{"data":{"id":"us-ky/krs-205.5355","jurisdiction":"us-ky","citation":"KRS 205.5355","heading":"Identification and disenrollment of nonresidents and individuals","body":"concurrently enrolled in multiple states -- Procedures -- Notice -- Penalties.\nFor the purpose of identifying and, when appropriate, disenrolling individuals from the\nKentucky Medi caid program who are concurrently enrolled, or suspected of being\nconcurrently enrolled, in one (1) or more other states' Medicaid programs or are\notherwise ineligible for enrollment in the Kentucky Medicaid program because they no\nlonger reside in Kentucky, to the extent permitted under federal law:\n(1) The cabinet shall:\n(a) On at least a quarterly basis, review the Public Assistance Reporting\nInformation System, or PARIS, match files submitted to the state by the\nfederal Administration for Children and Families;\n(b) Identify individuals enrolled in the Kentucky Medicaid program who may be\nconcurrently enrolled in one (1) or more other states' Medicaid programs;\n(c) Notify any individual suspected of being concurrently enrolled in the\nKentucky Medicaid pro gram and one (1) or more other states' Medicaid\nprograms within thirty (30) days of identification under paragraph (b) of this\nsubsection. Notifications made under this paragraph shall inform individuals:\n1. That they are required to submit proof of curren t residency in the\nCommonwealth within thirty (30) days;\n2. Of the process for submitting proof of current residency to the cabinet\nand the documents required to be submitted to validate current residency\nin the Commonwealth; and\n3. That failure to submit proof of current residency in the Commonwealth\nwithin thirty (30) days shall result in the individual being disenrolled\nfrom the Medicaid managed care organization in which the individual is\nenrolled or assigned;\n(d) For individuals who fail to respond as required under paragraph (c) of this\nsubsection:\n1. Disenroll the individual from the Medicaid managed care organization\nin which the individual is enrolled or assigned and place the individual\nin the Medicaid fee-for-service program; and\n2. Make a second attempt to notify the individual within forty -five (45)\ndays from the date on which the notice required under paragraph (c) of\nthis subsection was made. Notifications made under this subparagraph\nshall inform individuals:\na. That they must submit proof of current residency in the\nCommonwealth within thirty (30) days;\nb. Of the process for submitting proof of current residency to the\ncabinet and the documents required to be submitted to validate\ncurrent residency in the Commonwealth; and\nc. That failure to submit proof of current residency in the\nCommonwealth within thirty (30) days shall result in the\nindividual being disenrolled from the Kentucky Medicaid\nprogram;\n(e) Not make capitation payments to any managed care or ganization with whom\nthe cabinet contracts for the delivery of Medicaid services on behalf of any\nindividual disenrolled from managed care in accordance with paragraphs (c)\nand (d) of this subsection;\n(f) Upon receipt of a notification required under subse ction (2)(b) of this section,\nprovide notice in accordance with paragraphs (c) and (d) of this subsection to\nthe individual identified by the managed care organization and disenroll the\nindividual as required under paragraphs (c) and (d) of this subsection; and\n(g) Establish administrative penalties for any managed care organization that fails\nto comply with the requirements of subsection (2) of this section;\n(2) Each managed care organization with whom the cabinet contracts for the delivery\nof Medicaid services shall:\n(a) On at least a monthly basis, make all reasonable efforts to identify any\nindividual who is:\n1. Enrolled in the Kentucky Medicaid program;\n2. Served by, enrolled with, or assigned to the managed care organization;\nand\n3. Covered by, insured by, or enrolled with the managed care organization,\nthe managed care organization's parent company, or any subsidiary of\nthe managed care organization or its parent company in another state,\nregardless of the type of coverage provided in the other state;\n(b) Promptly notify the cabinet of any individual identified in accordance with\nparagraph (a) of this subsection; and\n(c) On a monthly basis, report to the Department for Medicaid Services efforts\nand activities undertaken to comply with paragraph (a) of this subsection; and\n(3) (a) The cabinet shall impose a penalty of one thousand dollars ($1,000) for each\nviolation of:\n1. Subsection (2)(a) and (c) of this section with each month in which a\nmanaged care organization fails to comply with subsection (2)(a) and (c)\nof this section constituting a separate violation; and\n2. Subsection (2)(b) of this section.\n(b) Penalties collected under this subsection shall be deposited into the Medicaid\nmanaged care organization compliance fund established in KRS 205.5357.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=57026","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:03Z","sha256":"00fb856a379b078ef5dd4553d6a74161426b2c65a681150b5f2870cd7a247322","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.5353","next":"us-ky/krs-205.5356"},"notice":"GroundRules: Original legal text. Not legal advice."}