Members

Member Handbook

handbook

Please read your Member Handbook. It tells you about:

  • Your health plan
  • Your benefits
  • Extra programs and benefits
  • What is covered
  • How to get the services you need
  • How to contact us


 2026 Member Handbook

 

Need your Member Handbook in your language or format?

Call Member Services at (800) 578-0603 (TTY/TDD: 711)

*Printed copies of information posted on our website are available upon request.

 

CMS-0057 Prior Authorization Annual Reporting

This report shows how prior authorization requests are handled, such as how many were approved or denied and how quickly decisions were made. For services that require prior authorization, refer to (link to PA Guide pdf)

Kentucky Medicaid Prior Authorization Annual Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 92%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 8%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 43%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 21%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 90%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 10%
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 4
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 3
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 25
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 24

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