How to start an assisted living facility in Kentucky

Kentucky requires a Assisted living community license under 902 KAR 20:480, in three types: social-model ALC, ALC with basic health care (ALC-BH), and ALC with dementia care (ALC-DC). Communities were previously certified by DAIL under 910 KAR 1:240. Personal care homes are licensed separately (902 KAR 20:031). from Kentucky Cabinet for Health and Family Services, Office of Inspector General, Division of Health Care (previously DAIL certification) to operate an assisted living facility. Fee: OIG requires an 'applicable licensing fee' with Form OIG-20:480; the amount is not given in the FAQ.

License required

Yes

License

Assisted living community license under 902 KAR 20:480, in three types: social-model ALC, ALC with basic health care (ALC-BH), and ALC with dementia care (ALC-DC). Communities were previously certified by DAIL under 910 KAR 1:240. Personal care homes are licensed separately (902 KAR 20:031).

Issuing agency

Kentucky Cabinet for Health and Family Services, Office of Inspector General, Division of Health Care (previously DAIL certification)

Fee

OIG requires an 'applicable licensing fee' with Form OIG-20:480; the amount is not given in the FAQ.

Medicaid waiver coverage

HHS's 2015 compendium reported that Kentucky does not use Medicaid to pay for services in assisted living communities or personal care homes.

Regulation

KRS 194A.700–.729; 902 KAR 20:480 (assisted living communities); 910 KAR 1:240 (former DAIL certification)

1. Choose the license type for the highest level of care provided; campuses with a secured dementia unit need a separate ALC-DC license
2. Submit Form OIG-20:480 with documentation and the licensing fee (apartment-style personal care homes must apply at least 60 days before their PCH renewal date)
3. Pass the OIG survey

Program

Kentucky Medicaid (Department for Medicaid Services)

Enrollment portal

Kentucky Medicaid Partner Portal Application (MPPA)

Fiscal agent

Gainwell Technologies (fiscal agent for KY Medicaid claim processing, KYHealth-Net)

Application fee

Kentucky's MAP-811 checklist tells providers subject to the fee to attach a check payable to the Kentucky State Treasurer; DMS's provider-type summaries say which types owe it. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Kentucky Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Kentucky Cabinet for Health and Family Services, Office of Inspector General

Services covered

• hospitals
• ambulatory surgical centers
• home health agencies
• hospice (including residential hospice by a non-hospice entity)
• nursing facilities, personal care homes, ICF and ICF/IID
• chemical dependency treatment programs
• psychiatric residential treatment facilities (Level I and II)
• PET, MRI, megavoltage radiation and cardiac catheterization
• open heart surgery and organ transplant programs
• special care neonatal beds
• prescribed pediatric extended care facilities
• ground ambulance providers (unless exempt)
• nonsubstantive review: adult day health, private duty nursing agencies, PACE, hospital-owned off-campus freestanding EDs, industrial ambulance, certain acute bed transfers

Kentucky certificate of need details →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Assisted living facilities — active organization NPIs (NPPES)

85 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,264,449 (as of Jun 1, 2026)

All Kentucky Home care Medicaid rates, ranked →

• Acquired Brain Injury Waiver (1915(c))
• Acquired Brain Injury – Long Term Care Waiver (1915(c))
• Community Health for Improved Lives and Development (CHILD) Waiver (1915(c))
• Home and Community Based Waiver (1915(c))
• Model Waiver II (1915(c))
• Michelle P. Waiver (1915(c))
• Supports for Community Living Waiver (1915(c))

Kentucky waivers and waiting lists →