Kentucky’s Home and Community Based (HCB) Waiver provides care and support services to the elderly in their homes, allowing them to avoid institutionalization in a nursing home should they choose to do so. This waiver achieves the dual objectives of allowing individuals to age in place and saving money for the state of Kentucky.
Caring for the elderly at home is considerably less expensive than doing so in a nursing home. This is largely because it leverages family members as primary caregivers. Of course, the added benefit is individuals typically prefer to remain living in their homes. Please note that program participants are also able to live in adult foster care homes.
There is a Consumer Directed Option (CDO) for this waiver that allows participants to choose their own care providers for the non-medical care services they receive under this waiver. Family members and friends can be hired as paid caregivers, including spouses and adult children.
In Kentucky, it is also referred to as Participant-Directed Services (PDS). Not all services provided under this waiver are appropriate for consumer control. But those that require little to no medical skills training can be self-directed. Chief among these are personal care, homemaker services, unskilled respite care, and minor home adaptations. The one exception is that program participants who live in adult foster care homes are not able to self-direct their care.
What is a Medicaid Waiver?Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home care. However, those who wish to live at home, in assisted living or in adult foster care, sometimes Medicaid will pay for nursing-home-level care in those locations if it can be obtained at a lower cost than in a nursing home.
The Home and Community Based Waiver considers both general requirements and financial requirements.
Residence – an applicant must be a resident of the state of Kentucky.
Age – participants must be at least 65 years of age. This waiver is also open to those designated as disabled by Social Security who are 64 years of age and under.
Functional Ability – participants must require nursing home level care and be willing and able to receive that care in their home or community.
Income Limits
In 2024, an unmarried applicant is allowed income up to 300% of the Federal Benefit Rate (FBR). In dollar terms, an individual cannot have more than $2,829 a month in income. Married applicants, when both spouses are applying, are each allowed up to $2,829 a month in income, as income is considered separately.
If the applicant is married and his or her spouse is not also applying for Medicaid services, the applicant is able to transfer some of his or her income to the non-applicant spouse (also referred to as the community spouse) to prevent him or her from becoming impoverished. As of 2024, the applicant can transfer a maximum of $3,853.50 a month to the non-applicant spouse. This is called the Maximum Monthly Maintenance Needs Allowance (MMMNA).
This is intended to bring the non-applicant’s monthly income up to $3,853.50. If the spouse’s income is already at this amount, the monthly transfer is not permitted.
Asset Limits
For a single applicant, in 2024, countable resources must be valued at less than $2,000. Married couples that apply together can have up to $4,000 in assets. Items that are considered exempt from the applicant’s countable assets include the home in which the applicant lives (the home equity must be valued at or under $713,000), a primary vehicle, and certain other personal items.
For applicants who are married, all assets are considered jointly owned. Learn more here. If only one spouse is applying for Medicaid, the non-applicant spouse can keep 50% of the couple’s assets, up to $154,140 (as of 2024). If the couple’s assets are under $30,828, the non applicant spouse can keep all of the assets, up to this amount. In Medicaid-speak, this is called the Community Spouse Resource Allowance (CSRA). Please note that the applicant spouse is still able to keep $2,000 in countable assets.
Individuals who exceed the financial limits may still qualify for this waiver (and Kentucky Medicaid). A variety of options exist that can help individuals or families lower their monthly income or their countable assets so that they meet the program’s requirements. One can do this by working with a Medicaid Planning professional. This approach is only advised when consulting with a professional.
Past asset transfers for five years prior to the date of application are eligible for review by Medicaid. This is to make sure the applicant did not give away or transfer assets under market value with the goal of qualifying for this program. This is called the Medicaid Look-Back Period, and if one is found to be in violation of this rule, a period of Medicaid ineligibility may result.
Not all applicants will be approved for the same services. The following is a list of possible services that are covered by this waiver. Note that beneficiaries can choose their providers for some of these services, such as personal care, but not for others, such as assessments. Consumer direction allows participants to choose their providers, but does not allow them to choose how much to compensate them.
One must first be enrolled in Medicaid. One can do so several ways:
Once enrolled in Medicaid, applying for the Home and Community Based Waiver can be done through kynect or through a local Aging and Disability Resource Center .
More information on the HCB Waiver can be found here.