Page Reviewed / Updated - September 27, 2020
Kentucky’s Home and Community Based Services 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. This is largely because it leverages family members as primary caregivers. Of course, the added benefit is individuals typically prefer to remain living in their homes. Please note that program participants are also able to live in adult foster care homes.
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. Family members and friends can be hired as paid caregivers, including spouses and adult children. 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. In Kentucky, it is also referred to as Participant-Directed Services (PDS). Not all services provided under this waiver are appropriate for consumer control. But those that require little to no medical skills training can be self-directed. Chief among these are personal care, homemaker services, unskilled respite care, and minor home adaptations. The one exception is that program participants who live in adult foster care homes are not able to self-direct their care.
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. This waiver is also open to those designated as disabled by Social Security who are 64 years of age and under.
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 2020, an unmarried applicant is allowed income up to 300% of the Federal Benefit Rate (FBR). In dollar terms, an individual must have $2,349 / month or less in income. Married applicants (both spouses applying) are each allowed up to $2,349 / month in income, as income is considered separately. If the applicant is married and his/her spouse is not also applying for Medicaid services, the applicant is able to transfer some of his/her income to the non-applicant spouse (also referred to as the community spouse) to prevent him/her from becoming impoverished. As of 2020, the applicant can transfer a maximum of $3,216 / month to the non-applicant spouse. This is called the Maximum Monthly Maintenance Needs Allowance (MMMNA).
Persons who are over the income limit can still qualify by depositing their “excess” income into a Qualified Income Trust.
Assets - For a single applicant, in 2020, countable resources must be valued at less than $2,000. Married couples that apply together can have up to $4,000 in savings. The home in which the applicant or his/her spouse lives (for a single applicant, the home equity must be valued at or under $595,000), a primary vehicle, and certain other personal items are considered exempt from his/her countable resources. For applicants who are married, all assets are considered jointly owned. Learn more here. If only one spouse is applying for Medicaid, the non-applicant spouse may be allowed up to $128,640 in joint assets. In Medicaid-speak, this is called the Community Spouse Resource Allowance (CSRA). Please note that the applicant spouse is still able to keep $2,000 in countable assets.
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.
Kentucky’s Home and Community Based Services Medicaid waiver is available throughout the state. To learn more about this 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 enrolled in this program, individuals are re-assessed, at a minimum, 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.