The Community Health for Improved Lives and Development (CHILD) waiver is Kentucky Medicaid provider type 49. To bill Kentucky Medicaid, CHILD providers must:- Meet the certified waiver provider qualifications as defined in the approved waiver application.
- Be enrolled as a Kentucky Medicaid provider.
The CHILD waiver has a proposed effective date of early 2026.
Covered Services
The CHILD waiver offers services not otherwise available through the Medicaid state plan to support qualifying children or youth in the community as they work toward their unique goals. All services will be provided by certified, Medicaid-enrolled traditional agency providers. Services include:
- Case Management
- Clinical Therapeutic Services
- Community Living Supports
- Environmental and Minor Home Modifications
- Respite
- Supervised Residential Care
A CHILD waiver provider must meet the coverage provisions and requirements of the approved waiver application. Listing of services is not a guarantee of payment. Providers must follow all relevant state Medicaid regulations.
Eligibility
Verify participant eligibility by calling the automated voice response system at (800) 807-1301 or by using the web-based KYHealth-Net System.
Reimbursement
Duplication of Service
Kentucky Medicaid will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the service is covered during the same period.
Service Authorization
Case managers approve most 1915(c) HCBS services. DMS review requests for Clinical Therapeutic Services and Environmental and Minor Home Modifications. If you have questions about service authorization, call the 1915(c) Waiver Help Desk at (844) 784-5614.
Claims Submission
Kentucky Medicaid currently contracts with Gainwell Technologies to process fee-for-service claims.
Coding: Kentucky Medicaid uses the National Correct Coding Initiative edits as well as the McKesson Claim Check System to verify incidental or mutually exclusive codes. Kentucky Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. Kentucky Medicaid requires the use of CMS 1500 billing forms. Providers must bill Kentucky Medicaid using the correct CPT codes.
Claim Appeals: Appeal requests made on denied fee-for-service claims must be submitted to Gainwell Technologies. The request must include the reason for the request along with a hard-copy claim.
Timely Filing: Claims must be received the longer of either 12 months from the date of service or six months from the Medicare pay date or within 12 months of the last Kentucky Medicaid denial.
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