Key takeaway
Kentucky pays family caregivers through Medicaid HCBS waivers including the Home and Community Based (HCB) Waiver and the Michelle P. Waiver. Both can be combined with the Consumer Directed Option (CDO), which lets the recipient hire a family member.
- HCB Waiver: For adults 65+ or with disabilities; pays family caregivers under CDO.
- Michelle P. Waiver: For Kentuckians with intellectual or developmental disabilities; supports family caregivers.
- Consumer Directed Option (CDO): The mechanism that pays family caregivers; spouses and legal guardians are excluded.
- Veterans: Aid & Attendance and Veteran Directed Care can pay family, including spouses under VDC.
Overview
Kentucky Medicaid, administered by the Department for Medicaid Services (DMS) and the Department for Aging and Independent Living (DAIL), funds paid family caregiving primarily through HCBS waivers. The Home and Community Based (HCB) Waiver serves older adults and adults with physical disabilities. The Michelle P. Waiver and the Supports for Community Living (SCL) Waiver serve Kentuckians with intellectual or developmental disabilities.
Each of these waivers can be paired with the Consumer Directed Option (CDO), which lets the participant act as the employer of record and hire a family member as their paid caregiver. Spouses, legal guardians, and parents of minors are generally excluded under CDO. Kentucky's Area Agencies on Aging and Independent Living (AAAILs) coordinate non-Medicaid supports, and veterans have additional VA pathways including Veteran Directed Care.
Programs that pay family caregivers in Kentucky
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| Home and Community Based (HCB) Waiver (Medicaid 1915(c) waiver) | Kentuckians 65+ or adults with a physical disability who meet nursing-facility level of care and Medicaid financial limits. | Combined with the Consumer Directed Option (CDO), pays family caregivers. Spouses, legal guardians, and parents of minors are excluded. |
| Michelle P. Waiver (Medicaid 1915(c) waiver) | Kentuckians of any age with an intellectual or developmental disability who meet ICF/IID level of care. | Includes attendant care and supports that can be delivered by family caregivers under the Consumer Directed Option. |
| Supports for Community Living (SCL) Waiver (Medicaid 1915(c) waiver) | Kentuckians with an intellectual or developmental disability needing comprehensive supports. | Can pay family caregivers through participant-directed services, subject to waiver rules. |
| Consumer Directed Option (CDO) (Self-direction option) | Participants in the HCB, Michelle P., SCL, Acquired Brain Injury, and Model Waiver II programs. | Individualized budget lets the participant hire and pay caregivers, including family. Spouses, legal guardians, and parents of minors are excluded. |
| Aid & Attendance Pension (VA benefit) | Wartime veteran or surviving spouse who needs help with daily activities and meets VA pension rules. | Increases pension to offset care costs; can pay adult children and relatives. Spouses are not paid directly. |
| Veteran Directed Care (VDC) (VA program) | Veterans in VA health care needing nursing-home level care, living in a participating VAMC area. | Monthly care budget the veteran manages to hire caregivers, including spouses. |
Kentucky Medicaid programs
Kentucky Medicaid funds paid family caregiving through HCBS waivers, most often the Home and Community Based (HCB) Waiver and the Michelle P. Waiver. The Consumer Directed Option (CDO) is the self-direction mechanism that lets the participant choose and pay their family caregiver.
Home and Community Based (HCB) Waiver
The HCB Waiver serves Kentuckians 65 and older or adults with a physical disability who would otherwise need nursing-facility care. It funds personal care, homemaker, respite, and adult day services.
- Must be 65+ or have a qualifying physical disability and meet nursing-facility level of care.
- Financial eligibility follows Kentucky Medicaid long-term care rules.
- When paired with CDO, pays a family caregiver chosen by the participant.
- Spouses, legal guardians, and parents of minors are excluded from being paid.
Michelle P. Waiver
The Michelle P. Waiver serves Kentuckians with an intellectual or developmental disability and provides a broad set of community-based supports.
- Any age with a qualifying I/DD and ICF/IID level of care.
- Includes attendant care, community access, day training, and supported employment.
- CDO option lets family caregivers be hired (not spouses or legal guardians).
Consumer Directed Option (CDO)
CDO is the participant-directed model that pays a family caregiver. The participant (or their representative) recruits, hires, and supervises the caregiver, while a financial management service handles payroll.
- Available under HCB, Michelle P., SCL, Acquired Brain Injury, and Model Waiver II.
