UnitedHealthcare Community Plan of Kentucky

Medicaid

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.

This plan is available in all counties.

Benefits & Features

Well and Sick Care

Get the assistance you and your family need to stay healthy, to get better if you are injured or sick or — simply achieve your potential. Some member benefits include:

  • Hospitalization. You pay nothing for care in a hospital.
  • Lab and X-rays. Lab tests, x-rays and diagnostic imaging are covered.
  • Therapy Services. Therapy visits to help you recover or achieve your potential.
  • NurseLine℠. Speak with a registered nurse 24/7.
  • Well Visits. Annual checkups and screenings to help keep you and your family healthy.
  • Shots and Vaccines. Routine shots to help protect against illness.
  • No Copays. You pay nothing for doctor visits or prescriptions.
  • Virtual Visits. Connect to a live doctor through a smart phone or computer for non-emergent visits.

Behavioral health care includes mental health (your emotional, psychological, and social well-being) and substance (alcohol and drugs) use disorder treatment and rehabilitation services. All members have access to services to help with mental health issues like depression or anxiety, or to help with alcohol or other substance use disorders.

Talk to your PCP today about any health or behavioral health problems you have. Your PCP will refer you to a behavioral health provider with UnitedHealthcare Community Plan. They can refer you to specialists, and other facilities, such as hospitals and substance abuse and treatment services.

There are some treatments and services that need preapproval before you can get them. To learn more, talk to your doctor.

Search for a Behavioral Health Provider

Required care is 100% covered. If you need behavioral health care, your PCP and UnitedHealthcare Community Plan can help coordinate your care.

We cover:

Behavioral Health Services

  • Services to help figure out if you have a mental health need (diagnostic assessment services)
  • Individual, group and family therapy
  • Mobile crisis management services
  • Facility-based crisis programs
  • Specialized behavioral health services for children with autism
  • Outpatient behavioral health services
  • Outpatient behavioral health emergency room services
  • Inpatient behavioral health services
  • Research-based intensive behavioral health treatment
  • Partial hospitalization
  • Other Supportive Services such as: Peer Supports, Comprehensive Community Supports and Targeted Case Management

Substance Use Disorder Services

  • Outpatient opioid treatment
  • Outpatient withdrawal management
  • Non-hospital medical withdrawal management
  • Alcohol and drug abuse treatment center withdrawal management crisis stabilization
  • Peer Support Services and Targeted Case Management

Additional health resources can be found at [link to liveandworkwell.com/ky] Find the balance, support and care you need to live the healthiest life possible.

If you believe you need access to more intensive behavioral health services that UnitedHealthcare Community Plan of Kentucky does not provide, talk with your PCP or call Member Services  1-866-293-1796.

Member Handbook (English)

Member Handbook (Español)

What if I have a behavioral health crisis?

You are always covered for a behavioral health emergency. An emergency means a behavioral health condition that comes on suddenly, is life threatening, is painful, or other severe symptoms that cannot wait to be treated. You may have a mental health, drug, or alcohol use emergency.

Emergency services are covered anywhere in the United States. If you think you have a life threatening emergency, call 911 or go to the nearest hospital location where emergency providers can help you.

As soon as possible, call us to arrange for follow-up behavioral health care after an emergency.

A mental health crisis is a moment when someone's behavior can put themselves or others in danger, especially if they do not get help, such as:

  • Threatens to or talks about hurting or killing themselves
  • Feels hopeless
  • Feels rage or uncontrolled anger
  • Feels trapped, like there is no way out
  • Engages in reckless behaviors
  • Feels anxious, agitated, or unable to sleep
  • Increases alcohol or drug use
  • Withdraws from friends and family
  • Encounters dramatic mood changes
  • Sees no reason for living

Crisis Services:
If you think you have an emergency, no matter where you are, call 911 or go to the nearest hospital location where emergency providers can help you. As soon as possible, call your doctor or behavioral health provider to arrange for follow-up care after the emergency is over.

If you are experiencing a mental health crisis, call the Behavioral Health Crisis line at 1-866-293-1796 

Here are additional Behavioral Health Services and Crisis Intervention Contacts:

For a State Crisis Lines directory, visit: http://dbhdid.ky.gov/crisisnos.aspx

KY HELP Statewide Call Center: 1-833-859-4357 or text HOPE to 96714
toll-free line providing personalized, compassionate assistance and resources for Kentuckians seeking help for a substance use disorder and offering support to their families

Teen Link: 1-866-833-6546
Online: http://www.866teenlink.org

Suicide Prevention: 1-800-273-8255
TTY Users: 1-800-799-4TTY (4889)
Online: http://www.suicidepreventionlifeline.org

Additional health resources can be found here. Find the balance, support and care you need to live the healthiest life possible.

Member Handbook (English) 

Member Handbook (Español) 

Nothing is more important than the health and well-being of you and your baby. That's why our plan benefits include:
  • Choice of Birth Center. Pick from a large network of hospitals across Kentucky.
  • Choice of Doctor. Find a doctor or OB/GYN you trust in our network.
  • Healthy First Steps®. Extra support to help you and your baby stay healthy with additional reward opportunities.
  • Prenatal Visits. Care for you before your baby is born.
  • Care Management Services. For high-risk pregnancies during pregnancy and for two months after delivery.

 

If you have asthma, diabetes or another health condition, you can depend on us. Our plan makes sure you get the care and services you need. Benefits include:

  • Asthma and COPD Care. Exams, testing and supplies are covered.
  • Diabetes Support. Medicine, needles and more for managing diabetes. 14 home-delivered meals post discharge from the hospital for diabetic or prediabetic members.
  • Kidney Disease Care. Dialysis, medicine and treatments are covered.
  • Mental Health. Testing, medication and treatments are covered.
  • Personal Care Services. If you qualify, get personal help with activities of daily living for individuals with disabilities and ongoing health conditions.
  • Remote patient monitoring. Customized solution using integrated monitoring devices to quickly and easily track biometrics, interventions and custom self-trending reporting.

