Kentucky Medicaid Plan Glossary

Kev thov kev ncaj ncees

Ib qho kev thov kom muaj ib lub rooj mloog kev ncaj ncees hais txog ib yam dab tsi uas lub chaw ua hauj lwm pom zoo yuav nqis tes ua, ib yam dab tsi uas lub chaw ua hauj lwm muab ua tiav lawm, los yog ib qhov kev txiav txim uas lub chaw ua hauj ua tsis tau raws sij hawm.

Daim ntawv thov

Ib daim ntawv thov rau cov txiaj ntsig tau ua rau lub koom haum sau ntawv thiab kos npe los ntawm tus neeg thov lossis ib tus neeg ua haujlwm sawv cev ntawm tus neeg thov. Daim ntawv thov tuaj yeem tau txais los ntawm kev xa ntawv, xov tooj, fax, ntawm tus kheej, lossis hauv tshuab hluav taws xob.

Certificate of Coverage

A description of your health care coverage and benefits. Your member handbook serves as your certificate of coverage.

Countable Resource

A resource that is countable when determining resource eligibility.

Decertification

Loss of eligibility to participate as a Medicaid provider, or for a license to operate a Medical facility licensed by DMS.

Department of Community Based Services

The state agency that administers public assistance programs in Kentucky. 

Department of Medicaid Services

The state agency responsible for administering Kentucky Medicaid.

Tus Neeg Tseem Tos Lwm Tus Pab (Dependent)

An individual who is the financial responsibility of a member of the income unit. Example: This is someone who could be counted as a tax dependent, if income tax is filed.

Daim Ntawv Teev Npe Tshuaj (Formulary)

A list of approved prescription drugs developed the health plan.

Kev kub ntxhov

Ib qho tsos mob los yog cov tsos mob xwm txheej kub ceev thiab mob sai, suav nrog rau mob loj heev, uas ua rau ib tus neeg coj tus cwj pwm ntseeg tias yog ib tus mob uas yuav tau kho tam sid, yog hais tias tsis kho yuav ua rau muaj teeb meem loj rau lub cev ua tsis tau hauj lwm los yog ua rau ib yam khoom los yog ib feem hauv nruab nrog cev tsis ua hauj lwm, los yog yuav ua rau tus neeg txoj kev noj qab haus huv nyob rau qhov muaj kev phom sij loj heev.

Kev dag

Lub hom phiaj xav kom tau txais cov txiaj ntsig tsis tsim nyog lossis them nyiaj.

Good Cause

An acceptable reason to defer the requirement to cooperate for certain eligibility factors.

Kev taug xyuas

Kev taug xyuas yog qhov koj mus nug txog qhov kev pab cuam kev noj qab haus huv uas lawv tau txheeb xyuas koj daim ntawv ntawm koj li kev npaj thiab lawv tau tsis lees txais koj li kev thov.

Cov nyiaj khwv tau los

A gain or recurrent benefit measured in money.

Neeg Mob Pw Hauv Tsev Kho Mob

Ib tu neeg mob uas cia pw hauv ib qhov chaw kho mob ib hmos los yog ntev dua thiab tau txais cov kev pab kho mob uas pab them nqi rau.

Kentucky Medicaid

Kentucky’s managed care Medicaid program provides comprehensive free or low-cost health care to adults, families, people with disabilities, children under 19, children in foster care and pregnant women who meet income requirements.

Kentucky Resident

A person physically residing and maintaining a residence in the Commonwealth of Kentucky. You must be a Kentucky resident to be eligible for Kentucky Medicaid. To be considered a Kentucky resident, members who are temporarily out of Kentucky for any reason may be required to prove their intent to return to Kentucky.

Dependent children who are attending school out of state may be considered residents if they are out of state during the school year, as long as their primary residence is in Kentucky and they return to Kentucky during breaks. Dependent children attending school out of state may be required to provide proof that they pay out-of-state tuition, vote in Kentucky, and file income taxes using a Kentucky address.

Your residence may be a home you own or are purchasing or renting, a shelter or other physical location where you are staying in lieu of a home, or another person's home.

kynect

It's your way to find, compare and enroll in a Medicaid health plan. For more information about kynect go to kynect.ky.gov  or call 1-844-407-8398.

Legal Guardian

A person who has been granted custody of a minor by court order.

Maternity Benefits Program

The Kentucky Medicaid program includes all Medicaid benefits, including maternity benefits, maternity support services, and maternity case management, and is made available to Kentucky Medicaid members who become pregnant, notify Kentucky Medicaid and UnitedHealthcare Community Plan, and apply for benefits. Eligibility for the program is determined by Kentucky Medicaid.

Medicaid

A state health insurance program for people with low income who meet certain eligibility requirements. Programs can vary from state to state. For information on Kentucky’s Medicaid programs visit https://chfs.ky.gov/agencies/dms/Pages/default.aspx 

Medicare

A federal health insurance program for people who are 65 or older, people with disabilities, or those with end-stage kidney disease. Medicare eligibility is not based on income, and basic coverage is the same in each state.

Tswv cuab

Ib tus neeg muaj feem tau txais rau npe rau hauv daim phiaj UnitedHealthcare Health Plan.

Tus Neeg Mob Tsis Pw Kho Hauv Tsev Kho Mob

Ib tus neeg mob tsis pw hauv tsev kho mob tau txais cov kev pab kho mob uas them rau nyob deb ntawm lub tsev kho mob, xws li nyob hauv tus kws kho mob lub chaw ua hauj lwm los sis hauv tus neeg mob lub tsev, los sis hauv ib lub tsev kho mob neeg mob tsis pw kho los sis tsev kho mob chav kho mob xwm txheej kub ceev los sis chaw phais mob.

Tus Kws Kho Mob Xub Thawj (PCP)

Koj tus kheej tus kws muab kev kho mob. Your primary care provider can be a family or general practitioner, internist, pediatrician, or other provider approved by UnitedHealthcare Community Plan. To receive benefits, your primary care provider must provide or coordinate your care. If you need to see a specialist, your primary care provider will refer you.

Kws Pab Kho Mob

Ib tus kws tshaj lij fab kev kho mob (xws li ib tus kws kho mob, kws tu neeg mob, kws pab tiv thaiv thiab kho mob nkeeg, thiab lwm tus) los yog chaw kho mob (xws li ib lub tsev kho mob, tsev kuaj mob, thiab lwm qhov chaw).

Recertification

Kev tshuaj xyuas ib ntus ntawm koj tsev neeg cov nyiaj tau los thiab kev tsim nyog tau txais. During recertification, you must submit current income and residency documentation to verify your eligibility and/or level of premium subsidy. You must recertify for Medicaid every 12 months.

Kws Kho Mob Tshwj Xeeb

A provider of specialized medicine, such as a cardiologist or a neurosurgeon.

Spouse

An individual who is legally married to another or who presents to the community as a husband or wife in a non-legal relationship.

Third Party

An individual, institution, corporation or agency that is responsible for all or part of the medical costs for Medicaid.