Kentucky Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. This article focuses on Kentucky Medicaid Long Term Care for seniors, which is administered by the Kentucky Cabinet for Health and Family Services and will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. These programs are different from regular Medicaid, which is for financially limited people of all ages.

 

Kentucky Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Kentucky Medicaid will cover the cost of long-term care in a nursing home for eligible Kentucky residents who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

  • Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
  • Skilled nursing care
  • Physician’s visits
  • Prescription medication
  • Medication management
  • Mental health counseling
  • Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Kentucky Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover the nursing home expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $40/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Kentucky Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

  A Nursing Home Alternative – Kentucky Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through Kentucky’s Money Follows the Person (MFP) program. This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. In Kentucky, the MFP program is called Kentucky Transitions.

 

Home and Community Based Services (HCBS) Waivers

Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help financially limited Kentucky seniors who require a Nursing Facility Level of Care remain, or return to, living in the community instead of living in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Kentucky residents who live in their home or the home of a loved one. While Kentucky’s HCBS Waivers will cover some long-term care services and supports in those settings, it will not cover room and board costs such as mortgage payments, rent, utility bills and food expenses.

The HCBS Waiver that provides long-term care services and supports to Kentucky seniors living in the community is the Home and Community Based (HCB) Waiver.

Home and Community Based (HCB) Waiver
Kentucky’s Home and Community Based (HCB) Waiver provides long-term care benefits to Kentucky Medicaid beneficiaries who require a Nursing Facility Level of Care but live in their own home or the home of a loved one.

HCB Waiver benefits include adult day health care, case management, meal delivery, home modifications and personal care assistance with the Activities of Daily Living and the Instrumental Activities of Daily Living. These benefits can be provided by a licensed caregiver, but HCB Waiver beneficiaries also have the option to self-direct their services and hire a caregiver of their choice, including spouses and other family members such as adult children.

Unlike Nursing Home Medicaid, HCBS Waivers are not an entitlement. Remember, entitlement means guaranteed by law. Instead, there are a limited number of enrollment spots for each waiver program, and once those spots are full, additional applicants are placed on a waitlist. The HCB Waiver had roughly 17,000 enrollment spots in 2022.

 

Aged, Blind, and Disabled Medicaid

Kentucky’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to financially limited Kentucky residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the beneficiary’s region.

1. ABD Long Term Care Benefits
Eligible Kentucky seniors who show a medical need for long-term care services can receive those services through ABD Medicaid. These benefits can include in-home personal care, adult day care, meal delivery, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid recipients qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its benefits immediately available for anyone who qualifies. Instead, Kentucky seniors will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.

2. Program of All-Inclusive Care for the Elderly (PACE)
Kentucky residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and long-term care needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in their home or somewhere else in the community. PACE can be used by people who are “dual eligible” for Medicaid and Medicare and it will help them coordinate the care from those two programs. Kentucky’s PACE programs are located in Lexington (Bluegrass PACE Care), Louisville (Senior CommUnity Care of Kentucky) and Richmond (Horizon PACE). To learn more about PACE, click here.

 

Eligibility Criteria For Kentucky Medicaid Long Term Care Programs

To be eligible for Kentucky Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

 Just For You: The easiest way to find the most current Kentucky Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder.

 

Kentucky Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Kentucky residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Kentucky Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Kentucky Nursing Home Medicaid beneficiaries must give most of their income to the state to help cover the cost of nursing home care. They are only allowed to keep $40/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Kentucky Medicaid is a combined $4,000 combined, and the income limit is a combined $5,658/month. for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Kentucky Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Kentucky has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through Kentucky Medicaid is needing a Nursing Facility Level of Care, which means the applicant requires the kind of full-time care that is usually associated with a nursing home. The Kentucky Home Assessment Tool is used to determine if a Nursing Facility Level of Care is needed. This testing tool takes into consideration the applicant’s ability to to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, etc.), as well as their cognitive functioning.

