Kentucky assisted living community license: OIG categories, fees and rules

Kentucky moved assisted living from certification to licensure in 2022

If you read older material on Kentucky assisted living, much of it describes the wrong system. Before 2022, Kentucky assisted living operated under certification rather than licensure; OIG’s FAQ still refers to “certified” assisted living facilities.⁠¹³ Since July 14, 2022, 2022 Ky. Acts ch. 20 (amended in 2023) has required an OIG license. KRS 194A.710 now says plainly that “an assisted living community shall not operate unless it is licensed under this chapter,” and that the licensee is legally responsible for management, control and operations.⁠² The operating standards are in 902 KAR 20:480, which took effect July 25, 2023, and is due to expire on July 25, 2030, unless it is renewed.⁠³

The 2022 law also turned some personal care homes into assisted living communities. A licensed personal care home that met the assisted living unit standards in KRS 194A.703 was relicensed as an assisted living community as of July 14, 2022. If it had a secured dementia unit, it received a dementia care license.⁠¹⁰ OIG’s FAQ explains that only “apartment-style” personal care homes had to convert. Those homes apply on Form OIG-20:480 at least 60 days before their personal care home renewal date.⁠¹³⁠³ If you are buying an existing building, find out which license it holds now.

Does your building need this license?

An “assisted living community” is a licensed facility that provides sleeping accommodations and assisted living services for five or more adults not related within the third degree of consanguinity to the owner or manager.⁠¹ Assisted living services are defined broadly. Any one of the following counts:

• help with bathing, dressing, grooming, transferring, toileting or eating
• housekeeping, shopping, laundry, transportation or clerical help
• standby assistance or medication reminders
• three meals a day
• nursing, therapy, dietitian or social work services
• tasks delegated to unlicensed staff
• medication management
• scheduled daily social activities⁠¹

Two more statutory rules decide what kind of business you can run:

• Residents must be ambulatory. “Ambulatory” includes residents who move with another person’s hands-on help or with a walker or wheelchair. A non-ambulatory resident can stay only under a “temporary condition.” That means either the resident is expected to walk again within six months, as documented by a licensed professional, or the resident is receiving licensed hospice or end-of-life care. In both cases you need a written plan to reduce the risk.⁠¹
• No 24-hour nursing. The functional needs assessment must confirm that each resident does not need 24-hour nursing supervision.⁠³ Anyone who needs that level of care belongs in a nursing facility.

You also cannot market your business as an assisted living community until you have filed a current application or hold a license.⁠⁵

Smaller homes and neighboring licenses

Below five residents, a different license applies. A family care home may have no more than three residents who are not related to the operator. Kentucky law does not clearly say which license covers exactly four unrelated adults, so ask the Division of Health Care before you plan a four-resident home. If you want a daytime health program instead of housing, see the adult day program license type. Help delivered in clients’ own homes falls under a personal services agency certificate or a home health agency license; see also non-medical home care.

Choosing ALC, ALC-BH or ALC-DC

KRS 194A.710 creates three license categories, and 902 KAR 20:480 repeats them.⁠²⁠³

A few rules decide which license you need:

• Dementia marketing triggers ALC-DC. By statute, a community that is “advertised, marketed, or otherwise promoted” as providing specialized care for Alzheimer’s or other dementias is an assisted living community with dementia care. You may not operate a secured dementia unit without that license.⁠¹⁠²
• License at your highest level of care. OIG’s FAQ says that a community without a secured dementia unit must be licensed at the highest level of care it gives anyone. If even one resident receives basic health services, the community must be an ALC-BH. A single campus therefore cannot hold all three licenses.⁠¹³ The regulation says the same about mixed social and health residents.⁠³
• Dementia units get a separate license. A campus with a secured dementia unit and other assisted living units holds two licenses: an ALC-DC license and either an ALC or an ALC-BH license.⁠³⁠¹³
• Licenses are issued per building. OIG issues one license per building. Several buildings on one campus can share a license only if they have the same licensee and the same category.⁠³ Licenses cannot be assigned or transferred.⁠²

The social model is narrower than many founders expect. OIG says that a social model ALC may not give hands-on help with transfers and mobility, including gait belts, to residents who cannot move independently, because that “exceeds the scope of non-health related social model care.”⁠¹³ If your target residents need standby or hands-on transfer help, budget for ALC-BH staffing from the start.

