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Medicaid PE KY Resident Application

During the COVID-19 State of Emergency, individuals under the age of 65 who do not have medical insurance that pays for doctors, pharmacy, and hospital visits should complete this application to request Presumptive Eligibility under the Kentucky Medicaid program. By completing this application, you are attesting to the fact that you do not have medical insurance that covers doctors, pharmacy or hospital visits.


Presumptive Eligibility coverage is temporary. To maintain Medicaid benefits, individuals are encouraged to complete a full Medicaid application before their Presumptive Eligibility coverage ends. To complete a full Medicaid application, apply online at Kynect.ky.gov, call 1-855-306-8959 or contact a local kynector for application assistance (search online for a kynector at kynect.ky.gov).


Effective 1/1/21, all Presumptive Eligibility Medicaid members will be enrolled in Managed Care and assigned to UnitedHealthcare Community Plan of Kentucky (UHC). These members will receive a UHC member ID card and handbook. If members have questions about their UHC healthcare coverage, they can call UHC Member Services at 1-866- 293-1796 or visit www.myuhc.com. UHC call center is staffed M-F 7am-7pm ET. The first weekend in January they will have extended hours on Saturday 1/2 from 8am-4:30pm ET and Sunday 1/3 from 9am-4pm ET.

Personal Information

Complete the following personal information data fields. All fields are required.


Today's Date:
*
Last Name:
*
First Name:
*
Date of Birth:
*
Gender
*
Race (Choose All That Apply):





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Do you have a Social Security Number?
*

If you selected ‘Yes’ to having a Social Security Number, you will need to enter your Social Security Number in the field below.

Social Security Number:
Marital Status:
*
Telephone Number (Include Area Code):
*
Email Address:
*
Street Address:
*
 
City:
*
Zip Code:
*
Household Information

The following household information will help us know if others within your household are in need of Medicaid services.


Number of people in your family (count unborn if anyone is pregnant):
*

For each member of your family, include: Family Member Name, Income Amount and How Often:
*

Total family income (income should be counted before taxes are taken out):
*
Other Information

Preferred Method of Notifications:
*

By signing and submitting, I am requesting Medicaid coverage:
*
Next Steps

Once your application has been processed, you will receive notice based on your contact preference with your Medicaid ID. Your Presumptive Eligibility Medicaid is temporary unless you submit an application for regular Medicaid.


An application must be submitted for each individual needing Medicaid coverage.

 
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