Updated September 3, 2026. Quick answer: yes, through Participant Directed Services (PDS), formerly the Consumer Directed Option (CDO), under Kentucky’s 1915(c) HCBS waivers. Most adult family members can be hired and paid to provide the care. A spouse can also be the paid caregiver.
How Kentucky pays a family caregiver
| Program | Participant Directed Services (PDS), formerly the Consumer Directed Option (CDO), under Kentucky’s 1915(c) HCBS waivers |
|---|---|
| Can a family member be paid? | Yes. “Participant-Directed Services (PDS) is a service-delivery model included in five of Kentucky’s six Home and Community Based Services (HCBS) waivers… increases participant choice and control by allowing them to find and hire individual employees to provide non-medical, non-residential waiver services.” |
| Can a spouse be paid? | Yes. “Through an HCBS waiver, a state may elect to make payment for personal care or similar services that are rendered by legally responsible individuals when such services are deemed extraordinary care so long as the state specifies satisfactory criteria for authorizing such payments.” |
Why the spouse question is different
Federal Medicaid rule treats a spouse (and a parent paying for a minor child) as a “legally responsible relative”, someone already assumed to owe the care for free, so paying them is barred by default. A state has to build an explicit exception into its waiver or state-plan option to pay a spouse at all; the rule for any other relative (an adult child, a sibling, a grandchild) is looser and usually allowed. That is why the two rows above can carry different answers on the same page.
The going rate
Not published by the state in the materials reviewed this session.
How it works
A participant enrolls in one of the qualifying HCBS waivers through their case manager, elects the PDS option, and hires/trains/supervises their own worker through a Financial Management/Fiscal agency. Spouses and parents of adult participants must go through a formal DAIL review proving extraordinary-care criteria before being approved as a paid PDS employee; other relatives generally need no such review.
What this doesn’t answer
No published hourly rate was independently confirmed on an official page this session. Waitlist status was not verified.
Sources
- CHFS: Legally Responsible Individuals as PDS Employees (informational session slides)
- CHFS: Participant Directed Services (PDS) Frequently Asked Questions
- CHFS: Participant-Directed Services (PDS) program page
Read September 3, 2026.
Same question, other states: Louisiana · Maine.
Related: the private-pay caregiver-agreement rule · the household-employee tax rules once you’re being paid · what family caregiving actually costs unpaid.
General information drawn from each state’s own Medicaid agency and public program materials, not legal, tax or financial advice. Medicaid self-direction programs are administered state by state and change by budget cycle and waiver renewal; this page cannot see your own state’s current program status or your family’s eligibility. We are not a law firm, a benefits counselor, or a fiduciary, and this is not personalized advice. We sell nothing on this page and earn nothing from it.