Kentucky’s Home and Community Based Services (HCBS) Waiver for Aged and Disabled

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Waiver Description

 This program helps the elderly avoid nursing home placement and can compensate family caregivers for their assistance.

This Kentucky Medicaid waiver provides care and support services to the elderly in their homes, allowing them to avoid institutionalization in a nursing home should they choose to do so. This waiver achieves dual objectives of allowing individuals to age in place and saving money for the state of Kentucky. Caring for the elderly at home is considerably less expensive than doing so in a nursing home, largely because it leverages family members as primary caregivers. Of course, the additional benefit is individuals typically prefer to remain living in their homes whenever possible.

There is a Consumer Directed Option (CDO) for this waiver that allows participants to choose their own care providers for the non-medical care services they receive under this waiver. Certain family members and friends can be hired as paid caregivers. One might hear "consumer direction" referred to as "Cash and Counseling," as that was the original grant name that tested the concept of consumer control (or direction) over their caregivers. Not all services provided under this waiver are appropriate for consumer control, but those that require little or no medical skills training can be. Chief among these are personal care, homemaker services, unskilled respite care, and minor home adaptations.

 Did You Know?  Kentucky has some of the least expensive assisted living in the country with costs 25% below the national average.  Free assistance is available to residents to find affordable local care.  Learn more.

Eligibility Guidelines

The Home and Community Based Waiver for the Aged considers the applicant's residence, age, functional ability, income, and assets.

Residence – an applicant must be a resident of the state of Kentucky.

Age - participants must be at least 65 years of age. The waiver is also open to those designated as disabled by Social Security who are between the ages of 18 – 64. 

Functional Ability - participants must require nursing home level care and be willing and able to receive that care in their home or community.

Income - In 2017, an unmarried applicant is allowed income up to 300% of the federal benefit rate.  In dollar terms, they must have less than $2,205 / month in income.  Married applicants are permitted higher income levels, if only one spouse is applying for the program.  The non-applying spouse can have up to $3,022.50.   However, an exception to this income limits exists for persons with unusually high care expenses.   The Medically Needy (MN) Program evaluates the applicant's medical expenses and their income. If it is discovered they cannot afford their care and they spend-down all their excess income on their medical care, then they can qualify for Medicaid assistance.

Assets - for a single applicant, in 2017, they must have countable resources valued at less than $2,000. Married couples that apply together can have up to $4000 in savings. The home in which the applicant lives (as long as their home equity is valued at or under $560,000), primary vehicle, and certain other personal items are considered exempt for their countable resources. If only one spouse is applying for Medicaid, the non-applicant spouse may be allowed up to $120,900 in joint assets.  

 Individuals who exceed the financial limits may still qualify for this waiver (and Kentucky Medicaid).  A variety of options exist that can help individuals or families lower their month income or their countable assets so that they meet the program’s requirements.  One can do this by working with a Medicaid Planning professional. This approach may not be appropriate for everyone.  Learn more


Benefits and Services

Not all applicants will be approved for the same services. Follows is a list of possible services that are covered by this waiver. Note that beneficiaries can choose their providers for some of these services, such as personal care, but not for others, such as assessments. Consumer direction allows participants to choose their providers but does not allow them to choose how much to compensate them.

  • Assessments / Reassessments - for medical and personal care requirements
  • Case Management - for all waiver participants
  • Minor Home Adaptations - intended to increase the independence of the recipient. Can be consumer directed. 
  • Adult Day Health Care / Adult Day Care- group care during normal business hours
  • Homemaker Services - includes laundry, housekeeping, and shopping services for the waiver participant only. Can be consumer directed. 
  • Personal Care - can be consumer directed
  • Personal Emergency Response Services (PERS) – included under Home Modifications
  • Respite Care - temporary caregiving relief for the primary caregiver. Can be consumer directed. 
  • Attendant Care - provides assistance with daily tasks, such as dressing, eating, and moving from one location to another. Can be consumer directed.


How to Apply / Learn More

This waiver is available throughout Kentucky. To learn more about the program and to apply one should contact the local office of the Cabinet for Health and Family Services (CHFS) or visit the webpage for this program.  Once participating in the program, individuals are re-assessed, at a minimum, of one time per year to ensure their care needs have not progressed beyond the services they are receiving. 

It is very likely that waiting lists for services exist.  Another assistance option that may be relevant and more immediately available is the Adult Day Care and Alzheimer's Respite Program.