If you are caring for an aging parent, a spouse, or an adult child in Kentucky, a Medicaid waiver may be able to pay a family member to provide some of that care, on conditions. Participant Directed Services lets a Medicaid waiver participant hire their own workers for non-medical waiver services, and its rules do not bar a spouse from the payroll; they set conditions a spouse has to meet. Kentucky's caregiver programs also include waiver respite, NFCSP caregiver support, and VA benefits, each with its own eligibility rules.

You don't have to figure this out alone, and you don't have to fund all of it from your savings.

In This Guide

Kentucky Caregiver Programs at a Glance

Program What It Offers Who Qualifies Cost to You
Participant Directed Services (PDS) Participant hires and directs their own workers, including relatives (on HCB, immediate family need written approval) Medicaid 1915(c) waiver participants (HCB, SCL, Michelle P., ABI); each of these waivers currently has a waiting list Paid by Medicaid; the participant must meet any patient liability the Department for Community Based Services sets
Paid legally responsible individual (LRI) Spouse, or parent of a minor child, paid for care beyond what they would ordinarily provide PDS participants whose LRI meets the waiver's conditions (for an adult participant, one of three verified circumstances) and files the required request form Paid by Medicaid; the participant must meet any patient liability the Department for Community Based Services sets
NFCSP caregiver support Caregiver information, counseling, support groups, training, respite Caregivers of adults 60+ or of a person with ADRD; respite requires a frail older care recipient Ask your area agency on aging
VA PCAFC Monthly stipend; can pay a spouse Veteran with a 70%+ VA rating, a discharge or medical-discharge date, a 6+ month need for in-person care, and VA health care enrollment, plus VA's own assessment Free (VA benefit)
VA Aid and Attendance Monthly payment added to a VA pension; up to $29,093/yr for a single veteran, less countable income Wartime veteran or survivor who gets a VA pension, meets a functional requirement, and is under the net-worth limit Free (VA benefit)

Programs That Pay Family Caregivers

One threshold first: the paid routes in this guide run through a Medicaid waiver or the VA, so the person you care for needs to be enrolled in a Medicaid waiver or be a qualifying veteran. If neither is true yet, focus on the NFCSP caregiver support below while you work toward eligibility.

Participant Directed Services (PDS)

Participant Directed Services (PDS) is the self-directed option within Kentucky's Medicaid 1915(c) waivers. The Department for Aging and Independent Living (DAIL) answers PDS policy questions, and DAIL and the Department for Medicaid Services (DMS) jointly issue the PDS FAQ. The waiver participant is the employer of record: they hire, train, schedule, and terminate their own employees for non-medical, non-residential waiver services instead of using a traditional provider agency.

PDS is available through the Home and Community Based (HCB) waiver for the elderly and people with physical disabilities, the Supports for Community Living (SCL) waiver for people with an intellectual or developmental disability, the Michelle P. Waiver (MPW), and the Acquired Brain Injury (ABI and ABI-LTC) waivers.,, But PDS is a way to receive waiver services, not a way onto a waiver: CHFS states there is a waiting list for allocation of the SCL waiver and of the two brain injury waivers, and a waiting list for the Michelle P. Waiver. The HCB waiver's own page says there is currently a waiting list for HCB services and supports too.

Who can be paid on the HCB waiver. On the Home and Community Based waiver most older Kentuckians use, an immediate family member (under KRS 205.8451(3), a parent, grandparent, spouse, child, stepchild, and other listed relatives), a guardian, or a legally responsible individual can be paid only through PDS and only with the department's written approval. They file the PDS Request Form for Immediate Family Member, Guardian, or Legally Responsible Individual as a Paid Service Provider, and must have unique abilities and training or experience beyond caring for the participant; the services cannot be natural supports and must help the participant take part in the community; and either no provider is within 30 miles or no qualified provider can deliver the care plan or fit the participant's schedule. On HCB, every PDS worker is capped at 40 hours a week across all participants, and the PDS representative cannot be hired as a worker.

