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KCHIP Frequently Asked Questions

What is KCHIP?
KCHIP, the Kentucky Children's Health Insurance Program, provides health coverage at little or no cost to uninsured children who qualify.

Who is eligible for KCHIP?
Uninsured children younger than 19 living in households with an income at or less than 200 percent of the federal poverty level. View the Income Limit Chart.

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. YOu can make an appointment in advance or walk in for service, but you may have a longer wait without an appointment. To find your local DCBS office, call 877-KCHIP-18 or use our online office locator.

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 stataing your wages, employer's name, address, phone number and original signature. If you are self-employed, bring a copy of your last income tax return.
  • For unearned income, bring the 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

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 for which you may qualify
  • Learn about health care benefits covered under KCHIP and Medicaid
  • Learn how to use your KCHIP or Medicaid healthcare card
  • Ask questions about anything you do not understand

If you live in the Passport region, which includes Louisville and the 16 counties surrounding it, Passport staff will contact you regarding your primary care provider.

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.

Are there any out-of-pocket costs?
You will pay a co-payments to the pharmacy when a prescription is filled. Pharmacy co-payments range from $1 to $3, depending on the type of medicine you receive. You do not have to pay for allergy shots, but there is a $2 co-payment for allergy testing. Emergency room visits might have a 5 percent co-payment if visits are not true emergencies.

If you cannot pay the co-pay at the time of service, you still owe it.

Coverage for some children enrolled in KCHIP may required payment of a monthly premium. A 10 percent discount is given if premiums are paid three or six months in advance.

Who pays the premium?
Families with children in the KCHIP program with incomes more than 150 percent of the federal poverty level will be required to pay premiums. View the Income Limit Chart.

When do families pay the premium?
Premiums must be paid by the 5th day of each month to maintain health benefits for your child. You will receive a bill for your premium around the 22nd or 23rd of each month.

If your child is newly approved for KCHIP, you will receive a bill and will need 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 5th 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.

What happens if I miss a premium payment?
You will need to pay missed premiums or your child will lose health benefits and you will have to re-apply to restore health benefits. You will need to make up the missed premium payments for months the child received KCHIP coverage before the child can be re-approved for the KCHIP program. If you believe your child has been discontinued unfairly, you have a right to request a hearing.

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, your child's health care coverage starts on the date of application, but only after the premium is paid.

Is there a limit to the amount of co-payments and premiums?
Yes, you have a yearly out-of-pocket maximum of $225 for pharmacy and $225 for Medical services for a total of $450 per year.  Also, the total amount you pay in co-payments and premiums will not be more than 5 percent of your quarterly income.  You may call 1 (800) 635-2570 to find out if you have met your out-of-pocket maximum amount.

Will there be retroactive coverage for new KCHIP applicants?
No. Children in KCHIPl no longer receive three months of retroactive coverage. When a child is approved, his or her health care coverage begins 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.

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. Exceptions apply if the child loses health insurance for reasons that cannot be controlled. Contact your local DCBS office to find out if your child is eligible.

If a parent voluntarily leaves a job or is fired, will his or her 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.

Is my child eligible for KCHIP if I have dropped health coverage?
Your child may be eligible, depending on your income level. Contact your local DCBS office, or call 877-KCHIP-18 for more information.

How long will it take to find out if my child is eligible?
The local DCBS office has 30 calendar days or fewer 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.

What are the differences between the KCHIP Medicaid expansion and the KCHIP separate insurance program?
The KCHIP Medicaid expansion up to 150 percent of the federal poverty level 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 percent to 200 percent of the federal poverty level does not provide non-emergency transportation or Early Periodic Screening, Diagnosis and Treatment Special Services (EPSDT) 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, such as a third pair of glasses, and require prior approval from Medicaid. If your income increases, your benefits may change. Be sure to check with your caseworker when reporting income changes to find out if your benefits are affected.

Is the billing process different for the KCHIP Medicaid expansion and the KCHIP separate insurance program?
Yes. All claims must be completed as if they are Medicaid claims. Passport Health Plan providers submit claims to their managed care plan.

What do the health care cards look like?
Each KCHIP member will receive a white wallet-sized plastic card. You will keep this card as long as you receive KCHIP benefits.

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 also will be issued a wallet-sized plastic member card. Only the plastic, wallet-sized Passport card for the KCHIP separate insurance program has a purple stripe at the top.

How do I use the KCHIP or Medicaid cards?
Always take your card when you receive health care services. 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 also will receive a Passport card when you enroll. You must presnt both your Passport and KY Health Card to receive services. Learn more about Passport

How often do I renew KCHIP and Medicaid for my children?
You will receive a renewal form in the mail every 12 months. To renew (or re-certify)::

  • 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

Are immigrant children eligible to receive KCHIP benefits?
Immigrants who entered 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 obtain qualified alien status. The following qualified aliens are exempt from the five-year time period; refugees, asylees, Cuban and Haitian entrants, victims of human trafficking, aliens whose deportation is being withheld, Amerasian immigrants, legal permanent residents who first entered the country under another exempt category and who later converted to legal permanent resident 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. Learn more about immigration issues

Is a parent's immigration status part of a child's KCHIP eligibility?
No. If a child of an immigrant is a United States citizen or has obtained qualified alien status as described above, the parent can apply for KCHIP or Medicaid for the child only.

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.

 

Last Updated 10/30/2008