Make sure your sight and hearing are at their best. Benefits include:

  • Hearing. Benefits for members under 21 years; exams and testing with referral by physician to audiologist; benefits shall not exceed the members benefit of $800.00 per ear every 36 months.
  • Vision. Annual vision exam for all members. Lenses, frames and repairs are covered for those under 21 years and pregnant women.
  • For adults, one cleaning per 12 month period
  • For children under 21, one cleaning per 6 month period
  • Extractions
  • One set of standard x-rays every 12 months
  • Children under age 21 receive additional benefits: fluoride treatments, sealants, fillings
  • Dental emergency for adults/children

Get the medical care and equipment you or a family member needs to recover or live at home. For qualifying individuals with disabilities and ongoing health conditions, benefits include:

  • Personal Care. Someone to help with dressing, bathing and dining.
  • Equipment and Supplies. In-home medical and safety equipment is covered.
  • Home Health Care. Medical and personal care at home, if needed.

Managing your health care alone can be hard, especially if you are dealing with many health problems at the same time. If you need extra support to get and stay healthy, we can help. You may have a Care Manager on your health care team. A Care Manager is a specially trained health care worker who works with you and your doctors to make sure you get the right care when and where you need it.

Your Care Manager can:

  • Coordinate your appointments and help arrange for transportation to and from your doctor
  • Support you in reaching your goals to better manage your ongoing health conditions
  • Answer questions about what your medicines do and how to take them
  • Follow up with your doctors or specialists about your care
  • Connect you to helpful resources in your community
  • Help you continue to receive the care you need if you switch health plans or doctors

UnitedHealthcare Community Plan of Kentucky can also connect to you to a Care Manager who has special training in supporting:

  • People who need access to services like nursing home care or personal care services to help manage daily activities of living (like eating or bathing) and household tasks
  • Pregnant women with certain health issues (like diabetes) or other concerns (like wanting help to quit smoking)
  • Children from birth to age 5 who may live in stressful situations or have certain health conditions or disabilities

At times, a member of your Primary Care Provider’s (PCP’s) team will be your Care Manager. To learn more about our how you get can extra support to manage your health, talk to your PCP or call Member Services.

View Advance Directives in English | Spanish

Get extra benefits and support. You can rely on:

  • Healthy Rewards. Earn rewards for completing important preventive services.
  • Health Education. Free coaching to help improve your health.
  • Language Help. Connect to a translator through Member Services.
  • Programs for Kids and Teens. Free Boys & Girls Club memberships.
  • Quitting Tobacco. Coaches and supplies to help you quit using tobacco.
  • Acupuncture. Receive 30 acupuncture visits per year.

Contact Member Services to learn about extra benefits.

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.

Dental

  • For adults, one cleaning per 12 month period
  • For children under 21, one cleaning per 6 month period
  • Extractions
  • One set of standard x-rays every 12 months
  • Children under age 21 receive additional benefits: fluoride treatments, sealants, fillings
  • Dental emergency for adults/children

Diabetes Support

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.

Foot Care

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 

Hospitalization

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.

Interpreters

Your doctor and you need to understand each other. Not speaking English well makes 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 170 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:

  • Dialysis.
  • Medications.
  • 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.

Language Help

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 170 languages.

Medicines

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.

Member Services

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.

Additional Resources:

Teens can connect with teens during specific hours: 1-866-833-6546, teenlink@crisisclinic.org, www.866teenlink.org.

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.

NurseLine℠

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: 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.

Nurse Visits

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 will make home visits to:

  • Provide medical care.
  • Answer any questions and concerns.

Personal Care

Sometimes the basics are hard to do yourself after an illness or injury.

If needed and ordered by a doctor, we provide someone to help with:

  • Dressing.
  • Bathing.
  • Feeding.

Personal Care Manager

Do you or a family member have a serious health problem? If your health needs qualify then our care managers are in your corner. They will:

  • Help manage your physical and mental health care needs.
  • Work with your physician, behavioral health specialists and outside agencies.
  • Coordinate your doctor appointments.
  • Provide your care team with your medical records.

Your care manager will stay with you throughout the medical journey. He or she will:

  • Make sure you have support at home.
  • Connect you to the social services you may need.

Prenatal Visits

Your pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN. With our plan, you also will be rewarded with gift cards for prenatal and postpartum doctor visits.

All recommended prenatal clinical visits and tests are covered by our plan.

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 your questions.

Programs for Kids and Teens

Kids with positive role models make more healthy choices. That's why we provide free memberships to the Boys & Girls Clubs in your area.

Along with fun and games, these clubs offer help with:

  • Homework.
  • Mentoring.
  • Coaching.

Quitting Tobacco

You know the bad health effects of smoking. You know you need to quit. We support you while you quit with coaches and supplies. The only thing you won't get from us is a lecture. Call 1-866-QUIT-4-LIFE (1-866-784-8454) Or visit www.quitnow.net.

Residential Care

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.

Therapy Services

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.

Transportation

Transportation services:

  • 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 https://transportation.ky.gov/TransportationDelivery/Pages/Human-Services-Transportation.Aspx   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).

Vision Care

You'll get the care and treatment that let you see life more clearly. Coverage includes:

  • Annual vision exam for adults and children.
  • Lenses, frames and repairs are covered for those under 21 years and pregnant women.

Well Visits

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.
  • Mammograms.

There are no copayments for preventive care.

Member Resources

View Available Resources

Learn More

Kentucky Medicaid Plan