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State says providers have ‘misinterpreted’ guidelines for Medicaid for pregnant women, children

Staff report

The Kentucky Cabinet for Health and Family Services said pregnant women and children are eligible to receive all Medicaid services, including dental and vision, and have issued updated information and guidance to providers.

“We’ve received reports that some providers have misinterpreted earlier training and guidance, and we regret any confusion that caused Kentuckians on Medicaid to not receive the care for which they are eligible,” said CHFS Deputy Secretary Kristi Putnam.

The confusion came after last week’s federal court ruling that blocked the “community engagement” requirement for expanded Medicaid recipients as part of a waiver granted by the Trump administration that became the foundation of the Kentucky HEALTH program.

The ruling said the government did not adequately consider if work requirements and other changes would help give Kentuckians access to health care. Because of that, U.S. District Judge James E. Boasberg called the waiver “arbitrary and capricious.” 

“The Department for Medicaid Services has not changed any policies relating to the eligibility of pregnant women and children and they should continue to receive all services, including vision and dental,” Putnam said.

Putnam said that the Medicaid department has contacted various providers around the state and those offices have reported vision and dental eligibility are being correctly applied for pregnant women and children.

The Kentucky Oral Health Coalition says that they have heard from multiple KOHC dental providers across the state that the state’s changes to the dental program have resulted in the denial of routine dental care to eligible children and pregnant women.

“Due to a shortage of dentists who accept Medicaid in Kentucky, particularly in rural areas, we know that some families travel several hours just to get to a dental appointment,” KOHC writes in a statement, adding that summer vacation is typically a prime time for caregivers to schedule these visits. “This timing adds to the urgency. We cannot allow families to show up only to be turned away and miss their opportunity to access the dental care they need to stay healthy.”

Putnam pointed out that dozens of provider trainings were conducted throughout Kentucky, which included training on how to read the new screens starting July 1. There have been minor changes to language and how information was displayed since those trainings in response to the court ruling. CHFS says they have taken feedback from providers on how to better display the information and make it easier to understand.

“We have identified examples where providers have misinterpreted computer screen eligibility information and turned away some patients despite them having active coverage,” Putnam said. “To eliminate further confusion, we have created several documents aimed at educating Medicaid recipients about their benefits and outlining the beneficiaries who have routine vision and dental coverage. We are continuing to work with providers and MCOs to clarify benefits.”

For more information on the Medicaid changes, go to KentuckyHEALTH.ky.gov.

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