How to start a home care agency in Kentucky and reach your first client faster
Kentucky calls it certification, not licensing, but the rule is strict: a personal services agency cannot serve or even advertise until the Office of Inspector General issues its certificate. Every worker needs five checks before day one, dementia care needs an approved curriculum, and most Medicaid waivers do not accept a personal services agency on its own. Home health and hospice add a Certificate of Need, OIG licensure and Medicare. We put all of it in the right order for you.
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- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Kentucky rules906 KAR 1:180 and Kentucky Medicaid waiver regulations in 907 KAR
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Kentucky requires.
Nonmedical home care for Medicaid waiver participants
- State license
- OIG personal services agency certification, plus Medicaid waiver provider certification
- Who you deal with
- OIG, the Department for Medicaid Services and the waiver's operating agency (DBHDID for Michelle P. and SCL)
- Must haves
- OIG certification, certification as a waiver provider under 907 KAR 12:010 for Michelle P., Medicaid enrollment through KY MPPA, waiver staff training, EVV
- Realistic time to first client
- Several months
Orientation for Kentucky only. We confirm your exact path on the free call.
Three places new Kentucky agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Hiring and marketing before the certificate
KRS 216.712 says no personal services agency may be operated, maintained or advertised without OIG certification, and 906 KAR 1:180 says services may not start before it is issued. Owners who launch a website or sign a first client while the application is pending are breaking the rule, not getting a head start.
What it costs: Fines of up to $500 a day under KRS 216.714, and a first client you have to turn away.
Medicaid waivers that do not take a personal services agency
Traditional attendant care in the Home and Community Based (HCB) waiver can only be provided by adult day health centers, Medicare and Medicaid certified home health agencies, centers for independent living, health departments and area agencies on aging. The Michelle P. waiver accepts other providers only once the Department for Medicaid Services certifies them under the Supports for Community Living rules.
What it costs: Months of payroll built on Medicaid referrals that your agency type cannot accept.
Five checks before a caregiver's first shift
906 KAR 1:180 requires a criminal record check, two abuse registry checks, a drug test and a TB risk assessment before anyone works as manager or gives direct service. Staff who serve clients with dementia also need six hours of cabinet approved dementia training first.
What it costs: A client you cannot staff while a caregiver waits on results, and a caregiver who may take another job.
What does a delay cost your agency?
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Home care vs home health vs hospice in Kentucky
The three sound alike and are regulated differently. The one you choose decides your regulator, staffing, startup capital and timeline.
| Topic | Nonmedical home care | Home health (skilled) | Hospice |
|---|---|---|---|
| What your staff do | Help with walking and daily activities, facilitated self administration of prepared medications, companion, sitter, respite and homemaker services alongside personal care | Part time or intermittent skilled nursing plus therapy, medical social services or home health aide services | Palliative and supportive care for people who are terminally ill, and their families, with nursing on call around the clock |
| State license | OIG personal services agency certification (KRS 216.712; 906 KAR 1:180) | OIG home health agency license (902 KAR 20:081) | OIG hospice license (902 KAR 20:140) |
| Certificate of Need | No | Yes, from the OIG Division of Certificate of Need (KRS 216B.061), reviewed against the State Health Plan | Yes, from the OIG Division of Certificate of Need (KRS 216B.061), reviewed against the State Health Plan |
| Main payers | Private pay, Michelle P. and SCL waivers once certified as a waiver provider, HCB participant directed services, state funded Homecare contracts | Medicare, Kentucky Medicaid and its health plans, HCB and Michelle P. waivers, commercial insurance | Medicare hospice benefit, Kentucky Medicaid, commercial insurance |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment; check the CMS moratorium | Accreditation or state survey, then Medicare enrollment; check the CMS moratorium |
| Key staff | A manager responsible for daily operations, with a written backup; screened and trained caregivers | A physician, RN or physician assistant designated to supervise services, RN supervision of aides, Medicare administrator and clinical manager | Administrator, physician medical director, RN patient care coordinator, social worker and interdisciplinary team |
| Startup capital | Lowest | Higher: Certificate of Need process and clinical payroll before Medicare revenue | Highest: Certificate of Need and an interdisciplinary team before revenue |
