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Kentucky - Homemaker Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Homemaker services in Kentucky are funded primarily through the 1915(c) Home and Community Based (HCB) Waiver and the Acquired Brain Injury (ABI) Waiver, governed by administrative regulations 907 KAR 7:010 and 907 KAR 7:015. The Cabinet for Health and Family Services (CHFS) Department for Medicaid Services (DMS) defines this service as general household support, including meal preparation, laundry, shopping, and light housekeeping, provided when the waiver participant or their primary caregiver cannot perform these tasks.

Because Kentucky does not issue a standalone "Homemaker" license, agencies must first obtain a Personal Services Agency (PSA) license or a Home Health Agency (HHA) license from the CHFS Office of Inspector General (OIG) before applying for Medicaid enrollment. Once licensed, providers submit their enrollment applications through the Kentucky Medicaid Partner Portal to become an approved Provider Type 95 (HCB Waiver Provider) or Provider Type 32 (ABI Waiver Provider).

1. Service Definition and Scope

In Kentucky, Homemaker services are designed to maintain a safe and clean environment for waiver participants who are unable to manage general household activities independently. Under the HCB and ABI waivers, this service is strictly non-medical and focuses on environmental support rather than hands-on personal care.

The service must be explicitly authorized in the participant's Person-Centered Service Plan (PCSP) generated through the Medicaid Waiver Management Application (MWMA). Homemaker tasks cannot be billed concurrently with Personal Care services if the tasks overlap, and services are limited to the participant's specific living area rather than the entire household if other capable adults reside there.

2. Regulatory and Oversight Agencies

The Kentucky Cabinet for Health and Family Services (CHFS) serves as the umbrella organization for all Medicaid and licensure operations. Within CHFS, the Office of Inspector General (OIG) Division of Health Care is responsible for licensing the underlying agency (such as a Personal Services Agency) required to deliver these services.

The Department for Medicaid Services (DMS) Division of Long-Term Services and Supports (DLTSS) manages the waiver policies, while the Department for Aging and Independent Living (DAIL) handles the day-to-day administration and participant eligibility for the HCB Waiver.

3. Gatekeeping Prerequisites: Who Can Even Apply

Kentucky requires a foundational state license before an agency can enroll as a Medicaid waiver provider for Homemaker services. An applicant must hold an active Personal Services Agency (PSA) license or a Home Health Agency (HHA) license issued by the CHFS OIG. Medicaid enrollment applications submitted without this active licensure will be immediately rejected.

If an agency chooses the Home Health Agency route, they must first secure a Certificate of Need (CON) from the CHFS Office of Health Policy, which is a highly restrictive, need-based approval process. Agencies choosing the Personal Services Agency route are exempt from the CON requirement, making it the standard pathway for non-medical Homemaker providers.

4. Licensure and Certification Requirements

To obtain a Personal Services Agency (PSA) license, providers must submit an application to the CHFS OIG Division of Health Care. The application requires detailed operational policies, proof of liability insurance, and a designated agency manager who meets state qualifications.

The OIG conducts an initial on-site survey to verify that the agency's physical office, personnel files, and administrative policies comply with 902 KAR 20:380. Licenses must be renewed annually, and the agency is subject to unannounced compliance surveys.

5. Medicaid Provider Enrollment

Once licensed by the OIG, the agency must enroll in Kentucky Medicaid through the Partner Portal (KY MPES). Providers enrolling to offer Homemaker services under the HCB Waiver typically enroll as Provider Type 95 (HCB Waiver Provider).

The enrollment process requires the submission of the OIG license, an IRS W-9, and the payment of the federal Medicaid application fee. Providers must also complete a Medicaid provider agreement and undergo screening based on their categorical risk level.

6. Staffing, Training and Background Checks

Direct care staff providing Homemaker services must meet minimum age and education requirements, typically being at least 18 years old with a high school diploma or GED. Agencies must maintain strict personnel files demonstrating compliance with state training mandates.

Kentucky requires comprehensive background checks through the Kentucky Applicant Registry and Employment Screening (KARES) system. Staff must also be checked against the state child abuse and neglect registry and the adult abuse registry before providing services.

7. Documentation, Policies and Records

Agencies must maintain comprehensive records that align with the participant's Person-Centered Service Plan (PCSP) generated in the Medicaid Waiver Management Application (MWMA). Every billed unit of Homemaker service must be supported by a task log detailing the specific household chores completed.

Policies must cover incident reporting, grievance procedures, and emergency preparedness. Records must be retained for a minimum of six years and be readily available for DMS or OIG auditors upon request.

8. Billing, Rates and Claims

Homemaker services are billed to Kentucky Medicaid using the MMIS system (KYHealthNet) or through the participant's managed care organization (MCO) if applicable. Services are typically billed in 15-minute increments using specific HCPCS codes.

Kentucky mandates the use of Electronic Visit Verification (EVV) for all personal care and home health services, which often includes Homemaker services when provided in the home. Providers must use the state-sponsored EVV system or an approved alternate vendor to capture the start and end times of each visit.

9. Approval Sequence and Timeline

The approval process follows a strict sequence: business formation, OIG licensure, and finally Medicaid enrollment. An agency cannot bypass the OIG licensure step or apply for Medicaid concurrently.

The entire process typically takes 4 to 8 months. OIG licensure review and the initial survey usually take 60 to 90 days, followed by the Medicaid enrollment process in the Partner Portal, which can take an additional 30 to 60 days.

10. Common Denials and Survey Findings

Applications for licensure or enrollment are frequently delayed or denied due to incomplete documentation, such as missing background checks or failure to provide proof of required insurance. In the Partner Portal, mismatched NPI data or incorrect ownership disclosures are common rejection triggers.

During OIG surveys or DMS audits, the most frequent citations involve missing EVV data, task logs that do not match the billed time, or providing services that exceed the authorized limits in the participant's PCSP.

11. Key Contacts and Resources

Providers should utilize the official CHFS portals and help desks for guidance during the licensure and enrollment process. The OIG Division of Health Care handles all questions related to PSA regulations and surveys.

For Medicaid enrollment issues, the KY MPES Partner Portal help desk is the primary contact. Waiver-specific questions regarding participant eligibility and MWMA should be directed to DAIL.

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