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UnitedHealthcare Community Plan of Kentucky
Our plan offers a range of physical and behavioral health benefits. View the benefits below to see all that it offers. It's for people who meet income requirements and are eligible for Kentucky Medicaid. We serve pregnant women, children and young adults to age 21, families and adults.
Kentucky Medicaid Plan Eligibility
Get the health care you deserve.
Kentucky’s managed care Medicaid program provides comprehensive medical benefits to adults, families, people with disabilities, children and pregnant women who meet income requirements.
Anyone between ages 19 to 64 who meets income standards, is eligible. There are no pre-existing condition restrictions.
For more information on Kentucky Medicaid, please visit the Department for Medicaid Services website
We can also assist with interpreter services, including American Sign Language. To ask for help, please call 1-866-293-1796, TTY 711, Monday through Friday, 7:00 a.m. to 7:00 p.m. EST.
- Visit UnitedHealthcare's Coronavirus (COVID-19) Coverage and Resource Center | UnitedHealthcare Community Plan: Medicare & Medicaid Health Plans
- Find where to get vaccinated at vaccine.ky.gov
- The KY COVID-19 Hotline 1-800-722-5725 can answer general vaccine questions
- As a UHC-KY Member, when you get vaccinated against COVID-19 between July 1, 2021 and December 31, 2022 you can earn a $100 gift card
- As a UHC-KY Member, when you get vaccinated against COVID-19 between August 1, 2021 and June 30, 2022, you can receive 14 free home delivered meals. Call Member Services 1-866-293-1796, TTY 711, 7am-7pm EST Monday-Friday for additional information.
Find providers and coverage for this plan.
Search for doctors, hospitals, behavioral health and other specialists.
Find medications covered by this plan.
Find a pharmacy near you.
Search for a vision center.
Find a dentist near you.
Benefits & Features
Asthma and COPD Support
Individual care to help control your asthma or COPD.
You may qualify for care management services if you have asthma or COPD. Including respiratory equipment and supplies.
Choice of Doctor
You will have a primary care physician (PCP) who will be your main doctor. Your PCP is the person you should see for most of your care. This includes checkups, treatments, vaccinations, minor injuries and health concerns. Talk to your PCP about any behavioral health concerns you may have. Your PCP can help you decide the right options for you.
Your PCP is your main doctor for:
- Preventive care.
- Treatment if you are sick or injured.
- Referrals to specialists for certain conditions.
Use the Doctor Lookup tool to see if your doctor is in our network. If you don’t have a doctor or if your doctor is not in our network, we can help you find a new one close to you.
Choose a Birth Center
Where you have your baby is an important choice. That's why you can pick from a large network of hospitals across Kentucky.
We also encourage you to tour the hospital's birthing center. This way you will be familiar with it. And you'll be more relaxed when you have your baby.
If you have diabetes, we'll help make life a little easier for you. You'll get medicine, supplies and education to help you reach and stay your best. You are also rewarded with gift cards for taking simple steps to manage your diabetes.
If you experience a hospital stay and have diabetes or pre-diabetes, you are eligible to receive 14 home delivery meals post discharge.
Our diabetes program also includes self-care training and classes focused on:
- Planning healthy meals.
- Managing stress.
- Living a healthy lifestyle.
Equipment and Medical Supplies
Your health and safety at home are important.
Our plan covers medical equipment ordered by your doctor. This can include supplies like:
- Hospital beds.
- Oxygen tanks.
- Wheelchairs or walkers.
If you have diabetes or a circulatory condition, good foot care can help prevent much more serious problems. We provide the needed exams to help keep your feet in great shape.
Our podiatry coverage includes routine foot exams for certain conditions.
Healthy First Steps®
When you're pregnant, you receive help and advice from your mom, aunts, sisters and girlfriends. Yet every pregnancy is different. This program will support you through your pregnancy. Get pregnancy and parenting support by calling (toll-free) 1-800-599-5985 (TTY 711).
