Home care Medicaid rates in Kentucky are anchored by the best homemaker rate in the country. Kentucky Medicaid pays $9.00 per 15 minutes for personal care under its waiver code 580, or $36.00 an hour, which ranks 9th of 27 states and is 18.0% above the national median of $30.52. Its homemaker rate on S5130 is $39.00 an hour, first of the 9 ranked states.
That combination makes Kentucky one of the more workable states for a home care agency that offers a full mix of personal care, homemaker and companion services. The weak spot is respite, which pays below the national median. Each rate is compiled from official state Medicaid publications and links to its source document on the Kentucky Medicaid rates hub.
Kentucky's waiver rates for home care took effect January 1, 2025, and they place the state well above the middle on its two core agency services.
| Service | Code | Kentucky rate | Rank | vs national median |
|---|---|---|---|---|
| Personal care (hourly) | 580 | $36.00 / hour | 9 of 27 | +18.0% |
| Homemaker (hourly) | S5130 | $39.00 / hour | 1 of 9 | +26.6% |
| Companion care (hourly) | S5135 | $26.92 / hour | 10 of 20 | +3.7% |
| Respite (hourly) | T1005 | $24.00 / hour | 23 of 38 | -5.1% |
| Financial management (monthly) | T2040 | $121.00 / month | 6 of 14 | +6.2% |
The pattern is clear from the ranks alone. The services that make up most of an agency's scheduled hours, personal care and homemaker, are paid well. The services that tend to be added around them, companion care and respite, are paid close to or below the national middle. The table shows the headline rate for each service; the full set of 39,971 current Kentucky Medicaid rates, including every waiver code and modifier, is available with a subscription.
Kentucky pays $9.00 per 15-minute unit for agency personal care under its waiver code 580. Billed in quarter-hour units, a full hour of care is four units, or $36.00.
What the rank means
A rank of 9th of 27 puts Kentucky in the top third of states that publish a comparable hourly personal care rate. It is not at the very top: Utah, Oregon, Iowa, Delaware and Missouri all pay more. But the gap between Kentucky and most of those states is a few dollars an hour, while the gap between Kentucky and the bottom group is far wider. For an agency weighing where to grow, that places Kentucky closer to the leaders than to the low-paying states.
Why the state code matters
Code 580 is a Kentucky-specific waiver code rather than a national procedure code. Kentucky also publishes rates on standard codes such as T1019 and S5125 in other programs. A billing team needs to know which code the client's waiver authorizes, because the same hour of hands-on help can be priced differently depending on the program and code under which it is approved.
Homemaker services, billed on S5130 at $9.75 per 15 minutes, pay $39.00 an hour in Kentucky. That is first of the 9 ranked states and 26.6% above the national median of $30.80.
Homemaker work covers housekeeping, laundry, shopping and meal preparation for people who cannot manage those tasks alone. It is often delivered by the same aides who provide personal care, which gives Kentucky agencies an unusual advantage: homemaker hours pay slightly more than hands-on personal care hours. In most states the reverse is true, or homemaker services are not published as a separate hourly rate at all; only 10 states publish one.
Kentucky edges out North Dakota ($38.36) and New York ($35.61), while the lowest homemaker states are Idaho ($21.04), Nebraska ($20.73) and Texas ($17.40). An agency operating in several states will find that Kentucky's homemaker line is one of the few where non-medical support pays on par with personal care.
Kentucky Medicaid home care reimbursement is less generous outside the two core services.
Companion care on S5135
Companion care on S5135 pays $6.73 per 15 minutes, or $26.92 an hour. That ranks 10th of 20 states and sits just 3.7% above the national median of $25.96. Companion care is supervision and social support rather than hands-on help, and it is usually priced below personal care everywhere. In Kentucky the step down from personal care is meaningful, so companion hours need tighter scheduling to stay viable.
Hourly respite on T1005
Hourly respite on T1005 pays $6.00 per 15 minutes, or $24.00 an hour, 5.1% below the national median of $25.30 and 23rd of 38 states. Respite gives unpaid family caregivers a break, and it is one of the most widely used waiver services. Its rate is the lowest of Kentucky's hourly home care services in our data, which shapes how agencies treat respite referrals.
Kentucky pays for home care mostly through its 1915(c) home and community-based services waivers. Each waiver serves a defined population and authorizes a set of services:
- Home and Community Based (HCB) waiver, for older adults and people with physical disabilities.
- Michelle P. waiver, for people with intellectual or developmental disabilities living at home.
- Supports for Community Living (SCL) waiver, a broader developmental disability program.
- Acquired Brain Injury waivers, one acute and one long term care.
- Model Waiver II, for people who depend on a ventilator.
Kentucky also runs the 1915(i) Recovery, Independence, Support and Engagement (RISE) Initiative, and children's HCBS services carry the HA modifier on the DMS rate schedule.
Self-direction runs alongside agency care. When a participant hires their own worker, the financial management services provider is paid a flat monthly fee on T2040 with the HI modifier, $121.00 a month in Kentucky, 6th of 14 states. That fee covers payroll and tax handling, not hours of care.
The state median wage for home health and personal care aides was $17.52 an hour in May 2025, close to the US median of $17.21. Registered nurses had a state median of $38.96 against $46.90 nationally.