The building: 200-square-foot units and central spaces

KRS 194A.703 sets the physical standard that separates assisted living from older room-and-board models. Each living unit must:⁠⁴

• be at least 200 square feet, whether for one person or for two sharing by mutual agreement
• include at least one unfurnished room
• have a lockable entry door, except in a secured dementia unit
• have a private bathroom with a tub or shower
• have provisions for emergency response, a window to the outdoors and a telephone jack
• have an individual thermostat if the community has more than 20 units (dementia units excepted)
• stay between 71°F in winter and 81°F in summer, where residents cannot control the temperature, in communities of 20 or fewer units and in secured dementia units

Every resident must also have access to central dining, a laundry facility and a central living room.⁠⁴ The building must meet the building and life safety codes as determined by the enforcing authority with jurisdiction.⁠⁴⁠³ The licensee supplies the locks on unit doors and may never lock residents in their units.⁠³

Only communities that were open or under construction on or before July 14, 2000, are exempt from the 200-square-foot rule and the tub-or-shower-in-every-unit rule. Those communities must still have at least one tub or shower for every five residents.⁠¹⁵ A new build gets no exemption. An ALC-DC may ask OIG for a waiver of building requirements to meet the needs of residents with dementia. The request goes through the variance process in 902 KAR 20:008.⁠³ Dementia units built after July 14, 2022, must give residents access to secured outdoor space.⁠³

Fire marshal and occupancy

Your application must include proof of approval by the State Fire Marshal’s office.⁠³ OIG’s applications page, in its list for other health care facilities, tells applicants to contact the office before applying to ask whether fire marshal approval applies; for assisted living it posts only the AccessGov application, the FAQ and the functional needs assessment form.⁠¹² Ask the Division of Health Care and your local fire marshal’s office how to obtain approval for your building. For conversions, OIG’s FAQ notes that moving from a certified assisted living facility to a licensed community does not by itself change the occupancy classification under the 2018 Kentucky Building Code. Adding activities beyond those already performed could trigger a change of use or occupancy.⁠¹³

The application, in order

1. Settle certificate of need. You do not need one: KRS 216B.020(1) exempts “assisted living residences” and 902 KAR 20:480, Section 3(1), applies that exemption to ALC, ALC-BH and ALC-DC.⁠¹¹⁠³ OIG’s applications page separately says other long-term care facilities need a certificate of need before licensure.⁠¹²
2. Get State Fire Marshal approval for the building. Proof of that approval is part of the application packet.⁠³
3. Draft your lease. The cabinet does not provide sample leases.⁠¹³ KRS 194A.713 requires the lease to be in at least 12-point type and to cover 14 elements. They include resident data and advance directives, terms of occupancy, services and fees, refund and cancellation policies, at least 30 days’ notice of fee changes, at least 30 days’ move-out notice for nonpayment, help finding housing after a move-out notice, any special programming, and grievance policies.⁠¹⁴ You will submit a blank copy.⁠³
4. File at least 60 days before your planned opening. OIG links to the assisted living community application on the state’s AccessGov portal.⁠¹² The regulation lists what to submit:⁠³
   • the completed application (Form OIG-20:480 is incorporated by reference in the November 2022 edition)
   • proof of fire marshal approval and a blank lease
   • an organizational chart of everyone with a significant financial interest, meaning 25% or more of ownership
   • a description of any special programming
   • a floor plan that marks the living units, central dining area, laundry and central living room
   • a seven-year compliance history, with all enforcement actions, for any other care facility you operate
   • the nonrefundable fee, made payable to the Kentucky State Treasurer
5. Clear the ownership screen. OIG returns the application and fee in two situations. One is when anyone with a significant financial interest held such an interest, in the prior seven years, in a facility that lost or gave up its license after an investigation that put residents at risk of death or serious harm. The other is when the application contains false information.⁠³
6. Pass the initial on-site visit. KRS 194A.707 requires an on-site visit as part of initial licensure.⁠⁵ For an ALC-DC, the cabinet must also inspect on site before it issues the license.⁠⁸

Neither the statute, the regulation nor the OIG pages reviewed on October 12, 2026 state a processing time for an initial license, so ask the Division of Health Care how long a complete application is taking before you set an opening date; the only fixed lead time is the 60-day filing deadline.

Extra steps for a dementia care license

For an initial ALC-DC license, OIG weighs the applicant’s education and experience in managing residents with dementia, along with the applicant’s compliance history at any other care facility.⁠⁸ If you and your principals have no dementia experience, you must employ or contract with a consultant for at least your first six months of operation. The consultant needs two years of work experience in dementia, health care, gerontology or a related field and must have completed the core training in KRS 194A.7205. You must document a plan that responds to the consultant’s concerns, including any recommendations you decline to follow.⁠⁸

Fees as published on October 12, 2026

902 KAR 20:480 charges the same fee for an initial license and for each annual renewal. The fee has a base amount set by size plus $40 per unit.⁠³

The size tiers create a jump. Applying the schedule, 24 units cost $1,460 a year ($500 + 24 × $40), while 25 units cost $2,000 ($1,000 + 25 × $40). Other fees in the same section:⁠³

• Adding units: $60 per added unit, with an application at least 60 days before the increase. Report decreases within 60 days.
• Change of ownership: $500, filed by the new owner within 10 calendar days. A change of ownership occurs when one person acquires more than 25% of the facility, its stock or its voting rights.
• Name change: $25, with written notice within 10 calendar days.
• Change of managing agent: $25, within 10 calendar days.
• Financing information: $250 when OIG provides information to a lender under KRS 194A.729.
• Change of location: a full new application and fee before you move.

