Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official Medicaid.gov and state agency guidelines | Last Updated: March 2026
The Kentucky Medicaid fee schedule for 2026 sets the rates providers get paid for services.
As of March 2026, Kentucky has not released one single master fee schedule. Instead, rates come from new laws, federal updates, and managed care plans.
This guide covers everything you need to know. You will find copay changes, lab fees, equipment rates, managed care updates, and long-term care limits for 2026.
Quick Summary
- No single 2026 master fee schedule has been published by Kentucky DMS yet
- House Bill 2 (HB 2) introduces new copays up to $35 for hospital stays
- Clinical lab test rates stay the same — no cuts until 2027
- DME rates follow the 2026 federal fee schedule for Jurisdiction C
- MCO reimbursement policies vary by plan — check your specific MCO portal
- Long-term care income limit is $2,982 per month for individuals
- Use the Medicaid fee schedule 2026 page for a broader national overview
What Is the Kentucky Medicaid Fee Schedule?
The Kentucky Medicaid fee schedule is a list of payment rates. It tells providers how much Medicaid pays for each medical service.
Each service has a CPT code and a dollar amount tied to it.
Who Uses the Fee Schedule?
Doctors, hospitals, labs, and clinics use it. It helps them know what Medicaid will pay. Billing staff also use it to submit correct claims.
How Kentucky Sets Its Rates
Kentucky uses a mix of federal and state rules. The Department for Medicaid Services (DMS) sets base rates. Managed Care Organizations (MCOs) then set their own rates. These MCO rates must meet or exceed the state’s floor.
If you want to check whether you or a family member qualifies for coverage in the state, visit our guide on Kentucky Medicaid eligibility in 2026.
2026 Legislative Changes Affecting Reimbursement (HB 2)
Kentucky lawmakers passed a major bill that changes how Medicaid works in 2026. House Bill 2 (HB 2) passed the Kentucky House on February 27, 2026. It is now with the Senate.
New Copay Rules Under HB 2
HB 2 adds copays for Medicaid recipients. The maximum copay is $35 for some inpatient hospital services. This means patients now share part of the cost. Before this bill, most Medicaid patients paid nothing out of pocket.
Work Requirements
The bill also adds work requirements. Certain able-bodied adults must meet work or activity rules. This may change how many people stay enrolled. Fewer enrollees could mean fewer claims for providers.
Current Status of HB 2
As of March 2026, HB 2 has passed the House. It has been received in the Senate. Providers should watch for final passage and rule changes.
Clinical Laboratory Fee Schedule (CLFS) for 2026
Kentucky Medicaid often follows federal lab fee updates. Good news for labs — there are no payment cuts this year. Here is what the 2026 federal baseline looks like for clinical labs.
No Payment Reductions in 2026
There is no phase-in reduction for clinical diagnostic laboratory tests (CDLTs) in 2026. Labs will not see lower rates this year. However, cuts of up to 15% are set to begin in 2027.
New Data Reporting Period
A new reporting period for labs starts May 1, 2026. It runs through July 31, 2026. Labs must report their private payer rates during this window. This data helps CMS set future payment rates.
Durable Medical Equipment (DME) Fee Schedule 2026
DME covers items like wheelchairs, oxygen tanks, and prosthetics. Kentucky’s DME rates follow the federal Medicare fee schedule.
The CGS Medicare Jurisdiction C schedule sets the ceiling for these rates.
What the 2026 DME Schedule Covers
The 2026 Quarter 1 fee schedule is now active. It covers items like mobility aids, breathing equipment, and orthotics. Providers can find the full list on the CGS Medicare site.
How Providers Access DME Rates
DME suppliers should check the CGS Jurisdiction C portal. That portal has the most current rates. Kentucky Medicaid will not pay more than these federal ceiling amounts.
Managed Care Organization (MCO) Policy Updates for 2026
Most Kentucky Medicaid claims go through MCOs. Each MCO has its own reimbursement rules.
These rules can differ slightly from the state’s base rates. Providers must check with their specific MCO.
UnitedHealthcare Community Plan of KY Updates
UnitedHealthcare has updated several policies for 2026:
- CCI Editing Policy — updated March 8, 2026
- Discarded Drugs Policy — updated February 25, 2026
- Drug Testing Policy — updated February 20, 2026
Other MCOs to Check
Kentucky Medicaid works with several MCOs. These include Aetna, Anthem, Humana, Passport/Molina, United, and WellCare. Each one has its own provider portal. Log in to your MCO’s portal to see your specific rates.
