Kentucky's home health care industry operates within a regulatory framework overseen by the Cabinet for Health and Family Services (CHFS). With a growing elderly population driving demand and significant waiver expansions planned for 2025-2026, understanding Kentucky's home health care landscape is essential for agencies seeking to provide quality care while navigating licensing requirements and workforce challenges.

Home Health Agency Licensing in Kentucky

Kentucky requires licensure for home health agencies through the Cabinet for Health and Family Services (CHFS) Office of Inspector General (OIG). The licensing process involves multiple steps and regulatory requirements.

Regulatory Authority:

  • Kentucky Administrative Regulation 902 KAR 20:081 establishes minimum licensure requirements
  • Provider qualifications defined in 907 KAR 1:030
  • Complies with KRS 216B.042(1) requiring cabinet to promulgate licensure standards

Pre-Licensure Requirements:

  • Certificate of Need may be required (contact OIG to determine applicability)
  • Fire marshal approval may be required for certain facilities
  • Application for License to Operate a Home Health Agency (Form OIG004117)

Caregiver Screening Requirements:

Kentucky mandates comprehensive screening for home care workers:

  • State and federal criminal history checks
  • Searches of abuse and neglect registries
  • Verification against the federal OIG List of Excluded Individuals and Entities (LEIE)

Ongoing Compliance:

  • Quarterly reports required (after at least three months of operation)
  • Monitoring of 902 KAR 20:066 updates for in-home services
  • Regular compliance with all applicable regulations

For application forms and current requirements, agencies should contact CHFS OIG or visit their website. Regulatory questions can be directed to the Office of Legislative and Regulatory Affairs at [email protected] or (502) 564-6746.

State Registered Nurse Aide (SRNA) Certification

In Kentucky, Certified Nursing Assistants are known as State Registered Nurse Aides (SRNAs). The certification process is managed by the Kentucky Board of Nursing (KBN) and administered through the Kentucky Community and Technical College System (KCTCS).

Training Requirements:

  • Minimum 75 hours of instruction in classroom theory and clinical practice
  • At least 16 hours of supervised clinical training in a Medicaid-approved long-term care facility
  • Programs must be approved by CHFS through the NATCEP (Nurse Aide Training and Competency Evaluation Programs)

Certification Examination:

The SRNA examination consists of two components administered on the same day:

  • Written Exam: 75-100 multiple choice questions with a 2-hour time limit
  • Skills Evaluation: Demonstration of 5 randomly selected skills from a list of 34, must pass 4 of 5 within 30 minutes
  • Testing administered by KCTCS through the TestMaster Universe (TMU) system

Kentucky Nurse Aide Registry (KNAR):

The KNAR, maintained by the Kentucky Board of Nursing, has been in operation since October 1990 following the Omnibus Budget Reconciliation Act (OBRA). The registry serves two functions:

  • Maintains a list of qualified nurse aides
  • Records substantiated findings of abuse, neglect, or misappropriation

Renewal Requirements:

  • Certification valid for two years
  • Must complete 8 hours of nursing or nursing-related duties every 24 months
  • Submit renewal through KBN

Contact Information:

Home Health Aide (HHA) Certification

Home health aides working for Medicare-certified agencies in Kentucky must meet federal HHA competency requirements.

Federal HHA Requirements (Medicare-certified agencies):

  • 75 hours of training covering required competency areas
  • At least 16 hours of supervised practical training
  • Competency evaluation covering all required skill areas
  • Annual in-service training of at least 12 hours

Kentucky Medicaid and Home Care Services

Kentucky Medicaid, administered through the Department for Medicaid Services (DMS), provides coverage for home health services. The state operates a managed care system through MCOs for most Medicaid beneficiaries.

Key Medicaid Home Health Services:

  • Home health skilled nursing
  • Home health aide services
  • Physical, occupational, and speech therapy
  • Personal care services
  • Attendant care services

Participant Directed Services (PDS):

Kentucky offers Participant Directed Services for eligible waiver participants, allowing individuals to hire and manage their own care workers with support from Financial Management Services providers. PDS is available for participants in ABI-A, ABI-LTC, SCL, Michelle P, and HCB2 waivers.

HCBS Waivers in Kentucky

Kentucky operates six Home and Community-Based Services (HCBS) waivers under the 1915(c) benefit, providing alternatives to institutional care for specific populations.

Non-Residential Waivers:

  • Home and Community Based (HCB) Waiver: Serves adults 65 and older or individuals with physical disabilities. Provides attendant care, environmental and minor home adaptations, and respite. Approved for approximately 17,300 participants with 150 slots reserved for Money Follows the Person transitions. As of February 2025, there is a waitlist.
  • Michelle P Waiver (MPW): Targets individuals with intellectual or developmental disabilities. Approximately 9,500 participants enrolled. Providers must also be SCL or HCB providers.
  • Model Waiver II (MIIW): Provides additional community-based services options.

Residential Waivers:

  • Supports for Community Living (SCL): Serves individuals with intellectual or developmental disabilities. Approximately 4,000 participants. Waiting list managed by the Department for Behavioral Health, Developmental and Intellectual Disabilities.
  • Acquired Brain Injury (ABI): Serves individuals with acquired brain injuries.
  • Acquired Brain Injury-Long Term Care (ABI-LTC): Provides long-term care for individuals with acquired brain injuries.

