Kentucky Medicaid pays for home and community care for older adults and people with physical disabilities mainly through one program: the Home and Community Based (HCB) waiver.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY Among Kentucky Medicaid HCBS waivers, the HCB waiver is the one built for older adults and for adults and children with physical disabilities who meet a nursing-facility level of care but want to keep living in their own home or community instead of moving into a nursing facility.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY Home and community-based services, or HCBS, are the supports that make staying home possible.
In This Guide
- What Kentucky Medicaid HCBS Waivers Are
- Inside the HCB Waiver, Kentucky's Home and Community Based Program
- Who Qualifies for Kentucky Medicaid HCBS Waivers
- What the HCB Waiver Covers
- The Waiting List and How Enrollment Works
- How to Apply for the HCB Waiver
What Kentucky Medicaid HCBS Waivers Are
Home and community-based services (HCBS) waivers let a state use Medicaid to pay for long-term care outside an institution, in a person's own home or in the community. The tool that makes this possible is the federal 1915(c) HCBS waiver authority, which lets a state cover in-home supports for people who would otherwise need care in a nursing facility.
Kentucky uses that authority to run the Home and Community Based (HCB) waiver, a 1915(c) waiver with the federal waiver number 0144.R08.00.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY In plain terms, the HCB waiver is Kentucky's way of paying for the day-to-day help an older adult or a person with a physical disability needs, so that they can stay at home rather than move into a nursing facility.
The rest of this guide focuses on that program: how it works, who it is for, and the steps to get on it.
Inside the HCB Waiver, Kentucky's Home and Community Based Program
The HCB waiver is administered by the Kentucky Cabinet for Health and Family Services, Department for Medicaid Services (DMS), which operates the program together with the Department for Aging and Independent Living (DAIL).Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY That pairing matters because it reflects how the waiver is meant to work: the Medicaid agency pays for the services, and the aging-and-disability side helps coordinate the supports a person needs at home.
One feature sets the HCB waiver apart from a standard agency-only benefit. Participants can choose how their non-medical, non-residential services are delivered. You can have a traditional provider agency send its staff, you can hire and manage your own employees, or you can do a combination of both. Kentucky calls this Participant Directed Services (PDS).Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY For many families, PDS is the reason the waiver fits their life, because it lets the person receiving care, or a representative acting for them, have a direct say in who provides that care and how.
Who Qualifies for Kentucky Medicaid HCBS Waivers
Qualifying for the HCB waiver comes down to two separate tests, a functional one and a financial one, and you have to clear both.
Functional eligibility. You must meet a nursing-facility level of care. On the HCB waiver, that is defined as meeting the requirements for residence in a nursing facility under Kentucky's regulation at 907 KAR 1:022.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY The program is built for two groups: individuals with physical or other disabilities ages 0 to 64, and individuals ages 65 or older, who meet that level of care.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY The point of the level-of-care test is that the waiver is meant for people whose needs would otherwise justify nursing-facility placement, not for lighter, occasional help.
Financial eligibility. You must meet the financial qualifications for Medicaid, and the HCB waiver program applies special financial qualifications of its own.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY Because the income and asset rules that govern Kentucky Medicaid long-term care are detailed and can change, this guide points you to them rather than restating a figure that might drift out of date: see our Kentucky Medicaid eligibility and income limits guide, and, for the rules that apply specifically to long-term care, our Kentucky Medicaid long-term care guide. Confirm your own numbers with the state before you rely on them.
What the HCB Waiver Covers
The HCB waiver pays for a defined set of home and community services. Covered services include adult day health care, attendant care, environmental and minor home adaptation, home-delivered meals, case management, financial management services, and both specialized and non-specialized respite care.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY In practice: attendant care is the hands-on help with bathing, dressing, and getting around; adult day health care gives a caregiver hours to work or rest; home-delivered meals and minor home adaptations, like a grab bar or a ramp, keep the home workable; and respite care covers a caregiver so they can step away without leaving their family member without support.
Case management ties it together, helping a participant plan services and coordinate the people delivering them.
The Waiting List and How Enrollment Works
Meeting the eligibility rules is the first step, but it does not put services in place the same day. As of the most recent verification, there is a waiting list for HCB services and supports.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY Your place on that list is determined by the date your completed application is received.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY
Two things follow from that. First, the date-received rule rewards applying sooner rather than later, because a completed application filed today holds a spot ahead of one filed next month. Second, "completed" is the operative word: an application missing pieces can stall, so getting it fully in is what starts your clock. If your situation is urgent, contact the state to ask how your circumstances are handled, and keep your application current while you wait.
How to Apply for the HCB Waiver
Applying for the HCB waiver happens in two stages, and it helps to know that going in.
Stage one, qualify for Medicaid financially. You first establish Medicaid financial eligibility. You can apply online through kynect, Kentucky's benefits portal, or by calling the state's Medicaid intake office (the Department for Community Based Services, or DCBS) at (855) 306-8959.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY Federal Medicaid rules require the state to accept an application through several channels, including online, by phone, by mail, and in person, so you are not locked into a single method.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 After you apply, the state has a set window to decide: under federal rules a Medicaid eligibility decision generally must come within 45 days, or within 90 days when eligibility is based on a disability.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf
Stage two, apply for the HCB waiver itself. Once your Medicaid financial eligibility is in place, you complete the HCB waiver application. You can do this through kynect, through an Aging and Disability Resource Center, or through a Community Mental Health Center.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY From there, your completed application sets your place on the waiting list, and the program moves people into services as capacity allows.
For a fuller walkthrough of the state's Medicaid application in general, see our how to apply for Kentucky Medicaid guide.
Frequently Asked Questions
Can I hire a family member or direct my own care on the HCB waiver?
You can direct your own care through Participant Directed Services (PDS). Under PDS, you choose whether a traditional provider agency delivers your non-medical, non-residential services, whether you hire and manage your own employees, or whether you use a combination of both.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY This is what gives many participants the option to bring on caregivers they know and to have a direct hand in how their care is delivered.
How is the HCB waiver different from going into a nursing home?
Both paths serve people who meet a nursing-facility level of care, but the HCB waiver is designed so that a person can receive that level of support in their own home or community rather than in a facility.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY It pays for services such as attendant care, adult day health care, home-delivered meals, and respite care that make staying at home workable.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY Which path fits depends on a person's medical needs, their home setting, and the support available around them.
How do I apply, and how long does a Medicaid decision take?
Start by establishing Medicaid financial eligibility online through kynect or by calling the state's Medicaid intake office (DCBS) at (855) 306-8959, then complete the HCB waiver application through kynect, an Aging and Disability Resource Center, or a Community Mental Health Center.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY Under federal Medicaid rules, the state generally must decide an application within 45 days, or within 90 days when eligibility is based on a disability.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf
Learn More
Find personalized help applying for Kentucky's HCB waiver 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.