Starting a care business in Kentucky

Whether you need a certificate of need (CON) is the first thing to settle for an adult care business in Kentucky. KRS 216B.020 exempts assisted living and family care homes, so those two go straight to licensing. A home health agency needs a CON for each county it plans to serve, and the State Health Plan approves a new agency only where it projects at least 250 more patients than existing agencies serve there. An adult day health care program also needs a CON, but recent applications have been listed on the shorter nonsubstantive track, where OIG decides within 35 days and must approve unless someone requests a hearing. CON application fees start at $1,000.

Residential care has three size bands. A family care home is the operator's own residence with no more than three unrelated adults, licensed for $42 a year. An assisted living community serves five or more, with 200-square-foot units that each have a private bathroom, and you choose a social-model, basic health care or dementia care license. Assisted living has been licensed rather than certified since July 14, 2022. Kentucky sets no separate license for exactly four unrelated residents. The family care home guide concludes that a personal care home license, which needs a CON, is the route, but confirm that with the Division of Health Care.

In-home care is split by whether a clinician has to order the service. Bathing, dressing, companion, sitter and respite care delivered through staff need a personal services agency certificate, reviewed on paper with no site visit ($500 to apply, $350 a year to renew). A caregiver serving no more than three clients at a time is exempt. Kentucky law defines a home health agency as Medicare-certified, and the nationwide Medicare enrollment moratorium that began on May 13, 2026 bars new agencies from enrolling. The home health guide says the sources do not show whether OIG will license an agency without Medicare certification, so ask the Division of Health Care.

Child care begins at four unrelated children. With four to six in your own home you need a certified family child-care home certificate ($10, renewed every two years), and you can have up to 10 children counting your own and relatives. Seven to 12 children in your home, or four or more in a nonresidential building, require a child-care center license (Type II or Type I). It starts with a six-month preliminary license. A 2026 law created a capped child-care microcenter program, but the cabinet may not accept applications before July 1, 2027, and only providers with three years of licensed or certified operation qualify.

Two questions remain open in the official sources. The older rule for social-model adult day programs (910 KAR 1:160) is marked inactive, and nothing checked says whether a private-pay day program with no health services needs state approval, so ask the Division of Health Care. Kentucky Medicaid's HCB waiver also does not list personal services agencies as providers of traditional (not participant-directed) services, so a certified agency should confirm with the Department for Medicaid Services before counting on waiver revenue.