- A support broker helps plan and manage the individualized budget.
- Family caregivers can be paid except spouses, legal guardians, and parents of minors.
Kentucky Area Agencies on Aging and Independent Living
Outside of Medicaid, Kentucky's 15 Area Agencies on Aging and Independent Living (AAAILs) coordinate caregiver supports under the Older Americans Act and state-funded programs. These supports rarely replace a full caregiver wage but offset the cost of providing care.
Counseling, training, respite vouchers, and supplemental supports for unpaid family caregivers of older adults.
Kentucky AAAILs coordinate adult day services and short-term respite so family caregivers can take breaks.
Who qualifies
- Family caregivers of adults 60+ or of any age with Alzheimer's/related dementia.
- Grandparents 55+ raising grandchildren may also qualify.
- Availability and stipend amounts vary by AAAIL and funding year.
Veterans' programs
Kentucky veterans and surviving spouses can use VA benefits to fund in-home care. The Lexington and Louisville VAMCs offer the Caregiver Support Program, and Veteran Directed Care is available through several participating VAMC service areas.
Aid & Attendance Pension
A&A increases a qualifying veteran's or surviving spouse's pension to cover care costs when help with daily activities is needed. The veteran can use the boost to compensate a family caregiver.
- Wartime service, ADL need, and income/asset limits required.
- Commonly used to pay adult children and other relatives.
- Spouses cannot be paid directly through A&A.
Veteran Directed Care (VDC)
VDC provides a flexible monthly care budget the veteran manages with help from a financial management service. It is the only VA path that can pay a spouse.
- For veterans meeting nursing-home level of care in VA health care.
- Family caregivers, including spouses, can be hired.
- Availability depends on participating Kentucky VAMCs.
Long-term care insurance
A qualifying long-term care insurance policy may pay benefits used to compensate a family caregiver depending on policy terms.
What to check in the policy
- Policy must cover in-home personal care, not just nursing-facility care.
- Cash/indemnity policies that pay the policyholder directly are the most flexible.
If the policy only reimburses licensed agencies, families sometimes have the caregiver hired through a licensed Kentucky home care agency so the insurer will pay.
How to apply in Kentucky (step-by-step)
- Identify the path: HCB Waiver (65+ or physical disability), Michelle P. or SCL (I/DD), Consumer Directed Option, VA benefits, or LTC insurance.
- Gather documents: ID, proof of Kentucky residency, income/asset records, medical history, and (for veterans) DD-214.
- Contact the right agency:
- HCB Waiver: contact the Kentucky Department for Aging and Independent Living (DAIL) or your local AAAIL for an HCBS assessment.
- Michelle P. or SCL Waiver: contact your regional Community Mental Health Center (CMHC) or DAIL.
- Consumer Directed Option: ask your case manager or service coordinator about CDO and a financial management service.
- VA paths: speak with a VA social worker at the Lexington or Louisville VAMC about A&A and VDC.
- Complete a level-of-care assessment and a financial eligibility review through Kentucky Medicaid.
- Choose CDO and select your family caregiver; enroll with the financial management service for payroll.
- Begin services; submit timesheets and care notes; renew annually.
Kentucky paid caregiver FAQs
Can a spouse be paid as a caregiver in Kentucky?
No under Kentucky Medicaid HCBS waivers (HCB, Michelle P., SCL) when paired with the Consumer Directed Option. A spouse can be paid as a caregiver under VA Veteran Directed Care when the veteran qualifies.
How much do caregivers get paid in Kentucky?
Consumer Directed Option wages are set by the participant within their individualized budget and Kentucky Medicaid guidelines, typically about $12 to $17 per hour.
Can I be paid to care for my parent in Kentucky?
Yes. Adult children are commonly paid as caregivers through the HCB Waiver paired with CDO, or through VA A&A or VDC. Spouses and legal guardians are excluded under Medicaid.
What is the Michelle P. Waiver in Kentucky?
The Michelle P. Waiver is a Kentucky Medicaid 1915(c) HCBS waiver that serves people with intellectual or developmental disabilities. It funds attendant care, community access, day training, and respite, and can be paired with the Consumer Directed Option to pay a family caregiver.
How long does the HCB Waiver take to approve in Kentucky?
Once you contact DAIL or your AAAIL and complete the assessment, enrollment typically takes several weeks. Slot availability can extend timelines, so it is worth asking about current waitlists.
