Kentucky Medicaid for seniors and long-term care

Last verified: June 2026

Long-term care eligibility for seniors in Kentucky

Seniors age 65 and older seeking nursing facility or home-based long-term care through Kentucky Medicaid must meet clinical and financial eligibility criteria. Kentucky uses the standard 300% of the SSI Federal Benefit Rate income limit — approximately $2,829/month for an individual in 2025.

The countable resource limit for a single individual is generally $2,000. Excluded resources include the primary home (with conditions), one vehicle, household goods, prepaid burial funds, and certain other items. A community spouse may retain protected resources under federal spousal impoverishment rules.

• Must require nursing facility level of care (clinical determination required)
• Income at or below approximately $2,829/month (300% FBR, individual, 2025)
• Countable resources generally at or below $2,000 for a single individual
• Community spouse resource and income protections apply
• Must be a Kentucky resident and U.S. citizen or qualified noncitizen

Home and Community-Based (HCB) Waiver for seniors

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 DMS to operate this waiver; contact DAIL at 1-877-315-0589 for information on eligibility and enrollment.

• Personal care and attendant care
• Adult day health care
• Home health aide and skilled nursing visits
• Respite care for family caregivers
• Homemaker and chore services
• Medical equipment and supplies
• Environmental modifications
• Case management and care coordination

Michelle P. Waiver and Supports for Community Living: adults with intellectual disabilities

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.

The CHILD Waiver: new in 2025 for youth with complex needs

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. The CHILD waiver fills a gap that previously existed for youth whose needs exceeded standard Medicaid but who did not qualify for existing waivers.

PACE in Kentucky

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 MCO — you receive all services through the PACE organization.

Estate recovery in Kentucky

Kentucky 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.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Kentucky's share of that population is administered through Kentucky Medicaid. The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

Kentucky Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers 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. Not all states allow this; verify whether Kentucky uses this approach with Kentucky Medicaid.

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through Kentucky Medicaid differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact Kentucky Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult Kentucky Medicaid or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Kentucky's current CSRA is set by Kentucky Medicaid and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments