Kentucky - Housing Stabilization — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Kentucky does not cover a standalone "Housing Stabilization" or "Tenancy Support" service under its Medicaid program; instead, housing search, application assistance, landlord mediation, and retention planning are bundled into Community Living Supports (CLS) under the Supports for Community Living (SCL) and Michelle P. Waiver (MPW), or funded through the 1915(i) RISE Initiative for adults with serious mental illness. Providers seeking to offer these tenancy supports must apply to become certified waiver providers for these specific programs rather than applying for a distinct housing stabilization credential.

Before a provider can submit a Medicaid enrollment application through the KYHealthNet portal, they must pass an on-site Pre-Service Review and obtain a Pre-Service Certification letter from the Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID) or the Division of Community Alternatives (DCA). This certification requires fully developed operational policies, proof of commercial liability insurance, and completed background checks for all initial staff before any billing can occur.

1. Service Definition and Scope

Because Kentucky lacks a distinct Housing Stabilization service, tenancy support activities are delivered as components of broader community integration services. Under the SCL and MPW waivers, Community Living Supports (CLS) facilitate independence and community integration, which includes assisting participants in locating, securing, and maintaining housing.

For individuals with serious mental illness, the 1915(i) RISE Initiative provides targeted home and community-based services that encompass housing retention and stabilization goals. Providers must tailor their service delivery to the specific waiver or state plan authority under which the participant is enrolled.

• Applicable Service 1: Community Living Supports (CLS) under the Supports for Community Living (SCL) waiver.
• Applicable Service 2: Community Living Supports (CLS) under the Michelle P. Waiver (MPW).
• Applicable Service 3: 1915(i) RISE Initiative HCBS for behavioral health populations.
• Covered Activities: Assistance with housing searches, completing rental applications, understanding lease agreements, and landlord mediation.
• Excluded Activities: Direct payment of rent, security deposits, or utility bills using Medicaid HCBS funds.
• Service Setting: Services must be delivered in the participant's home or community settings that meet the HCBS Settings Rule.

2. Regulatory and Oversight Agencies

The Cabinet for Health and Family Services (CHFS) is the umbrella agency overseeing all Medicaid and waiver operations in Kentucky. Within CHFS, the Department for Medicaid Services (DMS) holds the ultimate authority for provider enrollment and claims payment.

Day-to-day operational oversight, provider certification, and quality assurance are delegated to specific departments based on the waiver. DBHDID oversees the SCL waiver, MPW, and the 1915(i) RISE Initiative, while the Division of Community Alternatives (DCA) manages other 1915(c) waivers.

• Umbrella Agency: Cabinet for Health and Family Services (CHFS) (https://chfs.ky.gov).
• Medicaid Authority: Department for Medicaid Services (DMS) (https://chfs.ky.gov/agencies/dms).
• Waiver Operating Agency (IDD/BH): Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID) (https://chfs.ky.gov/agencies/dbhdid).
• Waiver Operating Agency (Aging/Physical): Division of Community Alternatives (DCA) (https://chfs.ky.gov/agencies/dms/dca).
• Enrollment Portal: KYHealthNet (https://public.kymmis.com/kyhealthnet).

3. Gatekeeping Prerequisites: Who Can Even Apply

Kentucky requires prospective HCBS waiver providers to complete a rigorous pre-certification process before they are permitted to enroll in Medicaid. There is no Certificate of Need (CON) required for non-residential CLS or RISE Initiative providers, but the structural prerequisites are strict.

An applicant cannot access the Medicaid provider enrollment application for waiver services without first uploading a valid Pre-Service Certification letter from the applicable operating agency (DBHDID or DCA).

• Pre-Service Certification: Mandatory approval from DBHDID or DCA following an on-site operational readiness review.
• Business Registration: Must be legally established as a business entity with the Kentucky Secretary of State.
• Federal Identification: Must possess an active Employer Identification Number (EIN) from the IRS.
• NPI Requirement: Must obtain a National Provider Identifier (NPI) through NPPES prior to Medicaid enrollment.
• Insurance Mandate: Must secure general and professional liability insurance meeting Kentucky Medicaid minimums before the on-site review.

4. Licensure and Certification Requirements

Providers of CLS and 1915(i) RISE services are not licensed as traditional healthcare facilities; instead, they are certified as waiver providers under 907 KAR 7:005. This regulation establishes the baseline requirements for all certified waiver providers in Kentucky.

To maintain certification, providers must comply with all corrective action plans (CAPs) issued during annual or complaint-driven surveys. Failure to disclose required information or correct citations impacting health and safety can result in immediate suspension or revocation of the certification.

• Governing Regulation: 907 KAR 7:005 - Certified waiver provider requirements.
• Certification Entity: DBHDID or DCA, depending on the specific waiver program.
• On-Site Review: A mandatory pre-service inspection of the provider's administrative office, policies, and staff files.
• Corrective Action Plans (CAP): Must be submitted within specified timeframes if deficiencies are found during certification reviews.
• Renewal: Certification must be maintained continuously to remain an active Medicaid provider.

5. Medicaid Provider Enrollment

Once the Pre-Service Certification letter is obtained, the provider must complete the formal Medicaid enrollment process through the KYHealthNet portal. This step links the provider's NPI, tax ID, and certification status to the state's Medicaid Management Information System (MMIS).

Enrollment applications are reviewed by DMS Provider Enrollment. Any discrepancies between the certification letter and the KYHealthNet application will result in a return to the provider for corrections.

