Community Transition Services in Kentucky help Medicaid waiver participants transition from institutional or long-term care facilities into their own homes or community-based residential settings. These services provide essential support to ensure a smooth, stable move and to help individuals set up their new living environments safely. Covered under specific Home and Community-Based Services (HCBS) waivers, these services reduce institutional dependency and promote person-centered independence.

1. GOVERNING AGENCIES

Agency: Kentucky Cabinet for Health and Family Services (CHFS) — Department for Medicaid Services (DMS)
Role: Oversees eligibility, provider enrollment, and Medicaid reimbursement for transition services

Agency: Kentucky Department for Aging and Independent Living (DAIL)
Role: Coordinates community-based living initiatives and oversees compliance for transition providers

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures Community Transition Services align with federal HCBS waiver guidelines and support community integration

Agency: Managed Care Organizations (MCOs)
Role: Authorize transition plans, manage participant referrals, and reimburse approved services

2. SERVICE OVERVIEW

Community Transition Services are one-time, non-recurring expenses provided to help a participant establish a new home in the community after leaving a nursing facility, intermediate care facility (ICF/IID), or similar institutional setting.

Covered expenses may include:

• Security and utility deposits
• Furniture and essential household items (bed, table, chairs, cookware)
• Basic appliances (microwave, refrigerator if not included in lease)
• Initial groceries and personal hygiene products
• Health and safety items (fire extinguisher, first aid kit)
• Moving costs and delivery fees
• Basic home modifications (grab bars, shower chairs)
• Transition coordination and support services

All purchases must be reasonable, necessary, and not otherwise available through other funding sources. Services must align with the participant’s Person-Centered Service Plan (PCSP) and be approved in advance by the MCO.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Kentucky Secretary of State

Obtain IRS EIN and Type 2 NPI

• Enroll as a Community Transition provider via the Medicaid Partner Portal Application (MPPA)
• Maintain liability and general business insurance
• Submit a Community Transition Services Policy & Procedure Manual
• Establish vendor agreements with furniture and home goods suppliers
• Implement HIPAA-compliant documentation and expense tracking systems

4. KENTUCKY PROVIDER ENROLLMENT PROCESS

Step 1: Medicaid Enrollment via MPPA

• Apply as a provider of Community Transition or Move-In Services under appropriate HCBS waiver(s)
• Complete MCO credentialing for regional provider access

Step 2: Documentation Submission

• Submit business license, insurance, staff roles, and transition planning procedures

Step 3: Service Authorization & Purchase Coordination

• Work with the participant’s case manager to develop a Transition Support Plan
• Submit itemized budget to MCO for approval
• Purchase and deliver approved items, ensuring receipts and proof of delivery
• Submit documentation and claims for reimbursement

5. REQUIRED DOCUMENTATION

• Kentucky Articles of Incorporation or business license
• IRS EIN and NPI confirmation
• Proof of liability insurance

Community Transition Services Policy & Procedure Manual, including:

• Intake forms and referral acceptance process
• Transition budget planning templates
• Vendor purchase logs and delivery tracking
• Participant consent and household inventory forms
• Incident response and safety verification checklist
• HIPAA compliance forms
• Medicaid billing templates and reimbursement request records

6. STAFFING REQUIREMENTS

Role: Transition Coordinator / Move-In Support Specialist
Requirements: Experience in case management, housing navigation, or human services, valid driver’s license, cleared background check

Role (optional): Logistics or Delivery Assistant
Requirements: Must follow item tracking procedures and ensure proper documentation of purchases and deliveries

All staff must complete:

• HIPAA and participant confidentiality training
• Housing safety and community integration training
• Abuse, neglect, and exploitation prevention education
• Emergency preparedness and cultural sensitivity protocols

7. MEDICAID PROGRAMS & HCBS WAIVERS

Community Transition Services are available under:

• Supports for Community Living (SCL) Waiver
• Michelle P. Waiver (MPW)
• Acquired Brain Injury (ABI & ABI-LTC) Waivers
• Home and Community Based (HCB) Waiver

Eligible settings include:

• Private homes or apartments (leased or owned by the participant)
• Supported living residences (if participant holds tenancy rights)

Not permitted: group homes, institutions, or settings where rent and utilities are fully subsidized by another payer

8. TIMELINE TO LAUNCH

Phase: Business Formation and Vendor Sourcing
Timeline: 1–2 months

Phase: MPPA Enrollment and MCO Credentialing
Timeline: 60–90 days

Phase: Policy Manual Completion and Staff Training
Timeline: 30–45 days

Phase: Participant Referrals and Service Coordination
Timeline: Ongoing, based on waiver transitions and MCO authorizations

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9. CONTACT INFORMATION

Kentucky Department for Medicaid Services (DMS)
Website: https://chfs.ky.gov/agencies/dms

Medicaid Partner Portal Application (MPPA): https://mppa.ky.gov

Kentucky Department for Aging and Independent Living (DAIL)
Website: https://chfs.ky.gov/agencies/dail

Kentucky Cabinet for Health and Family Services (CHFS)
Website: https://chfs.ky.gov

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10. SCOPE OF WORK

• MPPA Medicaid enrollment and MCO credentialing
• Community Transition Policy & Procedure Manual development
• Purchase log templates, inventory sheets, and consent forms
• Vendor sourcing strategy and coordination tools
• Budget submission checklists and billing templates
• HIPAA-compliant documentation systems and audit support
• Referral outreach strategies for nursing homes, hospitals, and case managers