How Kentucky pays for disability services

Waiver inventory

HCB is included because it absorbs a large share of the same demand pool: 5,360 people were on its waiting list as of September 2025, and Kentucky's own analysis notes 14.8 percent of people on waiting lists are on more than one list and 31.1 percent already have an allocation in another waiver. Kentucky's other 1915(c) waivers (Acquired Brain Injury, Acquired Brain Injury Long Term Care, Model II) serve distinct populations and are excluded. Kentucky has no 1915(i) state plan HCBS benefit and no 1915(k) Community First Choice option.

State-only funded programs

• Hart-Supported Living Program (HSLP). Authorized by KRS 210.770 through 210.795, administered by the Department for Aging and Independent Living. Provides grant funds for individualized supports so that people with disabilities can live in a typical home of their choosing and avoid institutionalization. The program explicitly excludes segregated living arrangements, congregate models, and any setting where more than three people with disabilities share a unit. Applications are handled through Regional Coordinators. Annual appropriation: not published on the program page and not located in this research. chfs.ky.gov

What was checked and did not yield a second state-only IDD program: the DBHDID division landing pages, the Division of Developmental and Intellectual Disabilities page, the DBHDID Waiver Branch page, the DMS SCL waiver page, and the September 9, 2025 Medicaid Oversight and Advisory Board waiver update. Kentucky's state-operated ICF/IID facilities (Oakwood and Hazelwood) are funded with a mix of State General Fund and Medicaid rather than state dollars alone.

County / regional / local funding

None identified.

Kentucky delivers SCL and Michelle P. through a statewide network of Community Mental Health Centers, Aging and Disability Resource Centers, and certified private providers rather than through county boards or local levies. Applications are made statewide through kynect.ky.gov. No county levy, county board, or regional center allocation mechanism appears in the DMS or DBHDID materials reviewed.

Sources checked: chfs.ky.gov chfs.ky.gov apps.legislature.ky.gov

Funding scale

• SCL waiver services, CMS-approved cost neutrality projection for the waiver year beginning July 1, 2026: $489,967,723.17 all funds across 5,166 unduplicated participants. Source: KY.0314.R05.03 Appendix J, medicaid.gov
• Michelle P. waiver services, CMS-approved cost neutrality projection for the waiver year beginning July 1, 2026: $487,026,254.83 all funds across 10,850 unduplicated participants. Source: KY.0475.R03.03 Appendix J, medicaid.gov
• Combined SCL plus Michelle P. projected waiver service spending for the year beginning July 1, 2026: $976,993,977.99 all funds. Derived by addition from the two CMS documents above.
• Spending per participant: SCL Factor D of $94,844.70 in waiver year 1 rising to $114,601.73 by waiver year 5; Michelle P. Factor D of $44,887.21 rising to $62,600.52. Same sources.
• Actual FY 2025 cost per person: HCB $45,680; Michelle P. $48,330; SCL $110,250. Comparison institutional figures cited in the same reporting: nursing facility $135,990 per year; public ICF $700,600 per person per year (secondary). Source: lexingtonky.news
• Comparison institutional cost inside the CMS document: SCL Factor G, the average ICF/IID cost, is $392,042.63 per person per year in waiver year 1. Michelle P. Factor G is $400,990.48. Same CMS sources.
• Largest SCL service line, waiver year 1: Residential Support Level I at $213,336,832.24, which is 43.5 percent of all SCL spending, followed by Personal Assistance at $69,225,246.44 and Case Management at $25,509,200.64. Source: medicaid.gov
• Largest Michelle P. service line, waiver year 1: Community Access at $340,146,863.64, followed by Case Management at $44,769,558.00 and Respite at $14,899,032.72. Source: medicaid.gov
• Waiting list, as of September 2, 2025: SCL 3,742; Michelle P. 9,686; HCB 5,360. Unduplicated total across all waivers: 16,373. By December 2025 the figure reported across HCB, Michelle P., and SCL together exceeded 19,000, roughly two-thirds of all funded slots. Sources: apps.legislature.ky.gov and lexingtonky.news
• Average time on the waiting list, as of September 2, 2025: SCL 2,830 days (approximately 7.8 years), maximum 10,938 days (approximately 30 years); Michelle P. 1,274 days (approximately 3.5 years), maximum 3,133 days; HCB 119 days, maximum 243 days. Source: apps.legislature.ky.gov
• SCL waiting list distribution: 1,923 of 3,742 people, or 51.4 percent, have been waiting more than five years. Michelle P.: 2,982 of 9,686, or 30.8 percent, more than five years. Same source.
• New slot allocations effective July 1, 2025 for SFY 2026: HCB 500, Michelle P. 500, SCL 250. Same source.
• Kentucky FMAP, FY 2026: 71.41%. State share of SCL and Michelle P. services is therefore about 28.59%, the lowest state burden of the three states in this set. Source: kff.org
• Total all-funds Kentucky IDD spending across waiver, ICF/IID, and non-Medicaid programs: not found in a current published source.