The LRI review and the spouse rule. A worker who is not a legally responsible individual (LRI), such as an adult child of an adult participant, does not need to be reviewed as one. That exempts them from DAIL's LRI review only, not HCB's written approval. A spouse is an LRI, and Kentucky's rules permit an LRI to be paid, on conditions. The condition that runs through all of them is that the care exceeds the range of activities a legally responsible individual would ordinarily perform in the household for a person of the same age without a disability or chronic illness, and is necessary to protect the participant's health and welfare and avoid institutionalization. For an adult participant, at least one of three circumstances must also be identified and verified: caregiving has reduced or eliminated the spouse's ability to keep paid work within the previous twelve months and no other caregiver in the home is functionally able to provide care; the spouse can show attempts within the first thirty days to recruit a qualified provider, both traditional and PDS, but is unable to secure another provider or enough provider coverage for all care; or the participant has a communication barrier that affects their ability to communicate needs and wishes to a care provider., The rest are set waiver by waiver. Under the Supports for Community Living waiver, for instance, the particular service has to allow it, and some SCL services are closed to these relatives outright: an immediate family member, guardian, or legally responsible individual cannot provide participant-directed goods and services to the participant. The spouse also has to meet the conditions the regulation sets for a family member, which include that no qualified provider is available within thirty miles of the participant's residence or at the times and places the care is needed, that the service is not something the family member normally provides anyway, and that paying them is cost effective; a MAP-532 PDS Request Form has to be completed and uploaded to the MWMA, and DAIL decides within fourteen business days of receiving it. Two more SCL limits: a paid legally responsible individual or immediate family member cannot be reimbursed for more than forty hours of PDS a week, and anyone serving as the participant's representative is not eligible to provide waiver services to that participant at all. Our guide to getting paid to care for a spouse in Kentucky walks the route in full.

As Employer of Record, the participant is responsible to the federal, state, and local government for the taxes associated with having employees. A Financial Management Agent (FMA) expresses those taxes (federal and state unemployment taxes, FICA, and any local taxes) as a percentage added to employees' wages as timesheets are submitted. The rate varies with the participant's circumstances and with state and federal law, but is typically around 11.30%, and the FMA sets the exact percentage as part of the budget. The participant's authorization, which may be renewed annually, covers employees' wages for hours worked and the employer taxes incurred, so a change in the tax rate changes how many dollars are left for employees from year to year. The participant also authorizes that the time on employees' timesheets was worked to their satisfaction and sets the disciplinary rules up to termination.

PDS services are included in the 21% legislature-directed rate increase. To raise a worker's pay, start with the case manager; pay cannot exceed the maximum allowable rates in DMS's Home and Community Based Services Waiver Rates schedule, which DMS's fee and rate page now lists in a 2025 edition.

Before an employee can begin work under PDS, they must complete background checks, and the participant pays the fees: an Administrative Office of the Courts criminal record check ($20), a Nurse Abuse Registry check (which can be done online through the Kentucky Board of Nursing), a Kentucky Adult Caregiver Misconduct Registry check, and a Central Registry check ($10). The Central Registry check must be completed before employment starts under the Michelle P. Waiver, or within thirty days under the ABI-A, ABI-LTC, HCB, or SCL waivers; an employee whose results are not back in time is suspended from PDS payment until they are.

For the full guide to paid pathways, including how the pay is set: How to Get Paid as a Family Caregiver in Kentucky.

How to Apply for Kentucky Caregiver Programs

Here is the usual order.

1
Step 1

Call DAIL at (877) 925-0037

It is the Department for Aging and Independent Living's toll-free line for information about resources and supports in your community.

2
Step 2

Apply for the right Medicaid waiver

To be paid through PDS, the person you care for must be enrolled in one of Kentucky's 1915(c) waivers, the HCB, SCL, Michelle P., or Acquired Brain Injury waiver. The SCL, Michelle P., and brain injury waivers have waiting lists, so apply as early as you can. For HCB, you can apply online through kynect or in person at an Aging and Disability Resource Center or a Community Mental Health Center; there is currently a waiting list, and placement on it is set by the date your completed application is received.

3
Step 3

Choose your workers

Once enrolled, the participant must meet any patient liability obligations as determined by the Department for Community Based Services. The participant, or an authorized representative, then hires their own workers, who can include relatives. On HCB, immediate family need the department's written approval first.

4
Step 4

Set up payroll through the Financial Management Agent

The FMA adds the employer taxes to wages as a percentage, typically around 11.30%, as timesheets are submitted, but as Employer of Record you stay responsible for those taxes, for authorizing your employees' time, and for the fees for their required background checks.

Respite Care Programs

Caring for someone around the clock is exhausting, and needing a break does not make you a worse caregiver. This section covers two respite routes in Kentucky: one through Medicaid and one through the federal family caregiver program.

Medicaid Respite (HCB Waiver)

Kentucky's HCB waiver lists non-specialized and specialized respite care among its services, and an HCB participant can have non-medical, non-residential services delivered by a traditional provider agency, by employees they hire themselves, or a combination of both.

