Participant Directed Services (PDS) in Kentucky: Get Paid to Care for Your Parent

You are already providing full-time care for your parent with dementia. You have reorganized your schedule, reduced your work hours, and taken on responsibilities that would cost thousands per month if you hired an agency. But you are doing it unpaid.

Kentucky's Participant Directed Services (PDS) program changes that. It allows your parent to hire you — their adult child — as a paid caregiver using Medicaid Home and Community Based (HCB) Waiver funds. You set the schedule, and a state-approved fiscal agent handles payroll and tax withholding.

How PDS Works

PDS is a service delivery option within the HCB Waiver, not a separate program. When your parent qualifies for the HCB Waiver, they choose how they want their approved services delivered:

• Agency-directed — a certified home health agency assigns aides on their schedule
• Participant Directed Services (PDS) — your parent (or you, as their authorized representative) hires, trains, schedules, and supervises their own workers

Under PDS, your parent becomes the employer. They can hire family members, friends, or neighbors as their paid attendants. The fiscal agent — currently Acumen in Kentucky — handles the employment paperwork: W-2 processing, tax withholding, workers' compensation, and direct deposit.

Who Can Be Hired Under PDS

• Adult children — yes, you can be hired
• Other relatives (siblings, grandchildren, nieces, nephews) — yes
• Friends and neighbors — yes, if they pass a background check
• Spouses — no. Kentucky regulations prohibit a spouse from serving as a paid PDS worker
• Legal guardians — no. If you are your parent's court-appointed guardian, you cannot also be their paid PDS worker

What PDS Covers

PDS workers provide the same services covered under the HCB Waiver's attendant care and homemaker categories:

• Personal care — bathing, dressing, grooming, toileting, transfers
• Homemaker services — meal preparation, laundry, light housekeeping, grocery shopping
• Supervision — monitoring for safety, redirecting during confusion or agitation, preventing wandering
• Medication reminders — reminding your parent to take medications (you cannot administer medications unless you are a licensed nurse)

The number of hours you are authorized to work depends on your parent's assessed level of need, determined during the K-HAT (Kentucky Home Assessment Tool) evaluation. Typical authorizations range from 20 to 40 hours per week, though higher levels are approved for individuals with intensive care needs.

Pay Rates

PDS pay rates are set by the state and are lower than what agencies charge. Expect approximately $10 to $15 per hour depending on the service type and your parent's level of care. This is the rate paid to you as the worker — the state pays the fiscal agent a separate administrative fee.

The income is taxable. The fiscal agent issues a W-2 at the end of the year and withholds federal and state income tax, Social Security, and Medicare contributions from each payment.

How to Get Your Parent on PDS

PDS eligibility requires your parent to be enrolled in the HCB Waiver, which means meeting two thresholds:

Clinical eligibility: Your parent must require a Nursing Facility Level of Care (NFLOC), evaluated through the K-HAT assessment. For a parent with moderate to advanced dementia who needs assistance with at least two Activities of Daily Living (eating, bathing, dressing, toileting, transferring, walking), this standard is typically met.

Financial eligibility: Countable assets must be below $2,000 for a single applicant. Monthly income must be below $2,982 (the 2026 Special Income Standard), or excess income must be routed through a Qualified Income Trust.

The application process:

1. Contact your regional ADRC to initiate the HCB Waiver application
2. Have your parent's physician complete Form MAP-10 (Waiver Services Physician's Recommendation)
3. Complete the financial application through the kynect benefits portal
4. Once approved for the waiver, request PDS as the service delivery model
5. Select a case management agency within 60 days (failing to do this causes automatic loss of eligibility)
6. The case management agency connects you with the fiscal agent and helps set up your employment

The waitlist reality: The HCB Waiver in Kentucky has historically maintained a waitlist — as of recent data, over 5,360 individuals were waiting for a slot. Wait times vary significantly by region. Contact your ADRC for current waitlist estimates in your area.

Common Pitfall: The 60-Day Case Manager Selection Window

After your parent is approved for a waiver slot, the state requires selection of an approved case management agency within 60 calendar days. If you miss this deadline — which happens often due to confusion about the requirement or local provider waitlists — the state automatically terminates your parent's waiver eligibility, and you must restart the entire application process.

Mark the deadline the day your approval letter arrives. Ask your ADRC for a list of available case management agencies in your area and begin contacting them immediately.

The Kentucky Dementia & Memory Care Guide walks through the complete HCB Waiver application process, the PDS enrollment steps, and includes a Financial Record Tracker worksheet for assembling the 60 months of bank statements required for the Medicaid application.

See more Kentucky guides →