Gizmo Warehouseby Joe Eichenbaum | 17A

Medicaid work requirements · Kentucky

Medicaid work requirements in Kentucky: who is subject and who loses coverage (2027)

Data snapshot 2026-06-03 · part of These 5 Million People Are About to Lose Their Medicaid — But They Don't Have To

Kentucky expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 434,069 of them (16.3% of an expansion pool of 464,026) will have to prove 80 hours a month of work, school, or service, or an exemption, to keep coverage.

This model's bottom-up estimate is that 153,075 people in Kentucky lose coverage by 2034: 140,053 of them still eligible but lost to paperwork and reporting failures, and 13,022 not meeting the requirement. Nationally the same model gives 5,461,400, against CBO's 5,200,000.

Whether those eligible people keep coverage depends on the state's ability to renew them automatically (ex parte) from data it already holds. Kentucky scores 75 of 100 on this model's ex parte capability index, a low band; its eligibility system is kynect.

Key figures

Model v2-2026-06-03. "Strict" counts adults whose ACS record shows them subject with no observable exemption; "permissive" allows the broader exemption reading.
MeasureKentucky
Expansion stateYes
Subject to the requirement via waiverNo
Expansion pool (adults 19 to 64)464,026
Adults subject, strict definition434,069
Adults subject, permissive definition425,388
Share of expansion pool subject16.3%
Projected coverage loss by 2034153,075
Hardship exception statusAdopting
Early implementerNo
Ex parte capability score (0 to 100)75 (low)

Who is subject in Kentucky

Of the 434,069 subject adults, 38% already work 80 or more hours a month and 57% are not working. 39% have a child under 14 at home. Among those not working, 54% report a disability and 16% are caregivers.

ACS PUMS 5-year 2020 to 2024, subject adults only.
CharacteristicShare of subject adults
Age 19-2413%
Age 25-3422%
Age 35-4422%
Age 45-5419%
Age 55-6424%
Not working57%
1 to 19 hours a month1%
20 to 79 hours a month4%
80 or more hours a month (meets the bar)38%
Not working: Disabled54%
Not working: Caregiver16%
Not working: Postpartum0%
Not working: Student2%
Not working: Other28%

Why eligible people lose coverage

Of the 153,075 projected to lose coverage in Kentucky, 140,053 meet the requirement or qualify for an exemption but fail to document it. 63,210 of those are working people who cannot prove their hours through data the state can see, and 76,843 qualify for an exemption the state does not detect automatically.

Bottom-up model v8.0-2026-05-30; documentation-failure buckets compound over the 14 six-month renewal cycles through 2034.
GroupProjected to lose coverage
Variable shifts / on-call work16,987
Self-employed (other)13,759
Multiple part-time jobs (aggregation failure)11,710
Cash-paid construction & trades6,083
Volunteering / job training4,803
Full-time students not auto-verified4,730
Seasonal: agriculture, hospitality, food service3,725
Gig / courier (DoorDash, Uber, Lyft, Instacart)1,413
Medically frail without auto-match28,358
Caregivers of a disabled adult22,412
American Indian / Alaska Native (tribal exemption)6,228
Parent caregivers of children ≤13 without auto-match5,665
Recent incarceration (data-match gap)4,696
Kinship caregivers (non-parent) of children ≤134,402
SUD treatment not flagged in claims data3,455
Other categorical exemptions (foster, AYA cancer, SNAP/TANF)1,345
Pregnancy / postpartum data lag281

Can the state renew people automatically?

The ex parte capability index blends the state's observed automatic-renewal rate (88% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. Kentucky's composite score is 75 (low band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.

ComponentScore
Composite75
Observed ex parte88
Core capability64
Data sources68
Historical churn50

How subjects overlap across exemption categories

Each subject adult sits in exactly one cell. Categories: Working ≥ qualifying hours / income; Parent caregiver of child ≤13; Medically frail; Full-time student.
CombinationAdultsShare
None of the four149,68234.5%
Working ≥ qualifying hours / income75,36417.4%
Medically frail69,03915.9%
Working ≥ qualifying hours / income + Parent caregiver of child ≤1368,12915.7%
Parent caregiver of child ≤1330,7897.1%
Working ≥ qualifying hours / income + Full-time student9,0602.1%
Full-time student8,3471.9%
Working ≥ qualifying hours / income + Parent caregiver of child ≤13 + Full-time student6,2381.4%

Counties in Kentucky

Subject adults concentrate: Jefferson County (73,106), Fayette County (32,474), and Kenton County (16,362) account for 28% of the state's subject population.