NFCSP Support Through Kentucky's Area Agencies on Aging

The National Family Caregiver Support Program (NFCSP), authorized under Title III-E of the Older Americans Act and administered federally by the Administration for Community Living, makes grants to states. Its services are provided by an area agency on aging or an entity the agency contracts with, and must include information about available services, help gaining access to them, individual counseling, support groups and caregiver training, respite care, and supplemental services on a limited basis. Eligible caregivers include adult family members and other informal caregivers of someone 60 or older, or of someone of any age with Alzheimer's disease or a related disorder. Respite and supplemental services carry one more condition: for a family caregiver, the person cared for must be an older individual who is frail, meaning unable to perform at least two activities of daily living without substantial human assistance, or needing substantial supervision because a cognitive or other mental impairment leads to behavior that poses a serious health or safety hazard. In Kentucky, DAIL runs Caregiver Support Services and works with the state's Area Agencies on Aging and Independent Living; call (877) 925-0037 for resources in your community.

For the full respite guide: Respite Care in Kentucky.

VA Caregiver Benefits in Kentucky

If the person you care for is a veteran, a second door opens, and it is one that can pay a spouse.

VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays a monthly stipend to the approved Primary Family Caregiver of an eligible veteran. It can pay a spouse, but it is paid only once the caregiver is enrolled in direct deposit through the VA customer engagement portal. VA's first screen has four requirements, and all of them must be true: the veteran has a VA disability rating (individual or combined) of 70 percent or higher, was discharged from the U.S. military or has a date of medical discharge, needs at least six months of continuous, in-person personal care services, and is enrolled in VA health care. Meeting those four is necessary but not sufficient. You and the veteran apply together, and the regulation, 38 CFR 71.20(a), adds conditions VA assesses during that process, including that taking part is in the veteran's best interest, that the same personal care is not already being provided regularly by another person or entity, that the veteran receives care at home, and that the veteran gets ongoing care from a primary care team.

The stipend is not a flat national figure. It starts from the federal Office of Personnel Management GS-4, Step 1 annual rate for the veteran's locality, divided by 12, then multiplied by a stipend factor: in the current program, 0.625, or 1.00 if VA determines the veteran is unable to self-sustain in the community. Legacy participants and applicants follow a separate schedule set by the veteran's 2019 clinical ratings, which ends on October 1, 2028; our guide to the PCAFC caregiver stipend explains both schedules. Confirm your figure with your VA Caregiver Support Coordinator.

Where the PDS conditions for a legally responsible individual cannot be met, the PCAFC stipend can still pay a spouse who is the veteran's approved Primary Family Caregiver. Veteran-Directed Care is another route: the veteran manages a budget for services and, with a counselor's help, hires their own workers, which VA says might include a family member. VA says services may vary by location, so ask the veteran's VA social worker whether it is available in yours. For information related to caregiving, call the VA Caregiver Support Line at 1-855-260-3274, Monday through Friday, 8:00 a.m. to 8:00 p.m. Eastern.

VA Aid and Attendance Pension

Aid and Attendance adds monthly payments to a VA pension. A veteran or survivor may be eligible if they get a VA pension, which requires wartime service, and meet at least one of VA's functional requirements, such as needing another person's help with daily activities like bathing, feeding, and dressing., From December 1, 2025, to November 30, 2026, the net worth limit to be eligible for Veterans Pension or Survivors Pension benefits is $163,699. The VA sets the rates as annual maximums, not payments: a single veteran with Aid and Attendance can receive up to $29,093 a year, and a veteran with one dependent up to $34,488 a year, less countable income.

Taxes for Kentucky Caregivers

IRS Notice 2014-7

If you live in the same home as the person you care for and are paid through a Medicaid waiver program, those payments may be excluded from federal gross income under IRS Notice 2014-7. The exclusion applies only to payments for care in the provider's home where the care recipient lives under their plan of care, so a worker who keeps a separate home may not exclude them. Talk to a tax preparer familiar with the rule before filing.

Kentucky State Income Tax

Kentucky levies a flat individual income tax, and the Department of Revenue's 2026 withholding formula sets the 2026 rate at 3.5% of taxable income. The department's general income tax page still shows 4 percent with no tax year attached; for 2026 income, the dated 2026 figure governs. Kentucky's income tax law is based on the Internal Revenue Code in effect as of December 31, 2024, but whether a payment excluded federally under IRS Notice 2014-7 is also outside Kentucky income is not settled, so confirm it with the Kentucky Department of Revenue or a tax preparer before you file.

VA PCAFC Stipend

VA described the monthly personal caregiver stipend as a nontaxable benefit in its March 6, 2020 proposed PCAFC rule.

Not sure which Kentucky caregiver program fits your family? Chat with Brevy's care navigator for a comparison based on your loved one's Medicaid enrollment, veteran status, and whether you are a spouse or non-spouse caregiver.