| Time to first client | Weeks to months (private pay); several months (Medicaid waiver) | Longest: Certificate of Need, licensure, survey, enrollment | Longest: Certificate of Need, licensure, survey, enrollment |
Most new Kentucky owners start with a personal services agency, because home health and hospice must first win a Certificate of Need against the State Health Plan. Note that the HCB and Michelle P. waivers only count a home health agency as a provider if it is both licensed and Medicare and Medicaid certified, so the CMS enrollment moratorium affects waiver plans too. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
Kentucky requirements at a glance
| Nonmedical home care | Personal services agency certification from the CHFS Office of Inspector General (OIG) under KRS 216.710 to 216.716 and 906 KAR 1:180, renewed every year |
|---|---|
| Home health and hospice licensing | OIG Division of Health Care: home health agencies under 902 KAR 20:081, hospices under 902 KAR 20:140, fees under 902 KAR 20:008 |
| Certificate of Need | Required to establish a home health agency or hospice (KRS 216B.015 and 216B.061), reviewed against the State Health Plan in 900 KAR 5:020 |
| Medicaid agency | Department for Medicaid Services (DMS); providers enroll through the Kentucky Medicaid Partner Portal Application (KY MPPA) |
| Medicaid home care routes | 1915(c) waivers including HCB, Michelle P., Supports for Community Living (SCL), ABI, ABI LTC and Model II; Medicaid health plans for home health |
| Caregiver training | Abuse reporting, medication limits and communication before direct service; six hours of initial and three hours of annual dementia training for staff serving clients with dementia; DAIL attendant care training for HCB waiver staff |
| Background screening | Criminal record check, nurse aide and home health aide abuse registry, Vulnerable Adult Maltreatment Registry, drug test and TB risk assessment before direct service; optional fingerprint checks through KARES (906 KAR 1:190) |
| Electronic visit verification | Required by DMS for in home 1915(c) waiver services and Medicaid home health care services (since January 1, 2024); Therap is the free state system, or use a compatible third party system |
| Medicare (home health, hospice) | Accreditation by a CMS approved organization or a state survey, then Medicare enrollment; new enrollment paused by CMS since May 13, 2026 |
| Entity filing | Kentucky Secretary of State, then Department of Revenue tax accounts and an Office of Unemployment Insurance reserve account |
Summary of Kentucky requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Kentucky
The order matters. Steps 4 and 5 should be finished before step 6, because OIG checks your policies and screening documentation at application, and you cannot serve a single client until the certificate is issued.
Form the business with the Kentucky Secretary of State
File your LLC or corporation, get an EIN, open state tax accounts with the Department of Revenue, set up an unemployment insurance reserve account, and check local occupational license taxes in your city and county.
You do this; we give you the checklistDecide your payer mix
Private pay, Medicaid waivers or both. A personal services agency cannot be a traditional HCB waiver provider, so check which waivers fit your agency before you plan on Medicaid. Use the path finder above.
Decided on your free consultationSet up insurance and employment basics
Arrange workers' compensation, general and professional liability, and auto coverage for caregivers who drive. Your service agreement must tell clients about your employment practices and bonding, so decide on bonding now.
You do this; we specify what is requiredWrite policies to 906 KAR 1:180
Cover the written service agreement, service plans delivered within 10 days of starting care, grievances, abuse reporting, medication assistance limits, competency checks, records kept five years, and the gift, gratuity and loan policy KRS 216.712 requires.
We write this for youBuild the caregiver pipeline
Run the criminal record check, both registry checks, a drug test and a TB risk assessment before anyone starts. Train on abuse reporting, medication limits and communication, document competency for each task, and adopt a cabinet approved dementia curriculum.
We set up the system and trackerApply for OIG certification
Submit form OIG-1180 with the $500 fee, payable to the Kentucky State Treasurer, and the required documentation. An agency with three or fewer employees that plans to hire more may receive a 90 day provisional certificate.
We prepare the applicationBecome a Medicaid waiver provider
For the Michelle P. waiver, get certified by the Department for Medicaid Services under the SCL provider rules in 907 KAR 12:010, then enroll through KY MPPA. Waiver records live in the Medicaid Waiver Management Application (MWMA).
We prepare and manage itSet up electronic visit verification
In home waiver visits must be recorded in EVV. Therap provides the state system at no cost, or you can pay for a third party system that integrates with Therap. Set it up before your first waiver visit.
We walk you through setupRecertify every year
File the OIG-1180, the $350 fee and updated screening documentation at least 60 days before your certificate expires, and report name, location and branch changes within 30 days.
