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Kentucky Medicaid Managed Care

Below are previous updates and news posted to the homepage of this website.

November 2012 - Letters in both English and Spanish have been mailed with details regarding newly assigned managed care organization (MCO). View the: Region 31 Assignment letter: English - Versión en Español; Region 31 Side by Side Comparison: English - Versión en Español.

Members have from November 13 to change from your assigned MCO to another MCO, call us toll-free at 1-855-446-1245. You have until December 14 to call us to make a change and choose a different plan. You can call Monday through Friday from 8:00 am to 5:00 pm Eastern Time.

FRANKFORT, Ky. (Oct. 4, 2012) – Medicaid Managed Care Contracts Awarded for Jefferson and Surrounding Counties - The Commonwealth of Kentucky has signed contracts with four managed care partners to provide health care services to approximately 175,000 Medicaid recipients in Louisville and 15 surrounding counties. Read the Press release, Read the letter to Members regarding the change

(Wednesday, August 22, 2012) MEDICAID MANAGED CARE OPEN ENROLLMENT INFORMATION - Medicaid recipients in 104 counties of the Commonwealth currently have the opportunity to change their Managed Care Organization (MCO) without having to give a specific reason for the change as previously indicated in the Press Release regarding Medicaid Open Enrollment dated August 17, 2012. This is called an Open Enrollment period and it is from August 19, 2012 through October 20, 2012.

Members were notified by a Letter Regarding Open Enrollment and a Member Information Packet about the options provided by the three available MCOs: CoventryCares of Kentucky, Kentucky Spirit Health Plan and WellCare of Kentucky.

Medicaid members in managed care that would like to take this opportunity to change MCOs must do so by calling toll-free 1-855-446-1245 between the hours of 8:00 a.m. and 6:00 p.m. Eastern Time.

Members who choose to stay with their current MCO do not need to take any action .

(August 21, 2012) Important Notice for KY Medicaid Recipients and Providers - Effective October 1, 2012, there will be changes to the Non-Emergency Medical Transportation. Click to read the Important Notice regarding the Region 5, Non-Emergency Medical Transportation.

(May 17, 2012) MANAGED CARE ORGANIZATION (MCO) PRIOR-AUTHORIZATION CRITICAL ISSUE RESOLUTION MAILBOX: Due to providers having critical issues with obtaining MCO Prior-Authorizations, DMS/MCO Oversight Branch has established a resolution mailbox at PAMCO.Inquiry@ky.gov for providers to report: when there has been no response, an untimely response, or any other issues with the MCO Prior Authorization (PA) process. Note: This mailbox is not to be used in lieu of the normal PA process.

(March 20, 2012) Dental Comparison Grid

(March 5, 2012) Medicaid Members Can Receive Replacement Medications in Aftermath of Storms

(Nov. 18, 2011) Managed Care Policy for Out-Of-Network Dental Services

(Nov. 8, 2011) Managed Care Policy for Out-Of-Network Providers.

(Oct. 25, 2011) Letters have been mailed to Medicaid members with details regarding the start of managed care on Nov. 1. The letter provides information about the member's managed care organization (MCO) assignment and materials they will receive from the MCO. Members will be able to change MCOs for 90 days after managed care begins. Providers have also been sent a new letter with important information about the coming managed care implementation.

Prior Update: Important prior authorization information regarding RSV (respiratory syncytial virus) vaccine (Oct. 10, 2011) Magellan Medicaid Administration, the pharmacy benefit administrator for the Department for Medicaid Services, is handling prior authorizations (PAs) for the RSV vaccine for dates of service prior to November 1, 2011. For services rendered on or after that date, the member's assigned managed care organization (MCO) will be responsible for authorizations. The MCOs will honor existing PAs issued by Magellan for at least 30 days on or after Nov. 1.

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