All 120 counties in Kentucky with subject adults, sorted by count. County figures are model allocations of the state estimate by ACS tract characteristics.
CountyAdults subjectSubject rateProjected lossPoverty rateWorking-age population
Jefferson County73,10615.7%25,78114.0%465,628
Fayette County32,47416.0%11,45215.0%202,546
Kenton County16,36216.0%5,77012.0%102,610
Warren County14,50816.8%5,11617.0%86,186
Boone County13,30616.3%4,6926.0%81,716
Madison County10,16817.2%3,58616.0%59,172
Daviess County9,83916.8%3,47014.0%58,741
Hardin County9,61514.5%3,39112.0%66,226
Campbell County9,16316.2%3,23112.0%56,750
Bullitt County8,05515.9%2,84111.0%50,795
McCracken County6,45816.9%2,27715.0%38,303
Oldham County6,39615.6%2,2564.0%41,108
Christian County6,14914.8%2,16917.0%41,400
Pulaski County6,07416.1%2,14221.0%37,802
Laurel County5,63915.1%1,98821.0%37,313
Scott County5,57115.4%1,9659.0%36,256
Pike County5,31416.0%1,87424.0%33,156
Jessamine County5,11916.0%1,80512.0%31,992
Franklin County4,80515.7%1,69413.0%30,554
Shelby County4,73316.0%1,6698.0%29,554
Nelson County4,61116.6%1,6269.0%27,866
Calloway County4,48519.0%1,58219.0%23,620
Boyd County4,46816.3%1,57617.0%27,452
Hopkins County4,30016.8%1,51619.0%25,632
Henderson County4,20316.6%1,48217.0%25,322
Barren County4,15716.2%1,46621.0%25,630
Whitley County3,65317.6%1,28823.0%20,786
Greenup County3,46317.5%1,22115.0%19,782
Clark County3,40915.7%1,20215.0%21,680
Graves County3,36816.4%1,18820.0%20,588
Floyd County3,28516.3%1,15829.0%20,204
Marshall County3,26618.3%1,15212.0%17,902
Boyle County3,00116.6%1,05815.0%18,088
Muhlenberg County2,95616.7%1,04216.0%17,674
Taylor County2,86519.1%1,01014.0%15,026
Woodford County2,83818.5%1,0018.0%15,314
Meade County2,78715.0%98313.0%18,518
Rowan County2,74918.3%97025.0%15,044
Logan County2,72617.5%96116.0%15,604
Montgomery County2,70516.2%95416.0%16,720
Knox County2,63215.3%92834.0%17,257
Carter County2,58417.3%91124.0%14,900
Grayson County2,53716.6%89521.0%15,254
Grant County2,45116.7%86413.0%14,684
Anderson County2,36116.4%83313.0%14,386
Perry County2,33014.7%82224.0%15,862
Harlan County2,29115.9%80830.0%14,401
Mercer County2,29117.2%80811.0%13,340
Ohio County2,28317.1%80514.0%13,350
Lincoln County2,24516.3%79217.0%13,742
Breckinridge County2,17918.8%76824.0%11,580
Adair County2,14919.2%75820.0%11,176
Bourbon County2,10118.3%74115.0%11,459
Johnson County2,07816.2%73321.0%12,871
Bell County2,01814.7%71226.0%13,706
Spencer County2,00816.3%7088.0%12,286
Allen County2,00716.2%70817.0%12,382
Wayne County1,93217.4%68125.0%11,115
Simpson County1,91816.2%67614.0%11,846
Letcher County1,89616.2%66929.0%11,733
Hart County1,89216.9%66723.0%11,174
Marion County1,89016.5%66722.0%11,444
Russell County1,83018.3%64522.0%10,007
Harrison County1,79616.7%63416.0%10,780
Mason County1,66217.2%58619.0%9,660
Clay County1,62413.0%57331.0%12,474
Garrard County1,61715.7%57016.0%10,314
Henry County1,60317.7%56516.0%9,056
Larue County1,53817.4%54219.0%8,836
Rockcastle County1,52716.2%53924.0%9,418
Knott County1,51619.0%53528.0%7,987
Casey County1,49617.1%52726.0%8,774
Trigg County1,49319.0%52618.0%7,848
McCreary County1,49014.4%52534.0%10,323
Lawrence County1,48716.7%52426.0%8,888
Pendleton County1,44917.0%51118.0%8,532
Fleming County1,42416.4%50221.0%8,685
Union County1,41917.9%50019.0%7,942
Morgan County1,28914.9%45420.0%8,638
Bath County1,28817.7%45423.0%7,274
Owen County1,27019.7%44814.0%6,440
Todd County1,24918.3%44021.0%6,845
Estill County1,24815.3%44024.0%8,172
Butler County1,24517.8%43920.0%7,002
Lewis County1,23216.8%43527.0%7,350
Edmonson County1,20816.5%42617.0%7,336
Caldwell County1,18317.3%41716.0%6,857
Powell County1,18215.8%41721.0%7,503
Jackson County1,17215.9%41323.0%7,372
Breathitt County1,16814.8%41229.0%7,876
Webster County1,16816.0%41216.0%7,303
Green County1,14318.1%40321.0%6,306
Monroe County1,14018.0%40221.0%6,326
Washington County1,10416.1%38914.0%6,874
Magoffin County1,04915.9%37030.0%6,587
Carroll County1,02516.9%36220.0%6,072
Livingston County94519.2%33317.0%4,926
Metcalfe County94416.2%33324.0%5,838
Hancock County92718.2%32715.0%5,101
Gallatin County92417.6%32617.0%5,251
Martin County91913.5%32424.0%6,832
McLean County91517.9%3238.0%5,111
Clinton County90417.3%31920.0%5,238
Crittenden County89018.2%31418.0%4,901
Leslie County87914.6%31034.0%6,009
Trimble County87217.3%30814.0%5,055
Bracken County83117.1%29317.0%4,846
Ballard County81018.4%28614.0%4,408
Lyon County78614.5%27710.0%5,412
Nicholas County74516.8%26316.0%4,444
Menifee County68820.3%24327.0%3,397
Elliott County67115.4%23725.0%4,342
Wolfe County64317.6%22737.0%3,654
Fulton County64017.6%22627.0%3,632
Lee County58213.0%20531.0%4,486
Cumberland County54717.0%19328.0%3,227
Carlisle County47117.8%16620.0%2,645
Hickman County42217.3%14917.0%2,446
Owsley County34814.8%12329.0%2,354
Robertson County20616.1%7322.0%1,282

State brief and methodology

Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.

Sources

Back to These 5 Million People Are About to Lose Their Medicaid — But They Don't Have To