Kentucky Home and Community Based (HCB) Waiver

The Home and Community Based (HCB) Waiver is Kentucky Medicaid’s waiver for older adults and people with physical disabilities who need a nursing facility level of care and want to live in the community. For the wider picture, see our Kentucky Long-Term Care Medicaid guide.

Figures change periodically. Double-check current amounts before relying on them.

At a glance

Item	Details
Type of program	Medicaid home and community-based services (HCBS) waiver
Who runs it	Kentucky Department for Medicaid Services (DMS)
Age	Older adults, and adults and children with physical disabilities
Care need	Needs a nursing facility level of care
Kentucky 2026 income rule (long-term care)	$2,982 a month (special income standard)
Kentucky 2026 asset limit (single applicant)	$2,000
Waiting list	Yes. 8,782 people were waiting as of August 17, 2026; placement is by date of complete application

The HCB Waiver in brief

In short, the HCB Waiver is run by Kentucky Department for Medicaid Services (DMS). Its target group is older adults, and adults and children with physical disabilities; on care need, the rule is: Needs a nursing facility level of care. As for waiting: Yes. 8,782 people were waiting as of August 17, 2026; placement is by date of complete application. More detail on each point follows, and the Kentucky state guide covers the shared financial rules. Families weighing the HCB Waiver against other Kentucky options can use the related pages at the end to compare programs side by side.

What the program is

DMS runs the HCB Waiver. A case manager writes a person-centered service plan. Through Participant Directed Services (PDS), participants can hire their own workers for non-medical services.

Under federal law, Kentucky can run home and community-based waivers like the HCB Waiver, which bend some ordinary Medicaid rules so care can happen outside a facility. Slots are limited each year, every participant has an individual care plan, and a case manager or coordinator puts services in place. Waiver services sit on top of regular Medicaid, which still covers doctors, hospitals and prescriptions (after Medicare, for people who have it). See our overview of HCBS waivers.

Who qualifies in 2026

Eligibility for the HCB Waiver comes down to these points. The person:

Is an older adult, or an adult or child with a physical disability
Needs a nursing facility level of care
Qualifies for full Medicaid under Kentucky’s long-term care financial rules (see the money test below)
Lives in Kentucky and is a U.S. citizen or qualified non-citizen

The money test. The HCB Waiver requires full Medicaid eligibility under Kentucky’s long-term care financial rules. Figures shown above are the 2026 Kentucky long-term care limits from our state guide. Exempt items generally include the home within the equity cap, a car, household goods and a modest burial fund. If only one spouse needs the HCB Waiver, spousal impoverishment rules protect assets and income for the other. See Spousal impoverishment rules.

About the level-of-care assessment. The care test looks at how much help a person needs with everyday activities such as bathing, dressing, eating, using the toilet, moving around and taking medicines, and at memory problems and supervision needs. The visit is normally face to face, at home or in a hospital or facility. Before a the HCB Waiver assessment, it helps to line up a family member who can describe a typical bad day, and to have a list of diagnoses and medications ready. See Nursing home level of care and Activities of daily living.

What services it can pay for

What a participant receives under the HCB Waiver follows the care plan. Possible services include:

Adult day health care
Attendant care
Environmental and minor home adaptations
Home-delivered meals
Respite
Case management
Goods and services (self-directed)

Not every participant gets every service; the plan reflects assessed need and the help family already gives. When needs grow, request an updated assessment.

Directing your own care and paying family

Participant Directed Services lets participants hire their own workers for non-medical services, use an agency, or mix both.

How to apply

Getting the HCB Waiver means passing a money test and a care test. Step by step:

Apply for Kentucky Medicaid (kynect or DCBS).
Contact a case management agency or ADRC about the HCB Waiver.
Complete the level of care assessment.
Choose agency or self-directed services.

For the paperwork, use our documents checklist before applying for the HCB Waiver; Applying for a waiver explains the general process.

Waiting lists

Kentucky keeps a first-come, first-served waiting list for the HCB Waiver, based on the date CHFS receives a complete application. In June 2026, CHFS reported 7,960 people on the HCB waitlist against 17,800 funded slots, and reported 8,782 as of August 17, 2026. Under House Bill 2 (2026), people already on the HCB or Michelle P. waitlist must send a provider attestation, signed by a physician, physician assistant, APRN or psychologist, by January 31, 2027 to stay on the list. CHFS says it will make several contact attempts before removing anyone. Kentucky requires Medicaid financial eligibility before the waiver application, so apply for Medicaid first.

General advice is in Waiver waiting lists.

How it relates to nursing home Medicaid

The HCB Waiver uses the same level of care and 2026 income rule ($2,982 a month) and asset limit as nursing home Medicaid.

Where the nursing home rules still apply. Most money rules carry over from nursing home Medicaid. The five-year look-back for gifts generally applies, so a gift or transfer for less than fair value can cause a period when Medicaid will not pay for long-term care services. Kentucky Medicaid can also use estate recovery to seek repayment for long-term care services received after 55. Some participants pay a monthly share of income toward services.

Income in a nursing home. In 2026, Kentucky lets a nursing home resident keep $60 a month for personal needs; the rest of their income mostly pays toward care. Details are in our state guide.

Tips for families

Begin before it is urgent. Every step of the HCB Waiver takes time, and an early request protects your place.
Keep copies of every the HCB Waiver form, notice and letter, and write down the name of each person you speak with and the date.
Read every notice. If services are denied, cut or ended, the notice explains how to request a fair hearing and the deadline. Requesting one before the deadline often keeps services in place during the appeal.
Tell Kentucky Medicaid about changes in money, address or household as they happen.
Mark renewal dates. Eligibility and the care plan are usually reviewed annually; see Renewals.
Get help with complex the HCB Waiver cases, such as a spouse at home or past gifts. A certified Medicaid planner or a legal aid office can review how Kentucky’s rules fit a family’s situation.

Common questions

Can family be paid? Yes, through PDS you can hire friends, neighbors or certain family members. A spouse is a legally responsible individual and can be paid only if Kentucky approves an extraordinary-care request. Examples are a spouse who could not work because of caregiving and had no alternate caregiver, or a spouse who tried for 30 days to find a provider without success.

Does it pay for assisted living? Kentucky Medicaid generally does not pay room and board in assisted living.

What is PDS? Participant Directed Services: hiring your own workers.

I am already on the waitlist. Do I need to do anything? Yes. Under House Bill 2, people on the HCB waitlist must send a signed provider attestation by January 31, 2027 to keep their place.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.