AN ACT proposing to create a new section of the Constitution of Kentucky relating to Medicaid expansion.

2026 Regular Session Introduced by Cassie Armstrong

Codifies Kentucky Medicaid expansion for adults 19–64 at or below 138% FPL into the state Constitution, limiting future eligibility restrictions beyond federal law.

to Committee on Committees (S)

#constitution #ky. #countyclerks #federallawsandregulations #localmandate #medicaid #publichealth #secretaryofstate

Purpose and intent

Proposes a constitutional amendment to permanently enshrine and protect the current expansion of Medicaid eligibility in Kentucky.

Specifically targets non-disabled, low-income adults whose income is at or below 138% of the federal poverty level (FPL), aligning with the federal Medicaid expansion threshold.

Aims to prohibit additional burdens or restrictions on eligibility or enrollment standards beyond what federal law requires.

Key provisions

Section 2 (Constitutional amendment text):

(1) The Commonwealth shall provide Medicaid benefits to individuals aged 19 to 64 with income at or below 138% of the FPL, as authorized by federal law.
Coverage must meet or exceed the benchmark or benchmark-equivalent coverage defined by federal law.
(2) Kentucky shall not impose greater or additional burdens on eligibility or enrollment standards, methods, or practices for those eligible under this section than for other Medicaid-eligible individuals, except that work or cost-sharing requirements may be imposed if required by federal law or regulation.

Section 3: The amendment would be submitted to voters for ratification or rejection in the next available general election, per existing constitutional procedures.

Section 4–5: Administrative and procedural provisions for publication, ballot labeling, and the timing of certification to county clerks to ensure the amendment appears on the ballot at the next general election for members of the General Assembly (2026 general election, November).

Affected entities and implications

Voters: The amendment would go to Kentucky voters at the November 2026 general election for ratification.

County clerks and local election administration: Minor additional ballot programming and printing considerations to accommodate the constitutional amendment question.

General public health program: Codifies current Medicaid expansion into the Kentucky Constitution, providing a durable, constitutionally protected framework for expansion.

State and local finances: While the amendment itself codifies eligibility, ongoing funding decisions follow federal law and state appropriations; the fiscal note indicates minimal local-government cost impact related to ballot changes, not to program funding.

Procedural and timeline notes

Ballot timing: The amendment would appear on the November 2026 ballot, as required by Kentucky constitutional amendment procedures (Section 256).

Publication and certification deadlines: Publication by the Secretary of State would occur no later than the first Tuesday in August preceding the election; certification to county clerks would occur by specified deadlines in the weeks leading up to the election.

Local government fiscal impact: The Local Government Mandate Statement indicates minimal incremental costs to counties related to ballot preparation and printing; no direct change in program administration costs for local governments beyond ballot logistics.

Overall impact

SB 93 seeks to lock in Kentucky’s Medicaid expansion for adults 19–64 at or below 138% FPL via constitutional amendment, limiting future eligibility restrictions beyond federal requirements while preserving potential federal-imposed work or cost-sharing aspects. If ratified, the policy would be a constitutional guarantee of expansion status regardless of subsequent legislative changes, subject to federal law.

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