Radiology Services
This provider type provides radiological services. Radiological services (including x-rays, ultrasounds, computer-assisted tomography, and magnetic resonance imaging) are limited to procedures provided by a facility licensed to provide radiological services.
Renal Dialysis Services
Benefits include renal dialysis, certain supplies and home equipment.
Rural Health Clinic Services
Medicaid covers services provided by participating rural health clinics including basic diagnostic and therapeutic services, basic laboratory services, emergency services and other services provided through agreement or other eligible arrangements.
School-Based Health Services
School-based health services include evaluations, diagnoses, prevention and treatment services that offer maximum reduction of physical or mental disabilities to allow the recipient to function to his or her best possible ability, to prevent loss of existing function or to correct defects or conditions.
Supports for Community Living (SCL)
The SCL waiver provides various home- and community-based services to eligible members as an alternative to receiving services in an intermediate care facility for individuals with mental retardation or developmental disabilities.
Targeted Case Management - Adults
The Adult Targeted Case Management Program provides services for adults 18 and older diagnosed with severe mental illness.
Targeted Case Management - Children
The Child Targeted Case management Program provides services for children younger than 21 diagnosed with severe emotional disability.
Title V
Title V is a program provided through DCBS serving children younger than 21 who are in the custody of the Cabinet, under the supervision of the Cabinet or at risk for Cabinet custody.
Vision Services
Most examinations and certain diagnostic procedures performed by ophthalmologists and optometrists are covered for members of all ages.