The manager, staffing and background checks

Kentucky sets no numeric staff-to-resident ratio. KRS 194A.717 requires:⁠⁶

• staffing sufficient in number and qualifications to meet each resident’s 24-hour scheduled needs under the lease, functional needs assessment and service plan
• one awake staff member on site at all times, in each licensed building, including each building on a shared campus⁠³
• a designated manager who is at least 21, has a high school diploma or equivalency, and has shown management or administrative ability

The regulation adds a written staffing plan, evaluated at least twice a year, that covers reasonably foreseeable unscheduled needs and emergencies.⁠³ It also requires an emergency call system or personal alert device that residents can use 24 hours a day, seven days a week.⁠³

Background checks apply to owners, staff, and regularly scheduled volunteers in direct-care roles. You cannot employ anyone in those roles with a felony conviction related to theft, illegal drugs, adult abuse or a sexual crime, or with a misdemeanor related to adult abuse. Child abuse convictions also disqualify, as does a listing on the caregiver misconduct registry or the nurse aide abuse registry. Direct-care staff need a criminal check at hire and at least every two years, plus annual checks of the caregiver misconduct, nurse aide abuse and central registries. You may use Kentucky’s national background check program (906 KAR 1:190), and you may employ new hires provisionally while their results are pending.⁠³ OIG’s FAQ applies the owner check to anyone with direct resident contact or more than 25% ownership. In a corporation where no individual holds more than 25%, at least the CEO should be checked.⁠¹³

Training. All staff and management need orientation before working with residents on their own, and within 30 days of hire.⁠³ It covers 11 topics: resident rights, community policies, adult first aid, CPR (unless your policy is that staff do not initiate it), adult abuse and neglect, dementia, emergency procedures, the aging process, help with daily living, any special-needs programming you market, and assistance with self-administration of medication. Annual in-service training must cover at least four of those topics, and one must be dementia.⁠⁷ Staff without emergency and disaster training may work only alongside trained staff.⁠³

Health services: nurses and medication aides

ALC-BH and ALC-DC communities must have a nurse readily available, in person or by live two-way communication, whenever unlicensed staff perform delegated nursing tasks. Nurses delegate under 201 KAR 20:400, and every nurse and licensed health professional needs a current Kentucky license or a multistate privilege.⁠³

Medication administration is where staffing costs are decided. Under 902 KAR 20:480, Section 15, unlicensed staff who give oral or topical medications by delegation must hold a Certified Medication Aide I credential from a Kentucky Board of Nursing-approved program, or the Kentucky medication aide credential from the Kentucky Community and Technical College System. Giving preloaded insulin injections requires a Certified Medication Aide II credential.⁠³ Staff at a social model ALC who only assist residents with self-administration do not need to be CMAs.⁠¹³

Controlled substances must be kept under double lock and recorded in a bound book with numbered pages. Schedule II drugs are counted daily and Schedules III to V at least weekly.⁠³ Medication management policies must be written under the supervision of a nurse, licensed health professional or pharmacist.⁠³

Dementia care staffing and training

An ALC-DC takes on a separate set of statutory duties:

• Unit staff: at least 8 hours of dementia-specific orientation within their first 30 days on the secured unit. Until they finish it, they may give direct care only when a trained employee is on site.⁠⁹
• Direct care staff: at least 16 hours of specialized dementia training within 30 days of starting to work independently with residents who have dementia, then 8 hours every year.⁠⁹
• Manager: at least 10 hours of dementia continuing education each year.⁠¹⁷⁠³
• Unit assignments: only dementia-trained staff may work on the unit. The one exception is a documented emergency, and the record must show its nature, its duration and who covered.⁠¹⁸
• Programming: individual activity plans, daily structured and unstructured activities, behavioral symptom evaluations, and family support offered at least every six months.⁠³

The unit must also keep records of each training session’s course content, instructor qualifications, agenda and attendance.⁠⁹

Resident protections OIG checks

Some operating rules shape your business model:

• Assessments. A functional needs assessment (Form OIG-20:480-A) is done at move-in and updated at least every 12 months. The assessor needs a bachelor’s degree in health or human services, or an associate’s degree plus one year of relevant experience, or a high school diploma plus two years. Every resident needs a medical examination before admission.⁠³
• Money. Neither the community nor its staff may hold a resident’s power of attorney, serve as guardian or conservator, or borrow a resident’s money or property. Within 30 days of a move-out or death, you must deliver a final statement of account and any refunds.⁠³
• Meals. All levels serve three meals and snacks. ALC-BH and ALC-DC communities must also post menus a week ahead, keep a three-day food supply, serve two hot meals daily, and allow no more than 15 hours between the evening meal and breakfast.⁠³
• Closure. Give OIG and residents at least 60 days’ notice before giving up an ALC or ALC-BH license, except after a fire, natural disaster or government closure.⁠³

