The Department for Medicaid Services (DMS) uses managed care organizations (MCOs) to provide coverage for most Kentucky Medicaid members. DMS oversees the Medicaid program, and the MCOs cover the services each member needs.
Kentucky Medicaid offers five MCO options and members choose which one they want to use. Each MCO has a website and a phone number to help you to learn more.
MCO Information for Members
Choosing an MCO: What to Consider
When deciding which MCO you want to use, you should consider:
- Which MCO has all or most of the doctors my family and I visit?
- Which MCO has the hospitals my family and I like to use?
- Do I or any family member have a health problem that needs to be treated by a specific type of doctor or specialist?
MCO Benefits and Coverage
All MCOs must provide the same standard Medicaid benefits and coverage. MCOs can choose to provide extra services to help members live a healthy lifestyle. These are called "value-added benefits." Kentucky Medicaid offers an MCO Value Added Benefits Guide to help you understand the extra services each MCO offers. The Maternal Health Resources Guide shows you extra services offered to pregnant or postpartum women.
Confirming Your MCO Choice
When you are ready to select your MCO or if you'd like to change from your current MCO to a new MCO, you can do it
online using kynect or by calling (855) 459-6328.
When you sign up with an MCO, you will receive an insurance card as proof of health coverage. You may need to show this card each time you visit a provider or pharmacy, so they know who to bill for your services. Your MCO contact information will be located on the card. Contact your MCO for any questions you have about what your plan covers, value-added services, or other issues you have related to your health coverage.
MCO Grievances or Appeals
If you are having a problem with MCO services, you have the right to file a grievance or an appeal.
- Grievance: You can file a grievance when you don't agree with a decision the MCO made about your coverage, or if you are unhappy with the quality of care or services you received.
- Appeal: Members can ask their MCO to review and possibly change a decision made about their coverage. Providers can ask the MCO to review a claim that was denied.
The MCO you use for health coverage has a process for filing a grievance or an appeal. When you have an issue with your MCO, use the MCO's grievance and/or appeal process first and wait for it to end. If you are still not satisfied with the outcome, you may contact DMS.
MCO Quality Reports
MCOs must provide quality services to Kentucky Medicaid members. Each MCO publishes information on how it collects and measures information about the quality of care and services it provides.
- MCO Quality Improvement Information
Report Fraud, Waste, and Abuse
Kentucky Medicaid members have a responsibility to report any suspect Medicaid fraud, waste, or abuse. To report Medcaid fraud, waste, or abuse contact:
- Cabinet for Health and Family Services
Office of Inspector General
Division of Audits and Investigations
275 E. Main Street, 5E-D
Frankfort, Kentucky 40621
Toll-Free (800) 372-2970
Monday through Friday, 8 a.m. - 4:30 p.m. Eastern