State Fiscal Year 2026 Updates (Effective July 1, 2025):

  • New slot allocations: HCB +500, MPW +500, SCL +250
  • Additional Money Follows the Person and Kentucky Transitions reserved slots
  • House Bill 6 authorized funding to implement rates at 70% of benchmark rates

Eligibility for HCB Waiver (2025):

  • Monthly income limit: $2,901 (regardless of marital status)
  • Must meet nursing facility level of care
  • Age 65+ or any age with physical disability

Electronic Visit Verification (EVV)

Kentucky has implemented Electronic Visit Verification in compliance with the federal 21st Century Cures Act. EVV is required for personal care services and home health services requiring an in-home visit.

Kentucky EVV Requirements:

  • Captures type of service, member information, provider information, date, time in/out, and location
  • Implementation coordinated through Medicaid managed care organizations
  • Provider training and support resources available
  • Participant Directed Services have modified EVV requirements

Medicare Home Health in Kentucky

Medicare-certified home health agencies in Kentucky must comply with all federal Conditions of Participation and are subject to state survey activities.

Payment Model:

Kentucky Medicare home health agencies operate under the Patient-Driven Groupings Model (PDGM), which determines 30-day period payments based on:

  • Admission source and timing
  • Clinical grouping based on diagnosis
  • Functional impairment level
  • Comorbidity adjustment

Coverage Requirements:

  • Patient must be homebound
  • Services must be medically necessary
  • Patient must need skilled nursing or therapy services
  • Care must be provided under a physician's plan of care
  • Services must be provided by a Medicare-certified agency

Kentucky Labor Laws for Home Care

Home health care employers in Kentucky must navigate both state and federal labor regulations, with important exemptions for certain home care workers.

Minimum Wage:

  • Kentucky minimum wage: $7.25 per hour (matches federal minimum)
  • No scheduled state-level increases as of 2026

Overtime:

  • Time-and-a-half required after 40 hours per week
  • Kentucky also requires overtime for all hours worked on the 7th consecutive day in a workweek
  • Non-exempt minimum wage employees earn $10.875 per hour for overtime

Important Home Care Exemptions:

Kentucky law provides specific exemptions for home care workers:

  • Employees providing in-home companionship services for sick persons or older adults may be exempt from minimum wage
  • Domestic service employees may be exempt from minimum wage requirements
  • Companionship service workers and domestic workers may be exempt from overtime requirements
  • Live-in employees such as housekeepers may be completely exempt

Federal FLSA Considerations:

While Kentucky state law provides certain exemptions, federal FLSA protections may still apply. When federal and state laws differ, employers typically must comply with whichever law provides greater worker protection. Agencies should consult legal counsel to understand which rules apply to their specific workforce.

Workforce Challenges in Kentucky

Kentucky's home health care industry faces significant workforce challenges shaped by its demographics and healthcare landscape.

Key Challenges:

  • Growing Senior Population: Kentucky's elderly population grew from 13.3% in 2010 to 17% in 2020, projected to reach 20% in coming years
  • Healthcare Worker Shortage: Kentucky faces a critical shortage, needing over 16,000 additional nurses
  • Low Wages: The $7.25 minimum wage makes it difficult to attract workers from competing industries
  • Rural Geography: Many Kentucky communities are rural, creating recruitment and service delivery challenges
  • Waiver Waiting Lists: Waiting lists for HCB and SCL waivers can limit agency growth opportunities
  • Competition: Healthcare worker shortages create intense competition across care settings

Workforce Strategies for Kentucky Agencies

Successful Kentucky home health agencies are implementing creative strategies to recruit and retain quality caregivers.

Recruitment Approaches:

  • Partner with NATCEP training programs and community colleges
  • Develop relationships with high school career and technical education programs
  • Leverage the state's workforce shortage as an opportunity for career advancement messaging
  • Offer signing bonuses and referral programs
  • Recruit from adjacent healthcare settings and non-healthcare industries

Retention Strategies:

  • Offer wages significantly above the $7.25 minimum
  • Provide scheduling flexibility and work-life balance
  • Create career ladders with advancement opportunities
  • Invest in training and professional development
  • Develop recognition programs that acknowledge caregiver contributions
  • Consider benefits packages including health insurance, retirement plans, and paid time off

Technology Solutions:

  • Implement efficient scheduling software to optimize routes and reduce travel burden
  • Use mobile apps for easy clock-in/out and EVV compliance
  • Streamline onboarding and training with digital platforms
  • Leverage telehealth where appropriate

Resources for Kentucky Home Health Agencies

Key organizations and resources for home health providers operating in Kentucky:

  • Cabinet for Health and Family Services (CHFS) OIG: Home health agency licensing and regulatory oversight
  • Department for Medicaid Services (DMS): Medicaid home health benefits and waiver programs
  • Kentucky Board of Nursing: SRNA certification, Kentucky Nurse Aide Registry (KNAR)
  • KCTCS Nurse Aide Testing: SRNA examination administration (877) 528-2748
  • Department for Behavioral Health, Developmental and Intellectual Disabilities: SCL waiver waiting list management
  • Kentucky Association of Health Care Facilities: Industry advocacy and resources
  • kynect: Medicaid application and enrollment

The Bottom Line

Kentucky's home health care environment offers significant opportunities as waiver slots expand and rates improve through SFY 2026. However, agencies must navigate complex licensing requirements through CHFS OIG and address workforce challenges driven by a growing senior population and statewide healthcare worker shortages.

Success in Kentucky's home care market requires competitive compensation strategies that go well beyond the $7.25 minimum wage, strong relationships with training programs, and careful attention to the unique exemptions and requirements affecting home care workers. Agencies that invest in their workforce, maintain regulatory compliance, and stay ahead of waiver program changes will be best positioned to serve Kentucky's growing population of seniors and individuals with disabilities.