Inspections, renewal and enforcement

All inspections are unannounced.⁠³ After the initial visit, OIG returns 24 months after the previous licensure review. If that review found a violation that put a resident in imminent danger of death or serious harm, OIG returns in 12 months.⁠⁵ Complaint investigations can happen at any time.⁠³ Renewal is annual: you file the application and pay the fee at least 60 days before your renewal date.⁠³ OIG makes the findings from the most recent licensure review public.⁠⁵

If a denial or revocation is not appealed in writing within 30 days of the notice, it becomes final.⁠³ Grounds include fraud on the application, refusing background checks, unpaid fines, building code violations, and staff repeatedly working beyond their competency.⁠³ After a revocation, the cabinet may refuse to license the same property for seven years if ownership stays substantially the same.⁠⁵

Payment and pending changes

The statute itself tells OIG surveyors that assisted living is not subject to the rules of the Centers for Medicare and Medicaid Services.⁠⁵ In the 2026 Regular Session, House Bill 488 proposed adding assisted living services to Kentucky’s Medicaid home and community based waiver. Coverage would have gone to participants aged 65 or older in ALC-BH communities and would have excluded room and board. The bill’s last recorded action was its referral to the House Health Services committee on February 3, 2026.⁠¹⁶ The CHFS page for the Home and Community Based (HCB) waiver lists services such as adult day health care, attendant care, home adaptation, home-delivered meals and respite, and says participants receive non-medical, non-residential services; it does not list assisted living services.⁠¹⁹ The bill is not law, so confirm with the Department for Medicaid Services whether any program pays for services in an ALC-BH before you build a payer mix around Medicaid residents.

As of October 12, 2026, the KRS 194A sections cited here were last amended effective July 14, 2022, or June 29, 2023, and 902 KAR 20:480 has not changed since its July 25, 2023, effective date.⁠²⁠³

Sources

1. 1
   Kentucky Legislative Research Commission, KRS 194A.700 (Definitions for KRS 194A.700 to 194A.729) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Kentucky Legislative Research Commission, KRS 194A.710 (Licensure requirement, categories) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Kentucky Legislative Research Commission, 902 KAR 20:480 (Assisted living communities) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Kentucky Legislative Research Commission, KRS 194A.703 (Requirements for living units) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Kentucky Legislative Research Commission, KRS 194A.707 (Licensure, on-site visits, marketing restrictions, fees) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Kentucky Legislative Research Commission, KRS 194A.717 (Staffing requirements) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Kentucky Legislative Research Commission, KRS 194A.719 (In-service education for staff and management) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Kentucky Legislative Research Commission, KRS 194A.7061 (Assisted living community with dementia care licensure criteria) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Kentucky Legislative Research Commission, KRS 194A.7205 (Training requirements for assisted living community with dementia care) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Kentucky Legislative Research Commission, KRS 194A.704 (Assisted living community license to replace personal care home license) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Kentucky Legislative Research Commission, KRS 216B.020 (Certificate of need exemptions) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Cabinet for Health and Family Services, Office of Inspector General, Long-Term Care Applications Checked 12 Oct 2026 · Back to text ↑
13. 13
    Cabinet for Health and Family Services, Office of Inspector General, Assisted Living Community FAQs Checked 12 Oct 2026 · Back to text ↑
14. 14
    Kentucky Legislative Research Commission, KRS 194A.713 (Contents of lease agreement) Checked 12 Oct 2026 · Back to text ↑
15. 15
    Kentucky Legislative Research Commission, KRS 194A.721 (Exemptions for communities open or under construction by July 14, 2000) Checked 12 Oct 2026 · Back to text ↑
16. 16
    Kentucky General Assembly, 2026 Regular Session, House Bill 488 (Medicaid home and community based waiver program) Checked 12 Oct 2026 · Back to text ↑
17. 17
    Kentucky Legislative Research Commission, KRS 194A.7201 (Continuing education for manager of an assisted living community with dementia care) Checked 12 Oct 2026 · Back to text ↑
18. 18
    Kentucky Legislative Research Commission, KRS 194A.7203 (Dementia-trained staff, staffing levels) Checked 12 Oct 2026 · Back to text ↑
19. 19
    Cabinet for Health and Family Services, Department for Medicaid Services, Home and Community Based (HCB) Waiver Checked 12 Oct 2026 · Back to text ↑

Was this information accurate? Report an errorPrint or save as PDF