Because aide wages are near the national level while the core rates are above it, Kentucky's margins vary sharply by service:
- Homemaker at $39.00. Wages are 63.8% of the rate; the margin after loaded wages is $14.10 an hour.
- Personal care at $36.00. Wages are 69.2% of the rate; the margin is $11.10 an hour.
- Companion care at $26.92. Wages rise to 92.5% of the rate and the margin narrows to $2.02.
- Hourly respite at $24.00. Wages are 103.7% of the rate and the margin after loaded wages is -0.90 an hour.
The practical read: in Kentucky, homemaker and personal care hours fund the agency, while respite at the published rate does not cover a median-wage aide once payroll taxes and benefits are added. Agencies that take respite referrals generally do so to keep clients and aides engaged, not for margin. The margin figures cover wages only; travel time, supervision, training and administration come out of what remains.
Kentucky attaches prior authorization rules to every home care code in our data, and none of them carries a unit limit.
Personal care code 580 carries 1 prior authorization rule, and the homemaker, attendant and companion codes each carry 2. Respite on T1005 carries the most rules of any home care code.
For a billing team, that means authorization tracking, not unit caps, is the main administrative risk on Kentucky waiver claims. Respite is where the rule count is highest, which adds administrative cost to the service that already has the thinnest margin. Agencies that schedule respite without a current authorization on file risk unpaid hours that the rate gives no room to absorb.
Kentucky pays home and community-based services, personal care and intellectual and developmental disability services directly, outside managed care. Its managed care plans negotiate rates for physician, hospital, therapy and home health services, with the published rate applying out of network, but waiver home care is paid from the state's own rate tables.
That matters for an agency in two ways. First, there is no plan-by-plan contract negotiation for waiver personal care or homemaker hours: the published rate is the rate. Second, the rate changes only when the state changes it, so DMS provider letters and administrative regulation amendments are the documents to watch.
Our data lists 15 plans and programs in Kentucky, including PACE organizations such as Bluegrass Care Navigators and Senior CommUnity Care of Kentucky. PACE programs contract separately for in-home support for their enrollees. The Kentucky managed care page sets out the rule for each service line.
2026 brought a brief scare for Kentucky providers:
- A DMS provider letter: Medicaid Budget Impact on Provider Reimbursement, published June 8, 2026, enacted a 4.0% reduction effective August 1, 2026.
- The Update to that letter, published July 23, 2026, reversed the cut, so the January 1, 2025 home care rates above remain in place.
The larger movement came in 2025. The 907 KAR 1:835 amendment on Michelle P. waiver services and reimbursement took effect July 30, 2025 with a 21.02% change, and the 907 KAR 12:020 amendment for the Supports for Community Living waiver took effect the same day with a 33.13% change. Amendments to the Model Waiver II rules and both acquired brain injury reimbursement rules also took effect July 30, 2025.
Before those amendments, the 1915(c) HCBS Waiver Rate Increase Guidance letter set the January 1, 2025 effective date for the current rates, and a separate 1915(c) HCBS Waiver Respite Guidance letter followed in January 2025. The reversal of the 2026 cut is a reminder that budget pressure on waiver rates is real even when a cut does not land.
Kentucky is a top-tier state for homemaker care, upper-middle for personal care and middle for companion care and self-direction. Its weak point is respite.
On personal care, Kentucky's $36.00 an hour sits behind Utah ($84.84), Oregon ($42.24), Iowa ($42.00), Delaware ($39.35) and Missouri ($39.00). It is well clear of the bottom group of Pennsylvania ($19.48), Louisiana ($19.08) and Texas ($18.28).
Among neighbors, Kentucky pays above Indiana on homemaker services and below Missouri on personal care. Next door in Tennessee, rates are set under a different structure, so an agency working both sides of the border should benchmark code by code rather than assume parity.
The rates above are a starting point for several decisions an agency makes every year.
Budgeting by service mix
Because margins differ so much by service, an agency's blended margin depends on its mix of hours. A caseload weighted toward homemaker and personal care supports overhead; a caseload weighted toward respite and companion care does not. Building next year's budget service by service, rather than on one average rate, shows where the money is made.
Wage setting and recruitment
With aide wages near the national median, Kentucky agencies compete for the same workers as hospitals, nursing facilities and retail. The margin on personal care leaves some room for a wage premium on hard-to-fill shifts; the margin on respite leaves none.
Benchmarking and advocacy
When rates come up for review, comparisons with neighboring and peer states carry weight. Kentucky's ranks give a provider association concrete evidence: respite below the median is the clearest case for an increase.
Rates on this page are compiled from official state Medicaid publications, including DMS waiver rate schedules, provider letters and the Kentucky administrative regulations named above. Each rate links to its source document on the Kentucky Medicaid rates hub. Hourly figures are converted from the published unit, here 15 minutes, and ranked against every state that publishes a comparable rate for the same service and provider level. Wage figures are state and US medians for May 2025.
Compare every state on the home care Medicaid rates by state page, and read how rates are converted to hourly figures and ranked in our methodology. Access to all current Kentucky rates and their history since 2019 is described on the pricing page.