You do this; we give you the checklist
Caregiver screening and training in Kentucky
Section 6 and Section 7 of 906 KAR 1:180 set the screening and training rules for personal services agencies. An agency may not employ or keep anyone who fails a required check, and every employee must show competency for each task before working without direct agency supervision.
- Criminal record check: Before hire, through the Justice and Public Safety Cabinet, the Administrative Office of the Courts or an approved company. Felony convictions related to theft, illegal drugs, abuse, neglect or exploitation, or a sex crime disqualify the worker from direct service (KRS 216.710).
- Registry checks: The nurse aide and home health aide abuse registry (906 KAR 1:100) and the registry under 922 KAR 5:120, now titled the Vulnerable Adult Maltreatment Registry. A listing on either disqualifies the worker.
- Drug test and TB: A substance abuse test before hire, where a positive illegal drug result disqualifies, and a TB risk assessment before direct service and every year after, with follow up testing when risk is found.
- Training before direct service: Reporting adult and child abuse, neglect and exploitation; the limits on helping with medication (no injections, drops, mixing doses or tube medications); and communicating with each client.
- Dementia training: Staff who serve clients with Alzheimer's disease or other dementia need six hours of cabinet approved training before providing that care and three hours every year (KRS 216.713). Certificates of completion are portable between employers in Kentucky.
- Medicaid waiver staff: HCB waiver staff also need DAIL attendant care training at hire and every year, CPR and first aid within six months, and a Central Registry check within 30 days of hire.
- Home health aides: Home health aides complete a training and competency evaluation program. Medicare requires at least 75 hours of classroom and supervised practical training and 12 hours of in service training a year (42 CFR 484.80).
- Fingerprint checks through KARES: Personal services agencies, home health agencies and hospices may join the Kentucky national background check program (906 KAR 1:190), which runs registry checks and a fingerprint supported state and FBI check with ongoing monitoring.
Six mistakes that slow Kentucky agencies down
We look for every one of these in the first week of an engagement.
Serving or advertising before the certificate
- What it costs
- Fines of up to $500 a day for operating or marketing as a personal services agency without OIG certification (KRS 216.714).
- How we prevent it
- Your first call ends with your exact Kentucky path, the order of steps and what you can safely do while the application is pending.
Starting a caregiver before all checks are back
- What it costs
- Grounds for revocation under 906 KAR 1:180, and a worker you may have to remove from a client's home.
- How we prevent it
- A tracker that holds every hire until all five checks and the required training are documented.
Offering dementia care without an approved curriculum
- What it costs
- KRS 216.713 bars marketing dementia care without compliant training and allows fines of up to $500 a day.
- How we prevent it
- We build cabinet approved dementia training and annual refreshers into your training plan.
Counting on HCB waiver attendant care
- What it costs
- A personal services agency is not on the HCB waiver's list of traditional providers, so a business plan built on HCB referrals stalls.
- How we prevent it
- We match your agency to the waivers it can actually serve, such as Michelle P. through DMS certification.
Missing the 60 day recertification deadline
- What it costs
- Failure to renew is grounds for revocation, which means stopping services and starting over.
- How we prevent it
- Renewal dates, fees and screening updates tracked on one calendar from the day you are certified.
Planning home health or hospice without checking need
- What it costs
- A clinical agency that cannot be licensed until it wins a Certificate of Need, then waits on Medicare enrollment while the CMS moratorium lasts.
- How we prevent it
- We check Certificate of Need and the CMS moratorium status before you commit capital.
In a free 30 minute call we confirm your Kentucky path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Kentucky launch packages
Three fixed price packages, matched to the path you choose. Your exact price is quoted in writing after your free call, before any work starts.
Private pay launch
For nonmedical agencies serving families who pay privately.
- Kentucky path and a dated launch plan
- Policy and procedure manual written to 906 KAR 1:180 and Kentucky Medicaid waiver regulations in 907 KAR
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Medicaid waiver ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Medicaid waiver requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for the Department for Medicaid Services (waiver certification) and each Kentucky Medicaid health plan
- Survey and audit readiness
- Kentucky city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to CHFS OIG rules and the Medicare Conditions of Participation
- License application and inspection readiness
- Accreditation survey preparation
- Medicare and Medicaid enrollment support
Every package: one fixed price agreed in writing · you own 100% of your agency · no franchise fees or royalties.