Why MCO Rates Vary
MCOs negotiate their own rates with providers. They must meet the state’s minimum. But some pay more for certain services. Always verify your rate with your MCO before billing.
2026 Income and Asset Limits for Long-Term Care
These limits decide who qualifies for Medicaid long-term care. They affect nursing homes, assisted living, and home-based care. If a patient meets these limits, their care is billable under Medicaid.
Monthly Income Limit
The 2026 monthly income limit is $2,982 per individual. If your income is below this amount, you may qualify for long-term care coverage.
Asset Limits
The asset limit is $2,000 for a single person. For a married couple where both apply, the limit is $4,000. Assets include bank accounts, stocks, and other countable resources.
For a full breakdown of who qualifies based on income, check the Kentucky Medicaid income limits in 2026 page. You can also compare rates across all states on our Medicaid income limits by state in 2026 guide.
How Providers Can Access the Full Fee Schedule
Kentucky has not released a public 2026 master physician fee schedule yet. Here is how providers can find the rates they need right now.
Step 1: Log in to KYHealth-Net
Visit the KYHealth-Net Provider Portal. This is the secure state portal. You need your provider credentials to access it. Once inside, you can search rates by CPT code.
Step 2: Check Your MCO Portal
If you serve managed care patients, also check your MCO’s portal. Aetna, Anthem, Humana, Molina, United, and WellCare each publish their own schedules there.
Step 3: Watch for DMS Updates
The Department for Medicaid Services may release a consolidated 2026 schedule later this year. Check the DMS website regularly. You can also sign up for provider bulletins to get updates by email.
What Happens if 2025 Rates Are Still Active?
Since a full 2026 schedule is not out yet, many rates carry over from 2025. This is normal during transition periods. Here is what you should know.
Rate Rollover
Most fee-for-service (FFS) rates from 2025 stay active. They remain in effect until DMS announces new rates. Providers can bill using current posted rates on KYHealth-Net.
Possible Inflation Adjustments
DMS may apply a 2026 inflation adjustment later. When new rates are posted, they may be retroactive. Keep records of all claims so you can reconcile payments if rates change.
FAQ
Q: What is the Kentucky Medicaid fee schedule for 2026?
A: Kentucky has not released a single 2026 master fee schedule. Reimbursement rates come from federal updates, HB 2 reforms, and MCO policies. Providers should check KYHealth-Net and their MCO portals for current rates by CPT code.
Q: Are there new Medicaid copays in Kentucky for 2026?
A: Yes. House Bill 2 introduces copays for Medicaid recipients. The maximum copay is $35 for certain inpatient hospital services. This bill passed the House in February 2026 and is now in the Senate.
Q: Will clinical lab rates go down in 2026?
A: No. There are no payment reductions for clinical lab tests in 2026. The 15% phase-in cuts are scheduled to start in 2027. Labs should prepare for the new data reporting period starting May 2026.
Q: How do I find DME reimbursement rates for Kentucky Medicaid?
A: Kentucky DME rates follow the CGS Medicare Jurisdiction C fee schedule. The 2026 Quarter 1 schedule is active now. Visit the CGS Medicare portal for the full rate list covering wheelchairs, oxygen, and prosthetics.
Q: What is the Medicaid income limit for long-term care in Kentucky 2026?
A: The monthly income limit is $2,982 per individual. The asset limit is $2,000 for a single person and $4,000 for a married couple. These limits apply to nursing home and home-based care coverage.
Q: Where can I find the full Kentucky Medicaid provider fee schedule?
A: Log in to the KYHealth-Net Provider Portal to search specific CPT code rates. Also check your MCO portal (Aetna, Anthem, Humana, Molina, United, WellCare) for managed care rates. A consolidated public 2026 file has not been released yet.
Sources & Disclaimer
Sources:
- Kentucky General Assembly — HB 2 Bill History
- CMS Clinical Laboratory Fee Schedule 2026 Updates
- CGS Medicare Jurisdiction C Fee Schedule
- UnitedHealthcare Community Plan KY Reimbursement Policies
- Medicaid Planning Assistance — Kentucky 2026 Limits
Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official eligibility and rate information, contact the Kentucky Department for Medicaid Services or visit Medicaid.gov.
Last Updated: March 2026