Residential funding detail

Kentucky is the most explicitly tiered of the three states, with all residential rates set in administrative regulation rather than in a separately published fee schedule.

Group homes and supervised residential, under SCL (907 KAR 12:020, base rates effective January 1, 2025, all per day): - Residential Support Level I, 3 residents or fewer: $284.57 - Residential Support Level I, 4 to 8 residents: $215.09 - Residential Support Level II: $129.91 - Residential Support Level II with 12 or more hours of supervision: $198.70 - Technology Assisted Residential: $105.15

Level I is the staffed, higher-intensity model. The size-based split within Level I creates a $69.48 per day premium for settings of three or fewer people, which is a deliberate downsizing incentive. The CMS Appendix J projection for the waiver year beginning July 1, 2026 shows 2,468 people using Residential Support Level I for an average of 346 days at an average blended rate of $249.83 per day.

Shared living: $726.00 per day under 907 KAR 12:020. Note a discrepancy: the CMS Appendix J table for the same waiver lists Shared Living with a unit of "per month" at $726.00 across 7 users and 8 units. The regulation is the controlling rate authority; the CMS entry appears to carry a unit-of-measure error. Utilization is negligible either way.

Host home: not a named Kentucky service. The functional equivalent is Shared Living.

In-home and family settings: SCL funds Personal Assistance at $7.37 per 15 minutes and Community Access, Individual at $10.65 per 15 minutes. Michelle P. funds Community Living Supports at $6.70, Personal Care at $9.08, Attendant Care at $6.36, and Homemaker at $7.87, all per 15 minutes, all available in both traditional and participant-directed (PDS) form at identical rates.

Payment structure: per diem for all residential tiers, with the tier assigned by supervision intensity and setting size rather than by an acuity assessment score. Everything else is 15-minute units except case management (per month), financial management services (per month), transportation (per month), and capped lifetime or annual allowances for adaptations and goods.

Combined service cap: any combination of day training, community access, personal assistance, or paid community employment or on-site supported employment cannot exceed 16 hours per day. Community access cannot exceed 160 units per week.

Room and board: not funded. The SCL waiver application states that payment is not made for the cost of room and board, including building maintenance, upkeep, and improvement, in accordance with 42 CFR 441.310(a)(2). Room and board falls to the person's own income, principally SSI.

Rate structure link: apps.legislature.ky.gov

Comparable service rates

Additional SCL rates from the same regulation, all effective January 1, 2025: Community Guide $10.65 per 15 minutes; Person-Centered Coaching $7.66 per 15 minutes; Consultative Clinical and Therapeutic Services (behavioral, dietary, psychological, functional analysis) $29.95 per 15 minutes; Positive Behavior Support Plan $885.12 per plan; Financial Management Services $121.00 per month; Transportation $320.65 per month; Community Transition up to $2,420 per transition; Environmental Accessibility Adaptation up to $9,680 lifetime; Vehicle Adaptations up to $7,260 every five years; Goods and Services up to $2,178 per year; Natural Supports Training up to $1,210 per year.

Additional Michelle P. rates from 907 KAR 1:835, effective January 1, 2025: Behavioral Support Services $40.23 per 15 minutes; Occupational, Physical, and Speech Therapy $26.83 each per 15 minutes; Financial Management Services $121.00 per month; Environmental and Minor Home Adaptation up to $605 per plan of care, capped at $500 per member per calendar year.

Official rate schedule links

• 907 KAR 12:020, Reimbursement for New Supports for Community Living Waiver Services, full rate table: apps.legislature.ky.gov
• 907 KAR 1:835, Michelle P. waiver services and reimbursement, full rate table at Section 14: apps.legislature.ky.gov
• CMS-approved SCL waiver application KY.0314.R05.03, effective July 1, 2026, including Appendix I rate methodology and Appendix J unit costs: medicaid.gov
• CMS-approved Michelle P. waiver application KY.0475.R03.03, effective July 1, 2026: medicaid.gov
• DMS 1915(c) Medicaid Waivers Update to the Medicaid Oversight and Advisory Board, September 9, 2025, with slot allocation, enrollment, and waiting list tables: apps.legislature.ky.gov
• DMS SCL waiver program page: chfs.ky.gov
• DBHDID Waiver Branch: chfs.ky.gov

