How to Get Paid to Care for a Parent in Kentucky (2026): Participant Directed Services

ElderHearth offers general information, not financial, tax, or legal advice. Program rules and budgets change, so confirm the details with your parent's case manager or the Kentucky Department for Aging and Independent Living.

Most states that pay family caregivers draw a line at the spouse. Kentucky does not, and if you have been reading about other states, that is the first thing worth knowing here. The route to get paid to care for a parent in Kentucky runs through Participant Directed Services, or PDS, an option inside the state's Home and Community Based waiver where your parent holds a budget and hires their own workers. This guide covers who Kentucky lets your parent hire, the two rules that catch families out, and where the budget figure actually comes from.

How to get paid to care for a parent in Kentucky: Participant Directed Services

PDS sits inside Kentucky's Home and Community Based (HCB) waiver, which serves people who need nursing-home-level care but want to stay home. The state defines that threshold as a status determination rather than a diagnosis: NF level of care "means a high intensity or low intensity patient status determination made by the department in accordance with 907 KAR 1:022".

Under PDS, your parent stops being a recipient of an agency's schedule and becomes the employer. They choose who works, when, and on what terms, within a budget the department sets. That shift is what makes it possible for the person already doing the work to be paid for it.

Kentucky pays a spouse, which most states will not

The list of who your parent may hire is written into the regulation, and it is unusually short on exclusions. A PDS provider shall "Be a friend, spouse, parent, family member, other relative, employee of a provider agency, or other person hired by the participant".

Read that list against what other states do. New Mexico treats a spouse as a legally responsible individual and bars payment for the care that person would ordinarily provide anyway. Tennessee's route runs through consumer direction, where the rate is not published at all and the family has to ask for it. Kentucky simply names the spouse alongside the friend and the neighbor and moves on.

So the answer to can a spouse be paid as a caregiver in Kentucky is yes, and the answer to does Kentucky Medicaid pay family caregivers is yes through this route specifically. An adult child, a sibling, or a grandchild is equally eligible.

The rule that catches families: you cannot run it and be paid for it

Here the openness stops. Your parent may name a representative to direct the services on their behalf, which is what usually happens when a parent is willing to hire family but not to manage payroll and paperwork. The adult child who steps into that role often assumes they are also the paid caregiver.

They cannot be. A PDS representative shall "Not be monetarily compensated for acting as the PDS representative or providing a PDS". The bar covers both halves: no payment for representing, and no payment for providing the service.

The practical shape of this, which follows from the rule rather than being stated in it, is that a family with one available adult child has a choice to make rather than a role to fill. Either that child directs the plan unpaid and someone else is hired, or the child is hired and your parent directs the plan themselves or names a different representative. Deciding which before the paperwork starts saves a reversal later.

Where the budget comes from: last year's costs, minus five percent

Most states describe the budget as coming out of an assessment. Kentucky says something more specific, and the specificity matters because it tells you what your parent's first year will look like before anyone assesses anything.

The regulation states that "The department shall establish a budget for a participant based on the individual's historical costs minus five (5) percent to cover costs associated with administering the participant-directed services".

Two things follow for a family reading that sentence. A parent who has been receiving waiver services for a while carries their own spending history into PDS, so the budget reflects what they actually used rather than what they might need. And whatever that figure is, five percent of it goes to administration before any of it reaches a caregiver.

For a parent with no such history, the regulation supplies the fallback: "If no historical cost exists for the participant, the participant's budget shall equal the average per capita, per service historical costs of HCB recipients minus five (5) percent". A new participant is budgeted at the average, not at their own assessed need, which is worth raising with the case manager if your parent's needs sit above average.

The forty-hour ceiling

One more limit shapes what this can be worth. The regulation caps a single provider: "A PDS provider shall not provide more than forty (40) hours of PDS in a calendar week (Sunday through Saturday)".

Forty hours is a full-time week, so for most families the ceiling is not the constraint. It becomes one when a parent needs more than forty hours of covered support, because the balance has to come from a second hired person rather than from you working longer. Plan the second worker early if your parent's authorized hours run past that line.

Who qualifies

Eligibility runs through your parent rather than through you:

• Your parent must be on Kentucky Medicaid and meet NF level of care, the same threshold that opens the HCB waiver.
• Your parent must be enrolled in a waiver that offers PDS. The HCB waiver does; Kentucky runs other waivers with their own rules and populations, so confirm which one your parent is in before applying the rules on this page.
• You need no license or agency employment. The regulation's list of who may be hired includes a friend or relative hired directly by the participant.
• You cannot also be the paid representative, as above.

How to apply for PDS in Kentucky

The entry point is not the PDS program itself. It is whoever manages your parent's waiver enrollment.

1. Confirm the waiver. Ask which waiver your parent is enrolled in and whether it offers PDS. If your parent is not yet on a waiver, that application comes first.
2. Call the case manager and ask to discuss PDS enrollment. Existing waiver participants move into PDS through their case manager rather than through a separate application.
3. Reach the Area Agency on Aging and Independent Living for your region if you do not know who the case manager is. Kentucky's Department for Aging and Independent Living routes families through those regional offices.
4. Settle the representative question before the paperwork. Decide who directs and who is paid, since one person cannot do both.
5. Ask for the budget figure and how it was derived, specifically whether it came from your parent's own history or from the HCB average, and what the five percent leaves.

Frequently Asked Questions

Can I get paid to take care of my parent in Kentucky? Yes, through Participant Directed Services in the Home and Community Based waiver. Your parent becomes the employer and can hire a relative directly, without you working for an agency.

Can a spouse be paid as a caregiver in Kentucky? Yes. The regulation lists a spouse among those a participant may hire, which is unusual: many states exclude spouses as legally responsible individuals.

Does Kentucky Medicaid pay family caregivers? Yes, through PDS. Your parent must meet nursing-facility level of care and be enrolled in a waiver that offers the participant-directed option.

How many hours a week can I be paid for? No more than forty in a calendar week, Sunday through Saturday, as a single PDS provider. Care beyond that has to be covered by another hired worker.

Can I be my parent's representative and their paid caregiver? No. A PDS representative cannot be paid for acting as representative or for providing a service, so the roles have to go to two different people.

How is the budget calculated in Kentucky? From your parent's own historical service costs, minus five percent for administration. If there is no history, the state uses the average per capita historical cost for HCB recipients, minus the same five percent.

Where to start

Make one call to your parent's case manager and ask two questions in this order: whether their waiver offers Participant Directed Services, and what the budget would be if they enrolled. The second answer is the one that decides whether this changes anything for your family, because it is set before any negotiation and starts five percent short of what your parent has been using. Then settle who directs and who is paid, because Kentucky will not let that be the same person. For how other states structure the same choice, Indiana splits the money between the agency and a mandated caregiver share, and our guide to getting paid to care for an elderly parent compares the wider set. Paid or not, the arrangement has to fit a workable aging in place plan.

If you would like someone to read what you are dealing with, you are welcome to write to us.

Sources

• Kentucky Legislative Research Commission, 907 KAR 1:160, Home and community based waiver services, the PDS provider list, the representative bar, the forty-hour cap, and the budget methodology.
• Kentucky Cabinet for Health and Family Services, Participant Directed Services, Department for Aging and Independent Living.