On your own vs a franchise vs Lunaria
| Topic | On your own | Home care franchise | With Lunaria |
|---|---|---|---|
| Who owns the business | You | You, under the franchisor's brand and rules | You, 100% |
| Ongoing fees | None | Royalties and brand fees, usually a share of revenue | None. One fixed project fee |
| Knowing what Kentucky requires | Pieced together from manuals and forums | A national playbook, adapted | Confirmed on your first call, then in writing |
| Policy manual | A template, often from another state | The franchisor's standard manual | Written to 906 KAR 1:180 and Kentucky Medicaid waiver regulations in 907 KAR |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for the Department for Medicaid Services (waiver certification) and each Kentucky Medicaid health plan prepared together |
| Your brand and marketing | Up to you | The franchisor's brand, with territory limits | Your brand, plus local search set up for you |
The Kentucky home care startup checklist
Every Kentucky step in order: business setup, your payer path, policies, caregiver screening and training, Medicaid enrollment and getting found. The items to start first are starred.
- Choose your care type and payer mix (private pay, Medicaid waiver, or both)
- Form your LLC or corporation with the Kentucky Secretary of State
- Get an EIN and open Department of Revenue tax accounts
- Set up an unemployment insurance reserve account and check local occupational license taxes
- Buy workers' compensation, general and professional liability, and auto coverage; decide on bonding
- and 14 more steps
Christine Ochimas, RN, LMFT, MBA
Christine founded Lunaria Care Consulting to give nurses and caregivers a direct route from "I want my own agency" to a compliant business with clients. She reads state requirements the way a reviewer does and writes policies the way a nurse would actually use them.
- We serve owners in all 50 states and DC, with a plan written for Kentucky
- We help through enrollment and survey readiness, not just the application
- We tell you what we cannot promise: no one can guarantee a state or health plan decision
Have these ready for your consultation
- The care you want to provide and the clients you want to serve
- The Kentucky cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Medicaid waiver, Medicare
- Your target opening month and rough budget
No client or patient records. We never need them for a first call.
What it costs to start a home care agency in Kentucky
| Item | Notes |
|---|---|
| OIG personal services agency certification | $500 initial fee and $350 annual recertification, payable to the Kentucky State Treasurer (906 KAR 1:180). A change of more than 25 percent ownership costs $350. |
| Home health or hospice license | $500 initial and annual licensure fee for each under 902 KAR 20:008. Check current fees with OIG. |
| Certificate of Need (home health, hospice) | Application preparation, need data and filing costs; check the current filing fee with the OIG Division of Certificate of Need |
| Entity formation and local taxes | Secretary of State filing fee plus any city or county occupational license tax |
| Pre employment checks | Criminal record check, drug test and TB risk assessment per hire. KARES charges a cabinet fee of no more than $25 plus state police and FBI fees if you use it. |
| Training | Cabinet approved dementia training per affected caregiver; DAIL attendant care training, CPR and first aid for waiver staff |
| Insurance and bonding | Workers' compensation, liability, auto coverage and any bond you disclose in the service agreement |
| EVV and scheduling software | Therap is free from the state; a third party system is paid by the agency |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll, rent and insurance while certification, waiver enrollment or Medicare enrollment is pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Kentucky
Weeks to a few months: OIG certification must be issued before you serve anyone, but the statute calls for a review process without an on site visit.
Several months: OIG certification, then waiver provider certification, Medicaid enrollment and EVV setup.
Longest: Certificate of Need review, OIG licensure and inspection, certification survey and Medicare enrollment, subject to the CMS moratorium.
Demand concentrates around Louisville and Jefferson County, Lexington, and Northern Kentucky, where families on both sides of the Ohio River search for care across the Cincinnati area. Bowling Green, Owensboro and the smaller regional cities have steady private pay demand with fewer competitors. In Eastern and Western Kentucky, long drives and thin staffing make reliable scheduling your selling point. Many families search for care for a parent from out of town, so a complete Google Business Profile and clear city and county pages matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Kentucky?
Yes, though Kentucky calls it certification. Agencies that provide personal services must be certified as personal services agencies by the CHFS Office of Inspector General under KRS 216.712 and 906 KAR 1:180 before they provide or advertise services.
How much does Kentucky personal services agency certification cost?
The initial fee is $500 and annual recertification is $350, filed at least 60 days before your certificate expires. A change of more than 25 percent ownership costs $350. Insurance, screening, training and payroll are larger costs.
Who licenses home health and hospice agencies in Kentucky?
The Office of Inspector General. Home health agencies are licensed under 902 KAR 20:081 and hospices under 902 KAR 20:140, each with a $500 initial and annual licensure fee under 902 KAR 20:008.
