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  • Map 811 Non Credentialed Application Instructions Form

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In the program is not a guarantee; therefore, providing services to Kentucky Medicaid members prior to your effective date is at your own financial risk. Did you: Complete all questions. Questions not applicable should be completed with N/A . (Applications will be rejected for any questions left blank.) Sign and date signature page 6. Only original blue ink signatures are accepted. Copied or stamped signatures are not accepted. Attach appropriate licenses and/or certifications.

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Department for Medicaid Services - Cabinet for Health and Family Services.

Enrolling New Kentucky Medicaid Providers Review the provider type summary for your provider type to understand the documentation required to enroll. Review the training resources to help navigate the KY MPPA. Download multifactor authentication software. Create an account and start an application on the KY MPPA.

Visit the Kentucky Department for Medicaid Services website. Scroll down to “Forms” & select the forms needed.

​​​​​​​​​​​​​​​​​​​​​​Medicaid provides medical assistance to eligible low-income Kentuckians. Use the links below to learn more about some available programs and services. If members have any questions, please contact Member Services toll-free at (800) 635-2570.

The application fee for 2021 is $599. If you are subject to the fee at initial enrollment or revalidation submit the payment using the Kentucky Medicaid Partner Portal Application (MPPA). Providers having paid an application fee to Medicare or to another state Medicaid agency will not be required to make payment.

Income & Asset Limits for Eligibility 2023 Kentucky Medicaid Long-Term Care Eligibility for SeniorsType of MedicaidSingleIncome LimitAsset LimitInstitutional / Nursing Home Medicaid$2,742 / month*$2,000Medicaid Waivers / Home and Community Based Services$2,742 / month†$2,0001 more row • Feb 1, 2023

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232