Where to Get Help in Kentucky

These are the front doors that route you to the rest.

Kentucky Department for Aging and Independent Living (DAIL) Start here: DAIL's toll-free line for information about resources and supports in your community. DAIL works with Kentucky's Area Agencies on Aging and Independent Living and runs Caregiver Support Services. (877) 925-0037
Kentucky Participant Directed Services (DAIL) DAIL is the contact for PDS policy questions. www.chfs.ky.gov/agencies/dail/Pages/pds.aspx
VA Caregiver Support Line For families of veterans: information related to caregiving, and a direct connection to local VA Caregiver Support Program teams. It is not a crisis line; anyone in crisis should call 988 and press 1. 1-855-260-3274 (Monday through Friday, 8:00 a.m. to 8:00 p.m. ET) www.va.gov/family-and-caregiver-benefits/health-and-disability/comprehensive-assistance-for-family-caregivers

Frequently Asked Questions

Can I get paid to care for my spouse in Kentucky?

Yes, on conditions. Participant Directed Services does not bar a legally responsible individual, such as a spouse or the parent of a minor child, from being paid. It requires that the care exceed what that person would ordinarily provide in the household and that it be necessary to protect the participant's health and welfare and avoid institutionalization. For an adult participant, one of the three verified circumstances described above must also apply. On HCB, the department's written approval is also required. Add the request form and whatever conditions the specific waiver sets; under the Supports for Community Living waiver the particular service has to allow it, some services are closed to a spouse outright, and a paid spouse is capped at forty hours a week. If your spouse is a veteran, the PCAFC stipend can pay you as the approved Primary Family Caregiver once VA finds you and the veteran eligible and you are enrolled in direct deposit through the VA customer engagement portal.

Who can be a paid PDS worker, and which waivers offer PDS?

The participant acts as the employer who hires, schedules, and terminates PDS workers, and a worker who is not legally responsible for the participant, such as an adult child of an adult participant, does not go through the legally-responsible-individual review. On HCB, though, immediate family need the department's written approval, and every PDS worker is capped at 40 hours a week. PDS is available through the Home and Community Based (HCB) waiver, the Supports for Community Living (SCL) and Michelle P. waivers, and the Acquired Brain Injury (ABI and ABI-LTC) waivers.,

How do I get on a Kentucky PDS waiver if my loved one isn't enrolled yet?

Enrollment comes first, and CHFS lists a waiting list for the SCL, both brain injury, and Michelle P. waivers, so it is worth applying early. For the HCB waiver, you can apply online through kynect or in person at an Aging and Disability Resource Center or a Community Mental Health Center, and there is currently a waiting list for HCB services and supports too.

Is there respite in Kentucky without Medicaid?

Possibly. The National Family Caregiver Support Program funds respite through area agencies on aging, but for a family caregiver it is available only when the older person cared for is frail, as defined in the respite section above. Call DAIL at (877) 925-0037 to find resources in your community.

How do I reach my Area Agency on Aging in Kentucky?

Call DAIL's toll-free line, (877) 925-0037, for resources in your community; DAIL works with Kentucky's Area Agencies on Aging and Independent Living. You can also use the national Eldercare Locator at 1-800-677-1116.

Learn More

CaregiverCaregiver Programs: The 50-State GuideA directory of caregiver programs in all 50 states: paid family caregiver pathways, respite, NFCSP grants, and VA benefits. Find your state's complete guide. CaregiverMedicaid Self-Direction and Consumer-Directed ServicesHow Medicaid self-direction lets a family member be your paid caregiver: employer authority, budget authority, the 1915(j) spouse rule, and how to get started. CaregiverThe National Family Caregiver Support Program (NFCSP): A Complete GuideWhat the National Family Caregiver Support Program funds, who is eligible, and how to reach respite and caregiver support through your Area Agency on Aging. CaregiverHow to Get Paid as a Family Caregiver in KentuckyHow to get paid to care for a family member in Kentucky in 2026: Participant Directed Services, who can be hired, the spouse rule, and VA options. CaregiverRespite Care in KentuckyFunded respite options for Kentucky family caregivers in 2026: PDS waivers, NFCSP respite through Area Agencies on Aging, adult day, and VA respite. CaregiverCaregiver Burnout: Signs, Stages, and How to Get SupportHow to recognize caregiver burnout, why it happens, and what actually helps, from respite care to evidence-based programs like REACH II and Powerful Tools. VA BenefitsVA Aid and Attendance in KentuckyVA Aid and Attendance in Kentucky for 2026: who qualifies, the annual pension rates, how to apply, and free accredited help from KDVA field reps. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house.
Your next step Find personalized help navigating Kentucky caregiver programs at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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