Medically reviewed by Dr. Jerrel Boyer, D.O. — Medical Director, Fresh Start Health Centers · Last reviewed: October 21, 2026
Starting January 1, 2027, Kentucky Medicaid will add a work and community engagement requirement for some adults. If you are getting treatment for opioid use or another substance use disorder, you probably have two questions: will this affect my coverage, and will it affect my care? This guide explains the new rules, the exemptions you may qualify for, and simple steps to protect your coverage and stay in treatment.
What Changes on January 1, 2027
According to the Kentucky Health Benefit Exchange, the requirement applies to adults who are:
- Ages 19 to 64
- Covered by Medicaid Expansion, meaning they qualify based only on income
- Not exempt
If the rule applies to you, you can meet it in one of three ways:
- At least 80 hours a month of work, job training, volunteering, community service, or part-time school, or any combination that adds up to 80 hours
- Going to school at least half-time
- Earning at least $580 a month (for seasonal work, an average of $580 over the last six months)
Many people in recovery already work. Our article on working while on Suboxone covers what that looks like day to day.
Exemptions That May Apply to People in Addiction Treatment
Kentucky lists several exemptions. Two are especially important if you are in addiction care:
- “In a treatment program for mental health or substance use disorder.”
- “Medically frail or have a serious or complex medical condition, including a disability, mental health condition, or substance use disorder, that impacts your ability to complete community engagement requirements.”
If you are an active patient in a treatment program, you may qualify for an exemption. Kentucky Medicaid makes the final decision, and the state says it must be able to document that you meet an exemption. No clinic can promise that you will be exempt.
Other exemptions on the state’s list include being pregnant or within 12 months after pregnancy; being a parent or caregiver of a child 13 or younger or of a person with a disability; receiving SSI or SSDI; being enrolled in Medicare; being a member of a federally recognized tribe; being a former foster youth up to age 26; having been incarcerated in the past three months; and meeting TANF or SNAP work rules.
When and How You Will Need to Report
You do not need to report anything yet. Here is how the timing works:
- Current members: you will report at your 2027 renewal and must show you met the requirement for at least three of the six months before renewal.
- New applicants on or after January 1, 2027: you must show you met the requirement in the month before you apply.
- Notices: members who must meet the requirement will get notices starting 120 days before their 2027 renewal.
Kentucky also offers short-term hardship exceptions for a month when you are in a hospital or nursing facility, must travel for medical care not available locally, live in an area with very high unemployment, or live in a federally declared disaster area.
Steps to Protect Your Coverage and Your Treatment
- Keep your contact information current. Update your address and phone number through kynect so you receive every notice.
- Open your Medicaid mail. Missing a notice is one of the most common ways people lose coverage.
- Stay in treatment. Keeping your appointments supports both your recovery and the records that show you are in a treatment program.
- Ask us for documentation. Fresh Start Health staff can help with paperwork and can provide documentation that you are in treatment.
- Get free help. Call kynect at 1-855-459-6328 or visit khbe.ky.gov to talk with a kynector.
Our patient help center lists more ways to reach our team.
Addiction Care at Fresh Start Health
Fresh Start Health offers medication-assisted treatment with buprenorphine and other medications approved by the FDA for treatment of opioid use disorder, along with counseling and regular follow-up. Treatment is individualized, and outcomes vary. Learn more on our addiction care services page or our Suboxone treatment page.
We see patients in Ashland, Grayson, Morehead, and Vanceburg, with telehealth for many follow-up visits. We accept Kentucky Medicaid. Coverage varies; contact your plan for specifics.
Your treatment records are protected under federal privacy laws including 42 CFR Part 2, which provides stronger confidentiality protections than standard HIPAA rules. We share treatment information with Medicaid or anyone else only with your written consent or as the law allows.
Frequently Asked Questions
When do Kentucky Medicaid work requirements start?
Kentucky’s work and community engagement requirement starts January 1, 2027. It applies to some adults ages 19 to 64 who have Medicaid Expansion coverage based only on income. Current members will be asked to report at their 2027 renewal, and notices start 120 days before that renewal.
Am I exempt from Medicaid work requirements if I am in addiction treatment?
You may qualify. Kentucky lists being in a treatment program for mental health or substance use disorder as an exemption. A substance use disorder that affects your ability to meet the requirement may also count under the medically frail exemption. The state makes the final decision, so keep your treatment records current.
How many hours do I need for Kentucky Medicaid work requirements?
If the requirement applies to you, you can meet it with at least 80 hours a month of work, job training, volunteering, part-time school, or a combination. You can also meet it by going to school at least half-time or by earning at least $580 a month.
What should I do if I get a Medicaid notice about work requirements?
Read it right away and note any deadline. Do not stop your treatment. Call kynect at 1-855-459-6328 or visit khbe.ky.gov for help understanding what the notice asks. Ask Fresh Start Health staff if you need a letter or records showing you are in treatment.
Can Fresh Start Health help me with paperwork for a Medicaid exemption?
Yes. Our staff can help you with paperwork and can provide documentation that you are in treatment, with your written consent. We cannot decide whether you are exempt. Only Kentucky Medicaid can make that decision. Bringing your notice to your next visit helps us help you.
Questions About Your Coverage?
If you are worried about losing Medicaid, please do not stop treatment. Call Fresh Start Health at (606) 225-8200 or bring your Medicaid notice to your next visit. We will help you understand what the notice asks and gather the documentation you need.
Medicaid rules in this article reflect Kentucky Health Benefit Exchange information as of October 2026 and may change. This content is for informational purposes only and is not a substitute for professional medical or legal advice.