Does Kentucky require a Certificate of Need for home health or hospice?
Yes. Home health agencies and hospices are health facilities under KRS 216B.015, and KRS 216B.061 requires a Certificate of Need to establish one. The OIG Division of Certificate of Need reviews applications against the State Health Plan. Personal services agencies do not need one.
What training do Kentucky caregivers need?
Before direct service, personal services agency staff are trained on abuse reporting, medication assistance limits and communication, and the agency documents competency for each task. Staff who serve clients with dementia need six hours of cabinet approved dementia training first and three hours every year.
Can a personal services agency bill Kentucky Medicaid?
Only through waivers whose rules allow it. The HCB waiver limits traditional attendant care to other provider types, such as Medicare and Medicaid certified home health agencies. The Michelle P. waiver accepts providers certified by the Department for Medicaid Services under 907 KAR 12:010, and the HCB participant directed option lets a certified personal services agency provide services a participant chooses.
Is the CMS Medicare moratorium still in effect?
CMS paused new Medicare enrollment of home health agencies and hospices nationwide from May 13, 2026 for six months. It was set to end around November 13, 2026 unless CMS extended it, so check its current status before you plan Medicare billing. It does not affect personal services agencies.
Does Kentucky require electronic visit verification?
Yes, for Medicaid. DMS requires EVV for in home services in its 1915(c) waivers and for Medicaid home health care services since January 1, 2024. Therap provides the state system at no cost, or you can use a third party system that integrates with it.
Is a franchise a better way to start a home care agency in Kentucky?
A franchise gives you a brand and playbook in exchange for fees and ongoing royalties. Starting independently with Lunaria costs one fixed price, and you own 100% of your agency with no franchise fees or royalties.
How much does Kentucky home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Medicaid waiver or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges.
Sources checked for this guide (34)
- 906 KAR 1:180, personal services agencies (last amended eff. 2-10-2022; certified 11-24-2025)
- KRS 216.710, personal services agency definitions
- KRS 216.712, certification required, criminal background check, gift policy
- KRS 216.713, dementia training for direct care staff
- KRS 216.714, fines for operating or marketing without certification
- KRS 216B.015, health facility definition
- KRS 216B.020, Certificate of Need exemptions (amended 2025)
- KRS 216B.061, actions requiring a Certificate of Need (amended 2026)
- 900 KAR 5:020, State Health Plan (2025 Update, January 2026; eff. 1-22-2026)
- 902 KAR 20:081, home health agencies
- 902 KAR 20:140, hospice
- 902 KAR 20:008, licensure procedures and fees
- 906 KAR 1:190, Kentucky national background check program (KARES)
- 922 KAR 5:120, Vulnerable Adult Maltreatment Registry
- 907 KAR 7:010, Home and Community Based waiver services version 2
- 907 KAR 7:005, certified waiver provider requirements
- 907 KAR 1:835, Michelle P. waiver (eff. 7-30-2025)
- 907 KAR 12:010, Supports for Community Living waiver provider requirements
- 910 KAR 1:180, Homecare program for the elderly
- DMS Electronic Visit Verification page (Internet Archive copy, March 14, 2026)
- DMS Managed Care Organization contracts page (Internet Archive copy, January 24, 2026)
- DMS Anthem MCO transition page (Internet Archive copy, June 7, 2026)
- OIG Division of Health Care overview (Internet Archive copy, September 19, 2026)
- CMS letter to Kentucky DMS on EVV compliance, February 27, 2024
- Kentucky Secretary of State, business filings and next steps
- Kentucky Department of Revenue, business taxes
- Federal Register 2026-09717, nationwide moratoria on enrollment of home health agencies (govinfo)
- Federal Register 2026-09718, nationwide moratorium on enrollment of hospices (govinfo)
- CMS Home Health and Hospice Nationwide Moratorium Q&As (revised 7/09/26)
- 42 CFR 484.80, home health aide training (eCFR)
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
- CMS-855A Medicare enrollment application, institutional providers
- Kentucky Court of Appeals 2009-CA-001175, home health State Health Plan criterion (Justia, pointer only)
This guide is general information and reflects Kentucky requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Kentucky Cabinet for Health and Family Services (Office of Inspector General and Department for Medicaid Services) and CMS before filing. Lunaria Care Consulting provides professional consulting services and does not provide legal advice.
Other states: see all state guides. What we do: licensing, compliance, Medicaid enrollment and local search marketing.