{"data":{"id":"us-ky/krs-205.6485","jurisdiction":"us-ky","citation":"KRS 205.6485","heading":"State child health plan -- Eligibility criteria -- Schedule of benefits --","body":"Premium contributions -- Access.                        (Effective until January 1,\n2027)\n(1) As used in this section, \"KCHIP\" means the Kentucky Children's Health Insura nce\nProgram.\n(2) The Cabinet for Health and Family Services shall:\n(a) Prepare a state child health plan, known as KCHIP, meeting the requirements\nof Title XXI of the Federal Social Security Act, for submission to the\nSecretary of the United States Departm ent of Health and Human Services\nwithin such time as will permit the state to receive the maximum amounts of\nfederal matching funds available under Title XXI; and\n(b) By administrative regulation promulgated in accordance with KRS Chapter\n13A, establish the following:\n1. The eligibility criteria for children covered by KCHIP, which shall\ninclude a provision that no person eligible for services under Title XIX\nof the Social Security Act, 42 U.S.C. secs. 1396 to 1396v, as amended,\nshall be eligible for servic es under KCHIP, except to the extent that\nTitle XIX coverage is expanded by KRS 205.6481 to 205.6495 and KRS\n304.17A-340;\n2. The schedule of benefits to be covered by KCHIP, which shall:\na. Be at least equivalent to one (1) of the following:\ni. The standar d Blue Cross/Blue Shield preferred provider\noption under the Federal Employees Health Benefit Plan\nestablished by 5 U.S.C. sec. 8903(1);\nii. A mid-range health benefit coverage plan that is offered and\ngenerally available to state employees; or\niii. Health insurance coverage offered by a health maintenance\norganization that has the largest insured commercial, non -\nMedicaid enrollment of covered lives in the state; and\nb. Comply with subsection (6) of this section;\n3. The premium contribution per family for health insurance coverage\navailable under KCHIP, which shall be based:\na. On a six (6) month period; and\nb. Upon a sliding scale relating to family income not to exceed:\ni. Ten dollars ($10), to be paid by a family with income\nbetween one hundred percent (100%) to one hundred thirty -\nthree percent (133%) of the federal poverty level;\nii. Twenty dollars ($20), to be paid by a family with income\nbetween one hundred thirty -four percent (134%) to one\nhundred forty -nine percent (149%) of the federal poverty\nlevel; and\niii. One hundred twenty dollars ($120), to be paid by a family\nwith income between one hundred fifty percent (150%) to\ntwo hundred percent (200%) of the federal poverty level, and\nwhich may be made on a partial payment plan of twenty\ndollars ($20) per month or sixty dollars ($60) per quarter;\n4. There shall be no copayments for services provided under KCHIP; and\n5. a. The criteria for heal th services providers and insurers wishing to\ncontract with the Commonwealth to provide coverage under\nKCHIP.\nb. The cabinet shall provide, in any contracting process for coverage\nof preventive services, the opportunity for a public health\ndepartment to bid on preventive health services to eligible children\nwithin the public health department's service area. A public health\ndepartment shall not be disqualified from bidding because the\ndepartment does not currently offer all the services required by\nthis sec tion. The criteria shall be set forth in administrative\nregulations under KRS Chapter 13A and shall maximize\ncompetition among the providers and insurers. The Finance and\nAdministration Cabinet shall provide oversight over contracting\npolicies and procedures to assure that the number of applicants for\ncontracts is maximized.\n(3) Within twelve (12) months of federal approval of the state's Title XXI child health\nplan, the Cabinet for Health and Family Services shall assure that a KCHIP\nprogram is available t o all eligible children in all regions of the state. If necessary,\nin order to meet this assurance, the cabinet shall institute its own program.\n(4) KCHIP recipients shall have direct access without a referral from any gatekeeper\nprimary care provider to d entists for covered primary dental services and to\noptometrists and ophthalmologists for covered primary eye and vision services.\n(5) KCHIP shall comply with:\n(a) KRS 304.12-237; and\n(b) KRS 304.17A-163 and  304.17A-1631.\n(6) The schedule of benefits requi red under subsection (2)(b)2. of this section shall\ninclude:\n(a) Preventive services;\n(b) Vision services, including glasses;\n(c) Dental services, including sealants, extractions, and fillings; and\n(d) The coverage required under KRS 304.17A-129 and 304.17A-145.\nEffective: July 15, 2026","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=57590","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:04Z","sha256":"1a583f7787b4266a81ee46e927a835a3105fa103c3c2d0a84923a816e943368e","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.6483","next":"us-ky/krs-205.6487"},"notice":"GroundRules: Original legal text. Not legal advice."}