 

Kentucky Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Kentucky residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in Kentucky is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in Kentucky for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Kentucky is a combined $4,000, and the income limit is a combined $5,658/month per applicant. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Kentucky HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Kentucky has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through Kentucky Medicaid is needing a Nursing Facility Level of Care, which means the applicant requires the kind of full-time care that that is usually associated with a nursing home. The Kentucky Home Assessment Tool is used to determine if a Nursing Facility Level of Care is needed. This testing tool takes into consideration the applicant’s ability to to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, etc.), as well as their cognitive functioning.

 

Kentucky Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Kentucky residents have to meet an asset limit and an income limit in order to be financially eligible for Kentucky’s Aged, Blind, and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Kentucky ABD Medicaid for a single applicant is $235/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants in 2024, the asset limit for Kentucky’s ABD Medicaid is $4,000 combined between the two applicants/spouses, and the income limit is $291/month combined. These limits apply to married couples with both spouses applying and married couples with just one spouse applying.

These are low income limits, but Kentucky residents who receive Supplemental Security Income (SSI) can keep all of that income (up to $943/month for a single applicant and up to $1,415/month for married applicants, as of 2024) and still remain eligible for Kentucky’s ABD Medicaid.

  Plan Ahead: There are alternative pathways to eligibility for ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Kentucky has a Look-Back Period of five years for Nursing Home Medicaid and HCBS Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirement for Kentucky’s Aged, Blind, and Disabled (ABD) Medicaid is being aged (65 or over), blind or disabled. For ABD Medicaid applicants who require long-term care services and supports, Kentucky Medicaid will conduct an assessment of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications) to determine what kind of services the applicant needs and the state will cover.

 

How Kentucky Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

  • If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
  • If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
  • If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Kentucky Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Kentucky and how you can protect your home from it, click here.

 

Applying For Kentucky Medicaid Long Term Care Programs

The first step in applying for Kentucky Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Kentucky Medicaid coverage when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Kentucky Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Kentucky residents can apply for Medicaid coverage online at kynect benefits. They can also apply in person at their local Department of Community Based Services office.

For a comprehensive guide that will take you through the application process for all three types of Medicaid Long Term Care, click on the program you want: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

 Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney. 

 

Choosing a Kentucky Medicaid Nursing Home

After getting approved for nursing home coverage through Kentucky Medicaid, you or your loved one has to choose which Medicaid-accepting nursing home best meets your needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do might not have available space. Finding the right nursing home can be difficult, especially if you’re looking in a specific area.

There are roughly 260 nursing homes in Kentucky that accept Medicaid, and most of them are in the Bluegrass Region clustered around the state’s biggest cities. About 30 of Kentucky’s nursing homes are within 10 miles of Louisville. There are approximately 25 nursing homes within 25 miles of Lexington, which includes Nicholasville and Georgetown. There are a dozen or so nursing homes in and around Bowling Green, and there are about 10 in the Owensboro area on the Kentucky side of the Ohio River.

Residents in Owensboro and other Kentucky communities may regularly cross the state border for business or personal reasons, including healthcare. But Medicaid coverage does not cross state lines. So, if someone has Kentucky Medicaid, they are not covered in nursing homes in Cincinnati or Huntington, West Virginia, even if there are facilities in those cities that are more convenient.

 TOOLS: To find and compare nursing homes, Kentucky residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country.

Once you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can be a great source of information. You can also contact your local Area Agency on Aging and Independent Living to find out more information about nursing homes in Kentucky.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence provide transportation? Does it offer social activities? How does it handle oral and eye care? Who are the staff doctors? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

Data collected by CMS shows that Kentucky nursing homes are well above average when it comes to health inspections and fire safety. Nursing homes in Kentucky averaged 14.6 health deficiencies during a three-year period from 2019-2022, which is will below the national average of 25.7. The same goes for fire safety deficiencies: Kentucky nursing homes averaged 4.1 while the rest of the country was at 13.5.