Who We Are
The Department for Medicaid Services (DMS) contracts with managed care organizations (MCOs) to provide coverage for most Kentucky Medicaid recipients. DMS oversees the Medicaid program including the MCOs which process claims and provide disease management, prior authorization and other services for their recipients.
All MCOs must provide the same benefits and cost-sharing. However, some offer special programs, in addition to normal Medicaid benefits. Choosing the MCO plan that best meets your needs is very important.
Important Questions to Consider When Picking an MCO
- Which plan has all or most of the doctors my family and I visit?
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Which plan has the hospitals my family and I like to use?
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Do I or any family member have a health problem that needs treatment by a specific type of doctor or specialist?
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Which MCO offers special programs that may be of interest to me and my family?
Behavioral Health Prior Authoization instructions per MCO:
Aetna:
- Aetna’s plan will be posted on their provider website: Provider Notices & Newsletters | Aetna Medicaid Kentucky
- Training & Support
- To support our providers through this process, ABHKY will host provider training opportunities during Virtual Office Hours (VOH), on the prior authorization process both before and after the June 25, 2025, effective date.
- Virtual Office Hours Schedule:
- June 4, 2025, 10:00 am EST
- June 11, 2025, 10:00 am EST
- June 18, 2025, 10:00 am EST
- June 25, 2025, 10:00 am EST
- July 2, 2025, 10:00 am EST
- July 9, 2025, 10:00 am EST
- July 16, 2025, 10:00 am EST
- July 23, 2025, 10:00 am EST
Humana:
- May 20, 2025, 11:00 am to 12:00 pm EST or 1:00 pm to 2:00 pm
- May 29, 2025, 2:00 pm to 3:00 pm EST
- Please register for your desired session here and watch for your invitation with the Zoom link. If you have questions about this notification, email Provider Relations at KYMCDPR@humana.com.
Passport by Molina:
United Healthcare:
Wellcare:
- Wellcare invites providers to join the bi-weekly provider webinar every Friday at 1:00 pm EST hosted by their Provider Engagement team. These are one hour meetings where they discuss current key topics, such as utilization management, and other topics requested by providers. To receive an invite to the webinar series, please send an email to Johnie Akers (Provider Engagement) at johnie.akers@wellcare.com.
MCO Regional Breadown by County
Region 1: Ballard, Caldwell, Calloway, Carlisle, Crittenden, Fulton, Graves, Hickman, Livingston, Lyon, Marshall, McCracken
Region 2: Christian, Daviess, Hancock, Henderson, Hopkins, McLean, Muhlenberg, Ohio, Todd, Trigg, Union, Webster
Region 3: Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade, Nelson, Shelby, Spencer, Trimble
Region 4: Adair, Allen, Barren, Butler, Casey, Clinton, Cumberland, Edmonson, Green, Hart, Logan, McCreary, Metcalfe, Monroe, Pulaski, Russell, Simpson, Taylor, Warren, Wayne
Region 5: Anderson, Bourbon, Boyle, Clark, Estill, Fayette, Franklin, Garrard, Harrison, Jackson, Jessamine, Lincoln, Madison, Mercer, Montgomery, Nicholas, Owen, Powell, Rockcastle, Scott, Woodford
Region 6: Boone, Campbell, Gallatin, Grant, Kenton, Oldham, Pendleton
Region 7: Bath, Boyd, Bracken, Carter, Elliott, Fleming, Greenup, Lawrence, Lewis, Mason, Menifee, Morgan, Robertson, Rowan
Region 8: Bell, Breathitt, Clay, Floyd, Harlan, Johnson, Knott, Knox, Laurel, Lee, Leslie, Letcher, Magoffin, Martin, Owsley, Perry, Pike, Whitley, Wolfe