Adult Foster Care Services in Kentucky offer home-based living arrangements for adults who require 24-hour supervision, support with daily activities, and a safe, stable environment. These services are delivered in licensed private homes operated by trained providers and are a part of Kentucky Medicaid’s Home and Community-Based Services (HCBS) waiver programs. The goal of adult foster care is to promote independence, dignity, and community integration while avoiding institutional placement.

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1. GOVERNING AGENCIES

Agency: Kentucky Cabinet for Health and Family Services (CHFS) — Department for Medicaid Services (DMS)
Role: Administers Medicaid reimbursement, provider enrollment, and waiver policy compliance

Agency: Kentucky Department for Aging and Independent Living (DAIL)
Role: Licenses adult foster care homes, sets standards for home operations, and monitors care quality

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight to ensure participant rights and person-centered living environments

Agency: Managed Care Organizations (MCOs)
Role: Authorize adult foster care as part of the participant’s care plan, manage provider credentialing and service billing

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2. SERVICE OVERVIEW

Adult Foster Care (AFC) involves placing Medicaid-eligible adults in certified private homes where the provider offers personal support, supervision, and daily care in a non-institutional setting.

Services include:

• Room and board
• Assistance with Activities of Daily Living (ADLs): bathing, grooming, dressing, toileting, eating, mobility
• Medication reminders or administration (if permitted by waiver rules and provider’s training)
• Meal preparation and nutritional oversight
• Housekeeping and laundry
• Socialization and support with community participation
• Health monitoring and emergency response

All services must be based on a participant’s Person-Centered Service Plan (PCSP) and conducted in accordance with waiver-specific rules.

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business or residence with the Kentucky Secretary of State (as applicable)
• Obtain IRS EIN and Type 2 NPI if operating as an agency
• Apply for Adult Foster Care Home certification through DAIL
• Enroll through the Medicaid Partner Portal Application (MPPA)
• Complete home inspection for safety, accessibility, and cleanliness
• Maintain liability and homeowner’s or renter’s insurance
• Submit background checks for all household members over age 18
• Develop a Provider Policy & Procedure Manual for AFC services
• Ensure HIPAA compliance and emergency planning

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4. KENTUCKY PROVIDER ENROLLMENT PROCESS

Step 1: AFC Home Certification

• Apply through DAIL for approval to operate a certified adult foster care home
• Complete training, safety inspections, and environmental assessments

Step 2: Medicaid Enrollment

• Register as an AFC service provider through MPPA
• Complete MCO credentialing based on waiver requirements

Step 3: Participant Placement & Authorization

• Collaborate with case managers to identify eligible individuals
• Receive MCO authorization for placement
• Initiate care, submit documentation, and bill Medicaid for approved services

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5. REQUIRED DOCUMENTATION

• AFC Home Certification approval letter
• IRS EIN and NPI (if applicable)
• Home inspection records and insurance documentation

Adult Foster Care Provider Policy & Procedure Manual, including:

• Intake and admission forms
• Participant service plan logs and daily care notes
• Staff (if applicable) background checks and training logs
• Emergency plans and contact protocols
• Medication tracking and health monitoring forms
• Participant rights, grievance procedures, and visitor policies
• Incident reporting and monthly progress summaries
• Medicaid billing templates and audit documentation tools
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6. STAFFING REQUIREMENTS

Role: Adult Foster Care Provider (Live-in or On-site Caregiver)
Requirements: Age 21 or older, background check, CPR/First Aid certified, completion of AFC provider training

Role (optional): Relief Staff or Overnight Support
Requirements: Cleared background check, trained in ADL support and home emergency procedures

All staff and household members must complete:

• Abuse, neglect, and exploitation prevention training
• HIPAA and confidentiality training
• Fire safety and infection control procedures
• Ongoing annual training on person-centered service delivery

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7. MEDICAID PROGRAMS & HCBS WAIVERS

Adult Foster Care Services are reimbursable under the following waivers:

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

Service settings must be:

• Certified private residences with no more than a set number of participants (typically 1–3)
• Approved by DAIL and meet all fire, safety, and program criteria
• Non-institutional and support participant choice, dignity, and autonomy

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8. TIMELINE TO LAUNCH

Phase: Home Preparation and Certification
Timeline: 2–3 months

Phase: Medicaid Enrollment and MCO Credentialing
Timeline: 1–2 months

Phase: Staff (if applicable) and Compliance Setup
Timeline: 1 month

Phase: Participant Matching and Service Launch
Timeline: Rolling, based on referrals and care plan authorization

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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

• Home certification prep and DAIL licensing assistance
• MPPA enrollment and MCO credentialing
• Provider Policy & Procedure Manual tailored for AFC
• Participant intake forms, emergency plans, and daily documentation logs
• Background check coordination and household safety reviews
• Medicaid billing templates and compliance preparation
• Branding, intake packets, and outreach tools for case managers and referral agencies