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On September 1, 2018, our premium payment services changed. These changes will make it easier for you to pay your premium. Read more. ×
Based on a recent legal decision, changes to Medicaid under Kentucky HEALTH will not begin on July 1, 2018 as planned. Read more. Important Update about Kentucky HEALTH ×


Access key forms for authorizations, claims, pharmacy and more.

Kentucky HEALTH

This Attestation is to be completed by an enrolled Medicaid Provider whose scope of expertise qualifies them to assess the Member for "medical frailty".

This Guide is a reference to Medicaid Providers and Clinicians as they complete the “Kentucky Medically Frail Provider Attestation” form for determination of possible medically frail members.


The EPSDT Well Child Exam form is intended for providers to utilize when performing a complete well child exam.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Well Child Exam

Use this form to request a PCP change for a member.

Appeals and Grievances

Complete this form to submit an appeal.

Complete this form to submit a grievance.


Complete and submit this form online in order to request a prior authorization.

Print, complete and then mail this form in order to request a prior authorization.

Behavioral Health


Refund Check Information Sheet* (RCIS)


Kentucky Medicaid Substance Use Treatment Pharmacy Prior Authorization Form For Buprenorphine Products

Please fax completed form to the corresponding fax number of the health plan partner your patient is currently enrolled.

Instructions: Please complete all fields and fax completed form to 1-855-620-1868


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Last Updated On: 5/8/2017