Section 1115 Demonstration, Kentucky Helping to Engage and Achieve Long-Term Health (KY HEALTH), aimed to transform the Kentucky Medicaid program to empower beneficiaries and improve their overall health, was approved in January 2018. Eligibility was extended under the Kentucky HEALTH program for adults who do not qualify for Medicaid based on disability as a condition of participating in community engagement requirements while providing incentives for healthy behavior; several exemption categories that would prevent an individual from complying with established requirements. Pregnant women and medically frail individuals were included.
The KY HEALTH demonstration also includes aligning Medicaid beneficiary annual redetermination with their employer-sponsored insurance open enrollment period and extends eligibility for Medicaid to former foster care youth younger than 26 and who were in foster care under the responsibility of another state.
In December 2019, the commonwealth rescinded the Kentucky HEALTH program, keeping the following components of the KY HEALTH demonstration: SUD 1115, waiving of NEMT for methadone treatment, eligibility for out-of-state former foster care youth and alignment of ESI open enrollment dates.
Team Kentucky sections include;
- Substance Use Disorder (SUD) - in demonstration period
- Serious Mental Illness (SMI) - application pending CMS approval
- Reentry Section - submitted to CMS December 2023
Substance Use Disorder (SUD) Section 1115 demonstration available to all Kentucky Medicaid beneficiaries to ensure a broad continuum of care is available across the commonwealth for individuals with SUD. Kentucky received approval in October 2018 for the SUD 1115 demonstration protocol and began implementation on July 1, 2019. Under the SUD Section 1115, Medicaid expanded access to critical levels of care and adopted the American Society for Addiction Medicine (ASAM) criteria as the standard evidence-based treatment for SUD. The demonstration defines SUD residential treatment as a statewide average length of stay of 30 days and effective 2019 includes waiving of the IMD exclusion to allow reimbursement for up to 96 beds for programs meeting established provider qualifications, such as ensuring access to medication-assisted treatment and obtaining the newly established residential ASAM level-of-care certification.
Kentucky added methadone for SUD treatment to the State Plan. Under the demonstration, Kentucky received approval to waive non-emergency medical transportation (NEMT) for individuals receiving methadone in an opioid treatment facility, with exemptions for pregnant women or former foster care youth.
In November 2020, Kentucky Medicaid, in partnership with the Department of Corrections, filed an amendment to the Team Kentucky Demonstration requesting approval to allow the state to reimburse for SUD treatment to eligible individuals while incarcerated. Pending approval, services would be provided to Medicaid-eligible individuals participating in the established DOC SUD treatment programs to ensure these individuals receive needed treatment and begin coordination of care 30 days before release.
DMS requested an amendment to the original demonstration, entitled “TEAMKY (formally known as Kentucky Helping to Engage and Achieve Long Term Health (KY HEALTH))", to authorize the provision of certain reentry transitional services for identified individuals who are soon-to-be former inmates of a public institution, as well as limited services for eligible individuals participating in the Kentucky Behavioral Health Conditional Dismissal Program.
Read the Public Notice
Review the Application
Town Hall Recording (Nov. 27, 2023)
Town Hall Recording (Dec. 1, 2023)
Town Hall Presentation (slides)
Kentucky submitted an amendment application to CMS requesting authority to: (1) reimburse medically necessary short-term, defined as a state-wide average length of stay of 30 days, inpatient treatment services within settings that qualify as institutions for mental diseases (IMDs) for Medicaid-eligible adults with serious mental illness (SMI); and (2) implement a pilot program, specifically recuperative care services, also known as medical respite services, to adult beneficiaries who are homeless or at risk of homelessness, and need additional medical support and care coordination which will also address health-related social needs.
The request for the services in this waiver amendment application is part of Kentucky’s comprehensive plan to expand treatment and community support services across the state’s continuum.