A sweeping Republican bill aiming to reform Kentucky’s Medicaid program would impose copays on some patients, among other changes that advocates say would put up barriers to care.
House Bill 2 was approved by the House Appropriations and Revenue Committee Tuesday and can go to the House floor. It would impose new paperwork requirements on nearly 500,000 Kentuckians covered by the Medicaid expansion who would have to regularly demonstrate that they are working or otherwise engaged in the community.
Applications for Medicaid waiver programs would be sorted based on the seriousness of the applicants’ needs. Kentucky runs several Medicaid waiver programs that pay for some vulnerable populations to receive medical and other care in their homes. The waiver programs typically have long waiting lists.
Medicaid is the federal-state program that pays for almost 1 in 3 Kentuckians’ health care.
Primary sponsor Rep. Ken Fleming (R-Louisville) said this bill would put Kentucky in line with the federal requirements outlined in the One Big Beautiful Bill Act and rein in the program that will cost Kentucky roughly $4.5 billion this year. The federal government pays the rest of the $20 billion that Medicaid pays to Kentucky providers each year.
“What we have is a Medicaid budget (that) has nearly doubled, in fact, over doubled, over the past five years to an unsustainable level that we’ve got to do something (about) in terms of addressing the cost of this,” Fleming said.
He wants to do that while also maintaining “integrity” and “the quality of service” for those who need it, he said.
Emily Beauregard, the executive director of Kentucky Voices for Health, told the committee the legislation has some good components, but it “goes further than federal law requires, even as states continue to wait for CMS (the Centers for Medicare & Medicaid Services) to issue guidance through final rules.” Beauregard was one of four people who testified in at least partial opposition to the bill.
“While there’s no question that we must comply with federal law, it’s important to ensure that HB 2 strikes the right balance, to protect our health care safety net, to keep eligible Kentuckians enrolled, and to ensure that copays don’t reduce access to critical care,” Beauregard said.
Fleming said the changes are aimed at containing costs associated with the more than decade-old Medicaid expansion.
The 2014 Medicaid expansion — part of the Affordable Care Act – allowed low-income Kentucky adults who don’t have disabilities but can’t afford or who lack access to private health insurance to enroll in Medicaid. Within a year, the rate of uninsured Kentuckians fell from 14.4% to 6.1%. In 2023, 5.6% of Kentuckians’ were uninsured compared to 8% of the U.S. population.
In 2025, Congress cut Medicaid spending over 10 years by $880 billion as part of the sweeping One Big Beautiful Bill Act.
What’s in the bill?
Among many provisions in the 75-page bill, HB 2 says:
- Expansion members will pay a copay of $35 for inpatient hospital services. Prescription glasses and contacts will have an $8 copay. Copays will not be able to exceed 5% of the family’s monthly or quarterly income.
- New “applicable” Medicaid members need to prove “community engagement” for the month prior to application. Existing members seeking redetermination (renewal) need to show this for three of the six previous months.
- Beginning on July 1, and at least once every five years, the auditor will conduct “a full and comprehensive examination” of Kentucky’s Medicaid program. The audit will include a financial evaluation and will ensure the program is in compliance with all federal and state rules.
- Every six months, individuals will need to go through eligibility redeterminations.
- Starting Jan. 1, Medicaid waivers will be tiered by priority based on an applicant’s risk of hospitalization if they don’t get the waiver services, physical or cognitive impairment, health and safety risks and other factors.
- The Department for Medicaid Services will hire a Medicaid dental director by July 1, 2027. This person will “be responsible for overseeing the administration of Medicaid-covered dental services.”
- And more. Read the current version of the bill here.
Should the copays remain in the bill, Beauregard with Kentucky Voices for Health, asked that lawmakers “consider taking them down to $1 or leaving it to the regulatory process to set the rates.”
“Either of those approaches would comply with federal law,” she said.
The copays are a way to redirect patients from using emergency rooms as defaults and incentivize them to seek out primary care, which does not have copays, Fleming said.
”We’re trying to change the behavior of the individual. So, when somebody goes in, we’re trying to get them to go to the primary care where, under this particular law, there is no cost sharing,” Fleming said. “We’re trying to shift people from the emergency care over into seeing their primary care physician.”
A mother’s grief: ‘Advocacy was not a choice for me.’
One woman, Maggie Chism, told the committee that her daughter died waiting on a heart transplant she needed for hypoplastic left heart syndrome, a rare condition in which half the heart is underdeveloped and cannot pump blood properly, according to the Mayo Clinic.
Chism’s daughter received services through one of the Medicaid waiver programs, she said, and maintaining it was a process belabored by red tape.
“I had to fight every year just to get her waiver renewed,” Chism said. “It was exhausting and time consuming, and the amount of paperwork required was overwhelming, but I did it. I did it because there was no room for inaction.”
When she was 7 years old, Chism’s daughter suffered heart failure and was put on the heart transplant waitlist.
“In September of 2024 while she was fighting to survive, I was notified that she was going to be removed from her Medicaid waiver because she was not, quote, ‘utilizing services,’” Chism said. “Let that sink in. My child was dying, waiting for a heart that never came, and I was told her coverage might be terminated because she was too sick to use it. The very condition that qualified her for care was being used to justify taking it away.”
Her daughter died in November 2024. Chism pleaded with lawmakers to consider her story in Medicaid legislation.
“When we add stricter requirements, more frequent redeterminations and more paperwork, we do not create efficiency,” Chism said. “We create barriers for families already fighting to survive. … We cripple a system already bottlenecked with the policy expectations we place on it. Kentucky families deserve stability. They deserve dignity, and they deserve a system that protects them when they are at their weakest, not one that forces them to fight for the right to survive.”
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Written by Sarah Ladd. Cross-posted from the Kentucky Lantern.
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