Getting paid to care for a family member in Kentucky
Depends.
In Kentucky, whether a family member can be paid depends on the program's rules, which are below with their sources. Whether a spouse can be paid depends on conditions set out below with their sources.
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Medicaid waiver
Home and Community Based Waiver
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Program status
There is a waiting list for HCB services and supports. Your place on the list is set by the date your completed application is received.
People who are age 65 or older and/or have a physical disability, who meet the requirements for living in a nursing facility (907 KAR 1:022), and who meet the financial qualifications for Medicaid, including special financial qualifications that apply to the HCB waiver.
The Department for Medicaid Services and the Department for Aging and Independent Living operate the waiver together.
People receiving services through the Home and Community Based (HCB), Acquired Brain Injury (ABI), Acquired Brain Injury Long-Term Care (ABI LTC), Michelle P. (MPW) or Supports for Community Living (SCL) waivers. You hire your own employees for some or all of your services, and you can keep other services with traditional providers.
As the employer you work with a PDS case manager on your service plan, and you hire, train, schedule and fire your staff.
Depends.
Depends. Kentucky's regulation and its newer guidance differ. The regulation, 907 KAR 7:010 Section 6(8), says an immediate family member (Kentucky law defines this to include a parent, child, stepchild, sibling, grandparent, grandchild or in-law) may provide participant-directed services only upon written approval from the department, and only if the person submits the department's request form, has unique abilities needed to meet your needs, has education, job experience, volunteer work or training beyond your direct care, provides services that are not natural supports, helps you take part in the community, and either the nearest provider is more than 30 miles from your home or no qualified provider can deliver your plan or fit your schedule. The Cabinet's PDS page says you may hire certain family members, and its PDS FAQ (updated June 27, 2024) says a person who is not a legally responsible individual does not need to be reviewed.
Kentucky law says an agency cannot change, expand or limit a regulation through internal policy, a memorandum or other action (KRS 13A.130), so the regulation is cited as the governing rule. The FAQ (https://www.chfs.ky.gov/agencies/dms/dca/waivers/WaiverPDSFAQ.pdf) says only a spouse or a court-appointed guardian is a legally responsible individual who must be reviewed: see the next two answers. Every PDS employee must be at least 18 and meet the regulation's background check requirements.
Depends.
Only after approval, and only if at least one of these is verified: caring for you has reduced or ended your spouse's ability to keep a paid job in the past 12 months and no other caregiver in the home is able to provide care; your spouse tried for the first 30 days to recruit a qualified provider, traditional or PDS, and could not get enough coverage for all care; or you have a communication barrier that affects your ability to tell a care provider your needs and wishes.
A spouse is a legally responsible individual, and can be paid only for care beyond what a spouse would ordinarily provide. A spouse hired on or after July 1, 2024 is reviewed at the time of hire, before beginning work.
Depends.
Only after approval. A court-appointed legal guardian of an adult is a legally responsible individual and must meet the same criteria as a spouse: at least one of lost paid employment with no other able caregiver in the home, 30 days of failed attempts to recruit another qualified provider, or a communication barrier.
A person holding a power of attorney is not a legally responsible individual unless they also meet that definition. A legal guardian is appointed by a Kentucky District Court.
Your PDS case manager helps you find service providers and negotiate rates. You track the services your employee performs and submit a timesheet, and a financial management agency pays the employee and withholds taxes.
First get financial eligibility for Medicaid: apply online through kynect, by calling the Department for Community Based Services at (855) 306-8959, or in person at a DCBS office. Then apply for HCB waiver services online through kynect, or in person at an Aging and Disability Resource Center or a Community Mental Health Center.
The Medicaid Waiver Services Fact Sheet (MAP 418) lists documents that are helpful to have when you apply.
If you are interested in enrolling in PDS, talk to your case manager. To find a PDS case manager, contact an Area Agency on Aging or a Community Mental Health Center.
