KY Affordable Care Act: Medicaid, Kynect, and Work Requirements

The Affordable Care Act gives Kentucky residents two main paths to health coverage: Medicaid, which was expanded in 2014 to cover adults with household incomes up to 138 percent of the federal poverty level, and private plans sold through kynect, Kentucky’s state-run marketplace, where most buyers qualify for premium tax credits that lower their monthly cost. For 2026 coverage, premiums rose by a weighted average of roughly 30 percent after enhanced federal subsidies expired, but about 80 percent of kynect enrollees still receive help paying for their plan.¹

Who Qualifies for What

Eligibility in Kentucky runs along a sliding scale tied to the federal poverty level. The rough ladder:

Adults, including parents and childless adults, qualify for Medicaid with household incomes up to 138 percent of the federal poverty level.²
Pregnant women qualify with family income up to 195 percent of the federal poverty level, and that coverage extends 12 months postpartum.²
Infants are covered by Medicaid up to 195 percent of the federal poverty level, and children ages 1 to 18 up to 159 percent. The Kentucky Children’s Health Insurance Program (KCHIP) extends coverage for children in families earning up to 213 percent.²
Marketplace premium tax credits are available to households earning between 100 and 400 percent of the federal poverty level. Cost-sharing reductions, which lower deductibles and copays, go to Silver plan enrollees at or below 250 percent.³

If your income lands in the Medicaid range, you apply for Medicaid. If it lands above the Medicaid threshold, you shop plans on kynect and apply any subsidy you qualify for. The same application handles both.

How to Enroll Through Kynect

Kynect is Kentucky’s state-based health insurance exchange. It was originally launched in 2013, replaced by HealthCare.gov from 2017 through 2021, and then relaunched as the state exchange for the 2022 plan year. Kentucky has operated its own marketplace ever since.¹⁴

Medicaid and KCHIP enrollment is open year-round. For private marketplace plans, open enrollment for the 2027 plan year runs November 1 to December 31, 2026. Outside that window, you can enroll only if you have a qualifying life event, such as losing other coverage, moving, or a change in household size.⁵

What Coverage Costs in 2026

Three insurers sell plans through kynect for the 2026 plan year: Anthem, which offers two network options called Pathway and Transition; Ambetter/WellCare; and Molina. CareSource left the Kentucky marketplace at the end of 2025.¹

Approved pre-subsidy rate increases for 2026 came in at 23.84 percent for Anthem, 37.02 percent for Ambetter/WellCare, and 16.31 percent for Molina, a weighted average of 29.8 percent. Across available options, that worked out to roughly $181 more per month before subsidies.¹⁶ The main driver was the expiration of the enhanced premium tax credits from the American Rescue Plan Act, which had held after-subsidy costs down through 2025. With those enhancements gone, households above 400 percent of the federal poverty level lost subsidy eligibility entirely, and subsidies for everyone else cover a smaller share of the premium.

Subsidies still do real work. During open enrollment that ended January 15, 2026, 89,028 Kentuckians selected a kynect plan for 2026 coverage. About 80 percent qualified for premium tax credits, averaging $634 per month, which brought the average net premium down to $168 per month. Around 6 percent of enrollees pay less than $10 per month.¹

Medicaid Expansion in Kentucky

Kentucky adopted the ACA’s Medicaid expansion effective January 1, 2014. Before expansion, Medicaid covered parents only if their income was below 57 percent of the federal poverty level, and most childless adults were excluded. Expansion raised the threshold to 138 percent of the federal poverty level for all adults.⁷

As of June 2025, 464,026 Kentuckians were enrolled through the expansion group.⁸²⁹¹⁰

Where Work Requirements Stand

Kentucky does not currently impose a work requirement for Medicaid. The state’s 2018 “Kentucky HEALTH” waiver, which would have required work or community engagement and imposed coverage lockouts for missed premiums or paperwork, was struck down in federal court and never fully took effect. Legislation enacted in 2022 (HB 7) authorizes a work requirement for non-disabled adults ages 19 to 59 without dependents, but it needs federal approval from the Centers for Medicare and Medicaid Services, which has not been granted.²¹¹

Keeping Your Coverage After the Unwinding

During the COVID-19 public health emergency, Medicaid enrollees kept coverage automatically. That continuous coverage requirement ended March 31, 2023, and Kentucky began redetermining eligibility for every enrollee. The state estimated more than 236,000 people could lose benefits over the 12-month unwinding period, often not because they were ineligible but because they didn’t return renewal paperwork.² Nationally, 69 percent of unwinding disenrollments were for procedural reasons rather than confirmed ineligibility.¹² The practical lesson: keep your address updated with the state, open renewal notices promptly, and respond by the deadline. If you lose Medicaid because your income rose, that loss is itself a qualifying event that lets you enroll in a kynect plan outside open enrollment.

What Could Change

Two federal threads could reshape what Kentuckians pay and who stays covered. The first is the enhanced marketplace subsidy question. The American Rescue Plan’s expanded premium tax credits have already expired for 2026, and the Urban Institute estimated that without them, 4.8 million additional people nationwide would become uninsured, with the sharpest increases hitting those below 250 percent of the federal poverty level.¹³

The second is the federal matching rate for Medicaid expansion. The federal government currently pays 90 percent of costs for the expansion population, compared with 71 percent for Kentucky’s traditional Medicaid program. Dropping the enhanced rate to the traditional level would cost Kentucky roughly $1.4 billion in federal funds, and eliminating the expansion population entirely would end coverage for over 450,000 people.¹⁴ Nothing changes your eligibility today, but if you’re relying on either program, it’s worth watching what Congress does with each.

1
healthinsurance.org. Kentucky Health Insurance Marketplace
2
healthinsurance.org. Kentucky Medicaid
3
Kaiser Family Foundation. Health Insurance Marketplace Calculator
4
WEKU. Kentucky Returns to State-Based Health Insurance Exchange Ahead of Open Enrollment
5
kynect. Kentucky Health Benefit Exchange
6
WKYT. Kentucky Feels Impact of Nationwide Health Insurance Premium Increases
7
The Commonwealth Fund. Medicaid Expansion in Kentucky: Early Successes and Future Uncertainty
8
Kaiser Family Foundation. Medicaid Expansion Enrollment
9
Kentucky Center for Economic Policy. New Gallup Poll Shows Kentucky Now Leading State in Insurance Coverage
10
America’s Health Rankings. Health Insurance in Kentucky
11
Kaiser Family Foundation. A Guide to the Lawsuit Challenging CMS’s Approval of the Kentucky HEALTH Medicaid Waiver
12
Kaiser Family Foundation. Medicaid Enrollment and Unwinding Tracker
13
Kentucky Lantern. Congress Limited Health Insurance Subsidies to a Few Years, Setting Stage for Current Fight
14
Kentucky Cabinet for Health and Family Services. Impact of Congressional Budget Proposals to Kentucky Medicaid