Notable features and flags

• July 1, 2026: amendments to both SCL (KY.0314.R05.03) and Michelle P. (KY.0475.R03.03) took effect. Both were approved by CMS in early July 2026. The Michelle P. waiver itself was renewed effective October 1, 2025 through September 30, 2030; SCL runs through April 30, 2029. medicaid.gov and medicaid.gov
• Rate study partially implemented. The SCL waiver application states that a set of services received no rate update in the current cycle: Case Management, the three Consultative Clinical and Therapeutic services, Person-Centered Coaching, Day Training, Personal Assistance, Residential Support Level I, Shared Living, Supported Employment, Financial Management Services, Community Access, Community Guide, Natural Supports Training, Positive Behavior Supports, Technology Assisted Residential, and Transportation. Where the study would have produced a decrease, Kentucky did not implement the new methodology, so rates did not fall. Some Appendix J average unit costs blend the historical and planned rates, for example Personal Assistance shown at $7.96 as the average of $7.37, $7.37, and $9.14. medicaid.gov
• July 1, 2025: 1,250 new slots allocated across three waivers for SFY 2026 (HCB 500, Michelle P. 500, SCL 250). Despite that, the December 2025 combined waiting list across HCB, Michelle P., and SCL exceeded 19,000, roughly two-thirds of all funded slots. apps.legislature.ky.gov and lexingtonky.news
• Waiting list reform is behind schedule and explicitly tied to expired ARPA funds. The 2023 Task Force and 2024 Waitlist Management Report commitments (aligning waitlist regulations across waivers, standardizing eligibility review with an urgency-of-need prioritization, and publishing a public waitlist dashboard) carry timelines of October 2024 through March 2027 and August 2026. The Cabinet's own status notes state that implementation of selected options was placed on hold pending exhaustion of ARPA funds. apps.legislature.ky.gov
• Participant-directed services are priced at parity. Every PDS-eligible service in both SCL and Michelle P. carries an identical base rate to its traditional counterpart, with Financial Management Services at $121.00 per month in both waivers. Residential supports are not PDS-eligible. apps.legislature.ky.gov
• HB 695 requires the Cabinet to begin waiver renewal work two years before the required renewal date, which is why 2026 amendments to waivers not expiring until 2029 and 2030 are already in the CMS record. apps.legislature.ky.gov
• Michelle P. waiting list churn is structural, not just volume. Cabinet analysis as of September 2, 2025 found 14.8 percent of people on waiting lists are on more than one list, 31.1 percent already hold an allocation in a different waiver, and 86 percent have Medicaid and can receive state plan services while waiting. Same source.

Confidence

Solid: every rate in the comparable service rates table is a base payment rate set in Kentucky administrative regulation (907 KAR 12:020 for SCL, 907 KAR 1:835 for Michelle P.), effective January 1, 2025, read directly from the Legislative Research Commission's own regulation text. The slot allocation, filled slot, and waiting list figures come from the Department for Medicaid Services presentation to the Medicaid Oversight and Advisory Board dated September 9, 2025, with data as of September 2, 2025. The cost neutrality totals, per-participant Factor D and Factor G, and per-service projected volumes come from the CMS-approved KY.0314.R05.03 and KY.0475.R03.03 applications approved in July 2026 for waiver years beginning July 1, 2026.

Estimated: the combined $976,993,977.99 figure for SCL plus Michelle P. is my addition of the two CMS Appendix J grand totals, not a published Kentucky number. The per-person FY 2025 costs ($110,250 SCL, $48,330 Michelle P., $45,680 HCB) and the institutional comparators ($135,990 nursing facility, $700,600 public ICF) come from news reporting citing state data and are marked secondary. The slot allocation table was recovered by optical character recognition from an image embedded in the DMS presentation; the numbers were cross-validated against the separately extracted waiting-list-by-timeframe table, where the SCL and Michelle P. totals reconcile exactly (3,742 and 9,686), which gives high confidence in the OCR.

Could not find: an annual appropriation figure for the Hart-Supported Living Program; enrollment or slot figures for the new CHILD waiver (KY.2486.R00.00); Kentucky's total all-funds IDD spending across waiver, ICF/IID, and non-Medicaid programs for FY 2025 or FY 2026; a current census for the state-operated ICF/IID facilities; and a University of Kansas State of the States current Kentucky state profile PDF, since the project's state profile pages are served through an interactive map that did not expose the underlying PDF URLs. There is one unresolved discrepancy: SCL Shared Living is priced per day at $726.00 in 907 KAR 12:020 but appears as per month at $726.00 in the CMS Appendix J table for the same waiver. I have treated the regulation as controlling.

All three states researched. Here are the profiles.