MedicaidPrior AuthHigh impact
Kentucky Medicaid Section 1115 Serious Mental Illness (SMI) Implementation
Kentucky Medicaid·KY · Psychiatry·Provider Letter
Effective date
Jan 15, 2026
We identified it
Jun 20, 2026
Summary
Kentucky Medicaid will begin covering short-term psychiatric hospital stays (up to 60 days) for beneficiaries ages 21-64 in Institutes for Mental Disease starting January 15, 2026. All new fee-for-service psychiatric admissions will require prior authorization with medical necessity review and continued stay reviews.
Action Required
By January 15, 2026: Billing team must implement prior authorization requirements for all new Kentucky Medicaid fee-for-service psychiatric admissions for patients ages 21-64. Update billing system to flag these cases for PA before admission. Staff must obtain PA through Kentucky UM Call Center (1-800-292-2392, 1-800-664-5725, 1-800-807-8842), fax forms to provided numbers, or use Essette Portal in KOG. For managed care patients, contact the specific MCO for their PA process. Claims will not be reimbursed if stays exceed 60 days.