• Enrollment System: KYHealthNet portal (https://public.kymmis.com/kyhealthnet).
• Required Upload: The Pre-Service Certification letter from DBHDID or DCA must be attached to the application.
• Application Fee: Subject to the ACA institutional provider application fee unless waived or paid to Medicare/another state.
• Background Disclosures: Must complete all ownership and control interest disclosure forms as required by 42 CFR 455.
• Approval Notice: DMS issues a Medicaid ID and enrollment confirmation letter upon successful processing.

6. Staffing, Training and Background Checks

Direct support professionals providing CLS or RISE tenancy supports must meet strict qualification and training standards before delivering services. Kentucky utilizes the ALMS (Assigned Learning Management System) for mandatory state-required training modules.

Agencies must maintain comprehensive personnel files demonstrating that all background checks, CPR/First Aid certifications, and ALMS training modules were completed prior to the staff member's first date of independent service delivery.

• Age Requirement: Direct care staff must typically be at least 18 years of age.
• Background Checks: Mandatory state and national criminal background checks, plus registry checks (e.g., abuse/neglect registries).
• Basic Certifications: Active CPR and First Aid certification required for all direct-facing staff.
• State Training: Registration and completion of waiver-specific training through the ALMS platform.
• Supervision: Agencies must have a designated supervisor or director meeting higher educational and experience requirements.

7. Documentation, Policies and Records

Certified waiver providers must maintain extensive documentation to support both their operational compliance and their claims for reimbursement. Policies must be fully drafted and approved during the Pre-Service Review.

Service delivery must be documented in alignment with the participant's person-centered service plan. Notes must detail the specific housing-related goals addressed, the interventions used, and the participant's progress.

• Policy Manual: Must include participant rights, grievance procedures, incident reporting, and emergency protocols.
• Person-Centered Plan: Services must be explicitly authorized and detailed in the participant's approved plan of care.
• Service Notes: Daily or per-visit documentation including date, start/stop times, specific activities, and staff signature.
• Incident Reporting: Mandatory reporting of critical incidents to CHFS within state-defined timeframes.
• Record Retention: Records must typically be retained for a minimum of five to six years, or longer if under audit.

8. Billing, Rates and Claims

Because tenancy supports are billed under CLS or 1915(i) RISE codes, providers must use the specific HCPCS codes and modifiers assigned to those services in the Kentucky Medicaid fee schedule. Claims are submitted electronically via KYHealthNet or an approved clearinghouse.

Services are typically billed in 15-minute increments. Providers must ensure that the units billed do not exceed the prior authorization limits established in the participant's service plan.

• Billing Portal: KYHealthNet MMIS system.
• Unit of Service: Typically billed in 15-minute increments for CLS.
• Prior Authorization: Required before any services can be delivered or billed.
• Fee Schedule: Rates are published on the DMS website under the specific waiver's fee schedule.
• Claim Format: Professional claims are submitted using the 837P electronic format or CMS-1500.

9. Approval Sequence and Timeline

The journey to becoming a billing provider is sequential and cannot be expedited. Providers must first establish their business entity and develop their policy manuals before engaging with the state.

The entire process, from submitting the initial letter of intent to DBHDID/DCA to receiving the final Medicaid ID, typically takes 4 to 6 months, depending on the provider's readiness and state processing volumes.

• Step 1: Establish business entity, obtain EIN, NPI, and liability insurance.
• Step 2: Submit application/letter of intent for waiver certification to DBHDID or DCA.
• Step 3: Undergo the on-site Pre-Service Review by state staff.
• Step 4: Receive Pre-Service Certification letter.
• Step 5: Submit Medicaid enrollment application via KYHealthNet with the certification letter attached.
• Step 6: Complete staff ALMS training and begin service delivery upon Medicaid approval.

10. Common Denials and Survey Findings

Applications for certification are frequently delayed or denied due to incomplete policy manuals or failure to secure the correct type of liability insurance prior to the on-site review. State reviewers expect policies to be customized to the agency, not generic templates.

During post-enrollment surveys, the most common citations involve missing or expired staff training records, undocumented background checks, and service notes that fail to align with the goals in the person-centered service plan.

• Denial Reason 1: Submitting the KYHealthNet Medicaid application before obtaining the Pre-Service Certification letter.
• Survey Finding 1: Direct care staff providing services before completing mandatory ALMS training or CPR/First Aid.
• Survey Finding 2: Service notes lacking specific start and stop times or failing to describe the actual intervention provided.
• Survey Finding 3: Failure to report critical incidents within the mandated timeframe.
• Survey Finding 4: Inadequate or missing background checks in personnel files.

11. Key Contacts and Resources

Providers should rely on the official CHFS and DMS websites for the most current waiver applications, fee schedules, and provider letters. The 1915(c) Waiver Help Desk is the primary point of contact for general waiver inquiries.

For specific questions regarding the SCL waiver or 1915(i) RISE Initiative, providers must contact DBHDID directly.

• CHFS HCBS Waivers Page: https://chfs.ky.gov/agencies/dms/dca/Pages/HCBSWaiver.aspx
• KYHealthNet Portal: https://public.kymmis.com/kyhealthnet
• DBHDID Contact: [email protected] or 502-564-7700.
• 1915(c) Waiver Help Desk: [email protected] or 844-784-5614.
• DMS Provider Enrollment: Accessible via the KYHealthNet portal support lines.

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