Kentucky Medicaid for Seniors & Long-Term Care

The Home and Community-Based (HCB) Waiver is Kentucky's primary 1915(c) waiver for individuals age 65 and older, and for adults with physical disabilities. It allows people who meet nursing facility level of care to receive services at home or in community settings. The Department for Aging and Independent Living (DAIL) partners with the Department for Medicaid Services to operate this waiver; contact DAIL at 1-877-315-0589 for information on eligibility and enrollment. There is currently a waiting list for HCB services, with placement determined by the date a completed application is received.

The Michelle P. Waiver serves adults with intellectual and developmental disabilities (I/DD). Named for Michelle P., a Kentucky resident whose court case established rights for individuals with intellectual disabilities, the waiver provides residential supports, employment supports, community integration, and behavioral health services. The Division of Developmental and Intellectual Disabilities (DBHDID) coordinates this waiver. The Supports for Community Living (SCL) Waiver covers similar services for people with intellectual disabilities who live in supported community settings. Both Michelle P. and SCL have waiting lists — early application is strongly encouraged. Contact DBHDID at 502-564-7700 to apply.

Kentucky launched the Community Health for Improved Lives and Development (CHILD) Waiver in 2025. This 1915(c) waiver serves individuals age 21 and younger with complex, multi-system behavioral health or developmental needs who require intensive supports to remain safely at home and in their communities, filling a gap that previously existed for youth whose needs exceeded standard Medicaid but who did not qualify for existing waivers.

Kentucky participates in the Program of All-Inclusive Care for the Elderly (PACE). PACE provides fully integrated medical, behavioral health, personal care, and social services for seniors age 55 and older who require nursing facility-level care but prefer to remain in the community. PACE serves as your managed care organization — you receive all services through the PACE organization.

Kentucky Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Once approved, Medicaid pays the nursing home directly, and the resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance of $60 per month — with Medicaid covering the gap. If income exceeds the institutional Medicaid limit, Kentucky may use a Miller Trust (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Kentucky also applies a 60-month (5-year) Medicaid look-back period on asset transfers preceding a Nursing Home Medicaid or waiver application; transfers below fair market value during this window can trigger a penalty period of ineligibility.

The Cabinet for Health and Family Services (CHFS) operates an estate recovery program. The state may seek reimbursement from the estate of a Medicaid member who received long-term care services — nursing facility, HCBS waiver, or PACE — after age 55. Recovery does not apply to other Medicaid-covered health care received before age 55 outside of institutional settings. A surviving spouse, minor child, or disabled child living in the home defers recovery. Consult an elder law attorney before structuring assets if a family member may need long-term care Medicaid in the near future.