We can help you:
- Find a doctor for both mother and baby.
- Learn about nutrition, fitness and safety.
- Find out what extra rewards you could be eligible for.
Home Health Care
After surgery or a serious illness—or if you have a disability—you may need extra help with day-to-day tasks. With approval, and ordered by your doctor, our plan covers:
- Time-limited skilled nursing services
- Specialized therapies, including physical therapy, speech-language pathology and occupational therapy
- Home health aide services (help with activities such as bathing, dressing, preparing meals and housekeeping)
- Medical supplies
This plan pays for all expenses related to a hospital stay, so you can rest and heal.
Our plan covers:
- Inpatient care
- Outpatient care
- Labs, X-rays and other tests
And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.
Your doctor and you need to understand each other. Not speaking the same language could make this difficult. We can arrange for a medical interpreter to be at your appointments.
We also have people in member services who speak more than one language. Chances are, we have someone who speaks your language or they can connect you with our interpreter service which covers more than 200 languages.
Kidney Disease Care
Kidney disease is a serious medical condition. After the kidneys stop working, regular treatments, called renal dialysis or an organ transplant are needed to live. Dialysis uses a machine to clean the blood just like healthy kidneys do.
Our plan includes:
- Health education and support.
- Organ transplant if needed.
Lab & X-rays
Knowing what's wrong and finding it early can make all the difference. Our plan covers:
- Labs and testing.
- X-rays, scans and other imaging.
We'll help you get the information needed to improve your health or be at your best.
You can receive information in your preferred language. Just ask. We also have people at our customer service centers who speak more than one language. Chances are, we have someone who speaks your language or they can connect you with our interpreter service which covers more than 200 languages.
Our plan includes prescription drugs and refills with no copays. We also cover over-the-counter medicines with a written order from your doctor.
And we make getting your medicine easy. You can fill your prescriptions at:
- Local pharmacies.
- Services that deliver routinely right to your door.
Sometimes you might need a little help understanding your health care options. With us, you have someone you can call. We’ll answer your questions simply and completely.
We can also help you find:
- Home care providers.
- Dentists and vision providers.
- Help finding housing, transportation and other community services.
Mental Health Services for Children and Youth
Problems such as depression and anxiety can also be challenging for children and teens.
There are no costs for covered services. We have therapists and doctors for youth and teens that can address their specific behavioral health or substance use. Help get them extra support to live a heathier life.
Dailystrength.org is an online support resource that provides over 500 support communities for people facing similar life challenges, medical conditions and mental health issues.
No Cost for Covered Services
Get the quality health care you deserve at no cost for covered services. You get:
- Care from highly skilled and compassionate doctors.
- Treatments at respected hospitals and clinics.
- Home medical equipment and supplies to help you be at your best.
Medical questions and situations sometimes happen at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week, 365 days a year: 1-800-985-3856 (TTY 711).
Our nurses will:
- Listen to symptoms.
- Help with self-care.
- Advise you about getting care at a doctor visit or an urgent care center.
- Help you know when to go to the emergency room.
Sometimes continued care is needed after leaving the hospital or urgent care. For example, after a serious illness, surgery or injury. In these cases, a nurse may make home visits to:
- Provide medical care.
- Answer any questions and concerns.
Your pregnancy is a walk you’ll want to make with the help of your friends, family and a pregnancy doctor, called an Ob-Gyn. With our plan, you also can receive gift cards for seeing your pregnancy doctor before and after having your baby.
All the visits at the pregnancy doctor’s clinic are covered, no cost to you. Seeing your doctor at all the visits before and after will help keep you and your baby as healthy as possible.
At these visits, the clinic will:
- Make sure both you and your baby are healthy.
- Explain what to expect at each stage of your pregnancy.
- Answer all of your questions.
We at UHC are excited for you and wish you the best for you and your family.
