Bill changing state Medicaid program passes the Kentucky House
The Kentucky House passed a bill that would significantly change the state’s Medicaid program, including adopting federal requirements that would impose copays and implement work requirements for some recipients.
House Bill 2, sponsored by Rep. Ken Fleming, R-Louisville, passed the House on a 77-21 vote Friday morning. Rep. Nick Wilson, R-Williamsburg, crossed party lines to vote no with the 20 Democrats.
Supporters of the bill say it will rein in the program and ensure its meets the needs of “the most vulnerable and the taxpayers who fund it.” Critics say it will increase barriers to care and goes beyond what federal law requires.
Fleming said the first nine sections of the bill focuses on adopting federal requirements that were passed by Congress in House Resolution 1, also called the Big, Beautiful Bill by President Donald Trump. Among those requirements are eligibility checks and work requirements, which Fleming said focuses on the Medicaid expansion population, not traditional recipients.
He also emphasized children will not be impacted by the proposed changes.
“In addition, even under expansion population, there are populations that are exempt from many of the federal provisions,” Fleming said. “These populations include pregnant women, caregivers for dependent child under 13, and individuals with serious or chronic health conditions, individuals currently receiving services through the home community based waivers.”
The Affordable Care Act, which was enacted in 2010, expanded Medicaid eligibility coverage to almost all adults with incomes up to 138% of the federal poverty level, which is known as the expansion population. The traditional population served is low-income children, pregnant women and people with disabilities.
States had to opt into Medicaid expansion, and Kentucky is one of 41 states to do so. According to KFF, an organization focusing on health policy, 1.4 million Kentucky adults and children are enrolled in the state’s program.
Fleming said the program is the state’s second-largest expense, and it will become unsustainable unless something changes.
Fleming said the bill aims to “streamline program operations and service delivery, strengthen program oversight and accountability, reduce fraud and align Kentucky’s Medicaid program with new federal requirements,” among other things.
Democrats push back
Some of the provisions surrounding work requirements and copays don’t match federal requirements or recommendations, which Democrats criticized during debate.
In HB 2, new “applicable” Medicaid members must prove “community engagement” for the month prior to when they apply. Current members meanwhile need to show three consecutive months of compliance at the time of eligibility redetermination.
That’s a contrast from federal law that requires only one month of compliance for eligibility redetermination, and federal guidance says states may permit, but not require, to prove consecutive months for community engagement and work requirements.
For copay requirements, expansion members would be responsible for a copay of $35 for inpatient hospital services, and a “non-emergency use of a hospital emergency department would require a copay of $8. While federal law does not specify copayment amounts, it does say it may not exceed $35 or 5% of member income annually.
That means, according to federal law, copays could be set as low as $1.
Rep. Adam Moore, D-Lexington, asked why the copays in HB 2 are above the federal minimum. Fleming said it’s because he believes those copay amounts will help decrease emergency room costs in the Medicaid program.
“(We’re) trying to get a change of behavior and understanding and change the mindset of these individuals go see a primary care physician, which under this there’s no cost-sharing at all,” Fleming said. “That’s the part of the goal of this.”
Moore attempted to add a floor amendment that would have set any cost sharing at the minimum level required to comply with federal law. It failed.
“We all share a goal of ensuring ... the long term sustainability of our Medicaid program, but we need to be careful that in our pursuit of oversight, that we don’t accidentally build a pay-to-play health care system that punishes or leaves out the Kentuckians that this program was designed to protect,” Moore said.
Other floor amendments filed by Democrats dealt with transparency, including one from Rep. Lindsey Burke, D-Lexington, which she said would require tracking data on reasons for disenrollment, enrollment trends, waivers and exemptions from work requirements, among other data points.
“This information will help policymakers identify barriers to care, evaluate whether the reforms are working as intended, and ensure that transportation and cost requirements are not preventing patients from getting to treatment,” Burke said.
Fleming said though he felt Burke’s amendment duplicated some of the language already contained in the bill; the amendment failed.
“I’ve had extension conversation with several members on the board that we’re going to do extensive work in terms of collecting data and so forth. I appreciate the suggestion, but consider this as a duplication and unfriendly motion,” Fleming said.
The bill now heads to the Senate for consideration.
Editor’s note: This story has been updated to attribute a quote to Rep. Adam Moore. A previous version misattributed the quote.
This story was originally published February 27, 2026 at 1:17 PM.
