DELIVERING 24/7 SUPPORT IN COMMUNITY-BASED SETTINGS FOR INDIVIDUALS WITH COMPLEX CARE NEEDS
Residential Care Services in Kentucky provide around-the-clock assistance in supervised, home-like settings for individuals who require support with daily living tasks, health monitoring, and community participation. Offered under several Kentucky Medicaid Home and Community-Based Services (HCBS) waivers, residential services aim to promote independence, dignity, and inclusion for participants who cannot live alone or with family caregivers.
1. GOVERNING AGENCIES
Agency: Kentucky Cabinet for Health and Family Services (CHFS) — Department for Medicaid Services (DMS)
Role: Manages Medicaid reimbursement, provider enrollment, and service integrity
Agency: Kentucky Department for Aging and Independent Living (DAIL)
Role: Oversees compliance with residential care standards under specific waiver programs
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Enforces federal person-centered planning, safety, and quality-of-care regulations
Agency: Managed Care Organizations (MCOs) in Kentucky Medicaid
Role: Authorize residential service plans, credential providers, and ensure billing and documentation compliance
2. SERVICE OVERVIEW
Residential Care Services support participants in provider-operated homes with 24/7 staff supervision and assistance to promote independent living within a structured, community-based environment.
Approved services may include:
- ADL assistance (bathing, dressing, toileting, eating, mobility)
- Medication administration or reminders (per state policy and staff licensure)
- Meal planning and preparation
- Housekeeping, laundry, and safety monitoring
- Community access and engagement
- Behavioral supports and skill development
- Supervision and overnight monitoring
- Health tracking and appointment support
All services must align with the participant’s Person-Centered Service Plan (PCSP) and be delivered in certified or licensed settings approved under the applicable waiver.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
- Register business with the Kentucky Secretary of State
- Obtain IRS EIN and Type 2 NPI
- Enroll with Medicaid via the Medicaid Partner Portal Application (MPPA)
- Obtain KDADS or DAIL licensing or certification for residential settings (based on waiver type)
- Maintain property, liability, and workers’ compensation insurance
- Pass environmental safety and health inspections
- Hire and train staff with background checks, CPR/First Aid certification, and HCBS training
- Develop Residential Care Policies & Procedures Manual
- Implement HIPAA-compliant documentation and risk management systems
4. KENTUCKY PROVIDER ENROLLMENT PROCESS
Step 1: Facility Licensing and Setup
- Secure appropriate licensure or certification from DAIL for group home or staffed residence
- Complete site inspections for fire safety, accessibility, and staffing requirements
Step 2: Medicaid Enrollment via MPPA
- Register as a residential care provider for applicable waivers
- Complete MCO credentialing and network participation agreements
Step 3: Documentation Submission
- Submit business license, staff credentials, site inspection reports, insurance, and policy manual
Step 4: Service Authorization & Launch
- Coordinate with case managers and caregivers to complete ISP
- Receive MCO authorization and begin service delivery
- Submit claims using approved T-codes or HCPCS codes for residential supports
5. REQUIRED DOCUMENTATION
- Kentucky Articles of Incorporation or business license
- IRS EIN and NPI confirmation
- KDADS/DAIL facility license or certification
- Liability, property, and workers’ compensation insurance
Residential Services Policy & Procedure Manual, including:
- Admission/intake forms and ISP implementation procedures
- House rules, emergency plans, and daily log templates
- ADL, behavioral support, and medication administration documentation
- Staffing schedules, training logs, and supervision reports
- Participant rights, HIPAA compliance, and grievance policy
- Critical incident and abuse prevention protocols
- Medicaid billing systems and audit tools
6. STAFFING REQUIREMENTS
Role: Direct Support Professional (DSP) / Residential Aide
Requirements: Experience with developmental disabilities or elderly care, background check, CPR/First Aid, HCBS training
Role: Residential Supervisor / Program Manager
Requirements: Oversee staff and site operations, ensure compliance, documentation, and staff development
Role (if needed): Nurse or Behavior Support Staff
Requirements: Licensed in Kentucky for nursing/clinical tasks as applicable to the participant’s care plan
All staff must complete:
- Abuse, neglect, and exploitation training
- HIPAA and participant rights training
- Fire safety and emergency response
- Person-centered care and ISP implementation
- Ongoing continuing education
7. MEDICAID PROGRAMS & HCBS WAIVERS
Residential Care Services are available under:
- Supports for Community Living (SCL) Waiver
- Acquired Brain Injury (ABI and ABI-LTC) Waivers
- Model II Waiver (MIIW)
- Michelle P. Waiver (for specific planned respite or transitional housing supports)
Service settings must be:
- Small, community-integrated homes (not institutional)
- Operated under KDADS/DAIL certification standards
- Aligned with participants’ autonomy, choice, and privacy rights
8. TIMELINE TO LAUNCH
Phase: Facility Preparation and Licensing
Timeline: 2–3 months
Phase: Medicaid and MCO Enrollment
Timeline: 2–3 months
Phase: Staff Hiring and Training
Timeline: 1–2 months
Phase: ISP Coordination and Program Launch
Timeline: 30–60 days
9. CONTACT INFORMATION
Kentucky Department for Medicaid Services (DMS)
Website: https://chfs.ky.gov/agencies/dms
Medicaid Provider Enrollment (MPPA): https://mppa.ky.gov
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
10. SCOPE OF WORK
- Facility readiness and licensing prep
- MPPA Medicaid enrollment and MCO credentialing
- Residential Policy & Procedure Manual development
- Staff hiring protocols, emergency plans, and HIPAA tools
- ISP documentation systems and service logs
- Medicaid billing templates and audit readiness checklists
- Branding, community outreach, and family engagement support
Waiver Consulting Group partners with developmental disability providers, community living operators, and supported housing organizations to launch licensed, Medicaid-compliant Residential Care programs in Kentucky.
To get started, click the link to request portal access.