Kentucky Medicaid pays for home and community care for older adults and people with physical disabilities through 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 Oct 13, 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 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 Oct 13, 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 home and community-based services for people who, without those services, would otherwise need care in an institution such as a nursing facility.U.S. Government Publishing Office. (n.d.). 42 CFR 441.302 — State assurances (eCFR, current). ecfr.gov. Retrieved Oct 3, 2026, from https://www.ecfr.gov/current/title-42/section-441.302
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 Oct 13, 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 Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY DAIL is also the office the Cabinet's HCB page sends you to with questions about the program itself, by email at CHFSDAILHCBWaiverParticipantInquiries@ky.gov or by phone at (877) 315-0589.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY
Participants on the HCB waiver 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 Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY Hiring your own employees gives the person receiving care a direct say in who provides that care.
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 Oct 13, 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 Oct 13, 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 a 1915(c) waiver serves people who, without its services, would otherwise be in an institution, not people who need lighter, occasional help.U.S. Government Publishing Office. (n.d.). 42 CFR 441.302 — State assurances (eCFR, current). ecfr.gov. Retrieved Oct 3, 2026, from https://www.ecfr.gov/current/title-42/section-441.302
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 Oct 13, 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. According to the federal Centers for Medicare & Medicaid Services (CMS), the waiver provides adult day health, attendant care, case management, environmental and minor home adaptation, financial management services, goods and services, home-delivered meals, and both specialized and non-specialized respite.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY The Cabinet's own page says its services include but are not limited to adult day health care, attendant care, environmental and minor home adaptation, home-delivered meals, and respite care, so treat neither list as complete and ask about a specific service you need.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY Together, these cover hands-on attendant help at home, adult day health care outside it, meals brought to the door, changes to the home itself, and respite that lets a family caregiver step away.
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 October 2026, the Cabinet's page states that there is currently 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 Oct 13, 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 Oct 13, 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 that is not yet complete does not set your date, so getting every piece in is what secures your place.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY The Cabinet's page describes no priority or emergency route around the list. If your situation is urgent, call DAIL at (877) 315-0589 to ask how your circumstances are handled, and keep your application current while you wait.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY
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 in one of three ways: online through kynect, Kentucky's benefits portal; by phone with the Department for Community Based Services (DCBS) at (855) 306-8959; or in person at a DCBS office.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Oct 13, 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: federal rules cap the agency at 45 days, or at 90 days for applicants who apply for Medicaid on the basis of disability, except in unusual circumstances, such as a delay caused by the applicant or an examining physician.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 That split follows the basis you applied under, not whether a disability question arises in your file, so an older adult applying on the basis of age is on the 45-day cap even though the HCB waiver requires a nursing-facility level-of-care review. Both are ceilings on the agency, not a decision you are promised on the last day, and the state may not use them as a waiting period or as a reason to deny you.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912
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 Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY From there, the date your completed application is received sets your place on the waiting list.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY
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 Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY Hiring your own employees is what gives you a direct hand in who delivers your care. A relative can be one of those employees, with limits. Under Kentucky's HCB regulation, an immediate family member (such as an adult child, parent, or spouse), a guardian, or a legally responsible individual can be paid only through PDS and only with the department's written approval, after submitting the PDS Request Form for Immediate Family Member, Guardian, or Legally Responsible Individual as a Paid Service Provider. Every PDS employee is limited to 40 hours a week of paid services across all the participants they serve, and the person chosen as your PDS representative cannot also be hired as your employee.apps.legislature.ky.gov. (n.d.). 907 KAR 7:010. Home and community based waiver services version 2 — Kentucky Legislative Research Commission. Retrieved Oct 14, 2026, from https://apps.legislature.ky.gov/law/kar/titles/907/007/010/ DAIL answers questions about the program at (877) 315-0589.Centers for Medicare & Medicaid Services. (1915). Kentucky Waiver Factsheet — Medicaid.gov (CMS), 1915(c) HCBS waiver descriptions. medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY Our guide to Kentucky caregiver programs lays out the approval conditions in full.
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 Oct 13, 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 Oct 13, 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, by calling DCBS at (855) 306-8959, or in person at a DCBS office, 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 Oct 13, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KY Under federal Medicaid rules, the state may not take longer than 45 days on an application, or 90 days for applicants who apply for Medicaid on the basis of disability, except in unusual circumstances such as a delay caused by the applicant or an examining physician.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 The longer window follows the basis you applied under, not whether a disability question arises, so an age-based application stays on the 45-day cap. Both are ceilings on the agency rather than a promised decision date, and the state may not use them as a reason to deny an application.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912
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