Programs for Kids and Teens
Kids with positive role models make more healthy choices. That's why we provide free memberships to participating Boys & Girls Clubs in your area.
Along with fun and games, these clubs offer help with:
The Kentucky Tobacco Quit line gives you one-on-one help to quit smoking. If you're ready to make a change, call 1-800-QUIT-NOW (1-800-784-8669) to join. Or visit www.quitnowkentucky.org for more information about:
- Deciding if you're ready to quit
- Planning to quit
- Staying on track after you quit
After a serious illness, surgery or injury you may need extra nursing and therapy. If needed, our plan covers short stays in a rehabilitation center where you can heal. Included are:
- Nursing home services.
- Help with activities of daily living.
- Physical, occupational and speech therapy.
Shots and Vaccines
Routine shots help protect you from illness.
Our plan covers:
- Recommended shots and vaccines.
- Influenza shots.
- COVID vaccine
Physical, occupational and speech therapy can help you recover from a serious injury or illness, or simply reach your full potential.
Our plan provides:
- Occupational therapy.
- Physical therapy.
- Speech therapy.
- In-home therapy.
- Emergency: If you need emergency transportation (an ambulance), call 911.
- Non-emergency: Non-emergency medical transportation is available if you can’t get a free ride to a covered service.
How to get non-emergency transportation
Kentucky Medicaid will pay to take some members to get medical services covered by Kentucky Medicaid. If you need a ride, you must talk to the transportation broker in your county to schedule a trip.
Each county in Kentucky has a transportation broker. You can only use the transportation broker for a ride if you can’t use your own car or don’t have one. If you can’t use your car, you have to get a note for the transportation broker that explains why you can’t use your car. If you need a ride from a transportation broker and you or someone in your household has a car, you can:
- Get a doctor’s note that says you can’t drive.
- Get a note from your mechanic if your car doesn’t run.
- Get a note from the boss or school official if your car is needed for someone else’s work or school.
- Get a copy of the registration if your car is junked.
- Kentucky Medicaid doesn’t cover rides to pick up prescriptions.
For a list of transportation brokers and their contact information, please visit the website www.chfs.ky.gov/dms/ or call Kentucky Medicaid at 1-800-635-2570. For more information about transportation services, call the Kentucky Transportation Cabinet at 1-888-941-7433.
The hours of operation are 8:00 a.m. to 4:30 p.m. ET, Monday through Friday; and 8:00 a.m. to 1:00 p.m. ET, Saturday. If you need a ride, you have to call 72 hours before the time that you need the ride. If you have to cancel an appointment, call your broker as soon as possible to cancel the ride.
You should always try to go to a medical facility that is close to you. If you need medical care from someone outside your service area, you have to get a note from your PCP. The note has to say why it is important for you to travel outside your area. (Your area is your county and the counties next to it).
Well visits with your doctor can help you stay healthy. These visits can catch health problems early, so they can be treated. Preventive services include:
- Checkups for children.
- Screenings for adults.
- Well-baby care.
- Care for women expecting a baby.
- Routine shots and tests.
There are no copayments for preventive care.
Wellhop for Mom & Baby
Connect with other expectant moms. Get support and information during your pregnancy and after you deliver. This program is part of your health plan and there is no extra cost to you.
Here’s how it works:
- Join video conversations every other week with women who have similar due dates and a group leader.
- Chat and share experiences with moms from your group on the Wellhop app or website.
- Visit the Wellhop library. You’ll find articles, videos and more.
Information about Renewing Your Coverage
Have you received information asking you to take action so that you can keep getting benefits?
Your Medicaid coverage needs to be renewed every 12 months. Don't let your health care coverage end. It's too important.
You can renew by going online to kynect, contacting a local kynector or through Department for Community Based Services (DCBS).
Or call: 1-855-306-8959
Clinical Practice Guidelines
UnitedHealthcare Community Plan has practice guidelines that help providers make healthcare decisions. These guidelines come from nationally recognized sources. UnitedHealthcare Community Plan has practice guidelines for conditions including:
- Attention deficit hyperactivity disorder (ADHD)
- Bipolar disorder
- Chronic obstructive pulmonary disease (COPD)
- Heart disease
- Heart failure
- High blood pressure
- Prenatal care
- Pediatric preventive healthcare
- Substance abuse disorders
Your Rights and Responsibilities
You have certain rights and responsibilities when you enroll. It is important that you fully understand both your rights and your responsibilities. For detailed information about your rights and responsibilities download here.
Filing a Grievance
If you are not happy with the service UnitedHealthcare Community Plan has provided, you can file a grievance. Download our Grievance and Appeals Process.
Medical Prior Authorization
We require prior authorization on all out-of-network referrals. The request is generally processed like any other authorization request. The nurse reviews the request for medical necessity and/or service. If the case does not meet criteria, the nurse routes the case to the Medical Director for review and determination. Out-of-network referrals are generally approved for, but not limited, to the following circumstances:
- Continuity of care issues
- Necessary services are not available within network.
Out-of-network referrals are monitored on an individual basis. Trends related to individual physicians or geographical locations are reported to Network Management for review.
To find out if a prior authorization request has been approved, check with your provider or call member services, at 1-866-293-1796 (TTY: 711). If the prior authorization request is denied, you will be notified in writing, including your right to appeal this decision.
UnitedHealthcare Community Plan provides member materials to you in a language or format that makes it easier for you to understand. Our provider network includes many doctors who are multilingual. Our provider directory shows which languages doctors speak. Additionally, many of our Member Services representatives speak multiple languages, so when you call they will be able to help you or connect you with our interpreter service which covers more than 170 languages.
If you have trouble hearing over the phone you can use a text telephone. This free service allows persons with hearing or speech disabilities to place and receive telephone calls. Call 711, give them the Member Services number 1-866-293-1796, and they will connect you to us.
You can also get information in large print, Braille or audio tapes. We can also assist with interpreter services, including American Sign Language. To ask for help, please call 1-866-293-1796 , TTY 711, Monday through Friday, 7:00 a.m. to 7:00 p.m. EST
Our toll-free Member Services number is 1-866-293-1796 (TTY: 711).
Forms and Notifications
Authorized Representative Form
Download the Authorized Representative Form. This form lets a UnitedHealthcare Community Plan member choose someone to help or act on their behalf. Authorized Representative form should be completed and must be mailed to: UnitedHealthcare Community & State Medicaid PO Box 30753, Salt Lake City, UT 84130
Quality and Member Access Committee (QMAC)
The UnitedHealthcare Quality and Member Access Committee (QMAC) provides members, community agencies, and providers with an opportunity to learn more about the services available, provide input on programs offer and feedback on ways to increase quality and satisfaction to our plan membership.
Quality and Member Access Committee (QMAC) meetings are held statewide with a virtual option four times a year.
Members can receive a $50 stipend for attending each QMAC meeting.
If you are a UnitedHealthcare Community Plan member and would like to participate, please contact Member Services at 1-866-293-1796, TTY: 711.
|UHC Community Resources|
|Community Action Council||http://www.commaction.org/|
|Division of Family Resource & Youth Service Centers|
|Homeless and Housing Coalition of Kentucky|
|Kentucky Department of Education|
|KY Department of Public Health|
KY Quit Line to help stop smoking
Kentucky Youth Advocates - Kentucky's Independent Voice for Kids
Supplemental Nutrition Assistance Program (SNAP)
For additional community resources, please contact Member Services
Kentucky Medicaid Plan
This link is being made available so that you may obtain information from a third-party website. This link is provided solely as a convenience and is not an endorsement of the content of the third-party website or any products or services offered on that website. We are not responsible for the products or services offered or the content on any linked website or any link contained in a linked website. We do not make any representations regarding the quality of products or services offered, or the content or accuracy of the materials on such websites.