Kentucky Medicaid Billing For Home Care Agencies
Kentucky’s Medicaid system has comparatively high reimbursement rates for agencies willing to stay compliant with its newly updated EVV requirements. Paradigm is your one-stop solution for handling it all: automating claims, preventing denials, and getting you paid on time.
Electronic Visit Verification
Kentucky moved to “hard EVV” edits in January 2025, a transition which caused an increase in denials that often came with no clear reason. Home-based care providers navigating Kentucky’s Medicaid system need to prioritize EVV compliance and clear knowledge of the state’s system to succeed.
Kentucky uses an open model, meaning agencies may choose their own EVV vendor, but the system must integrate with the state aggregator.
Therap is Kentucky’s state-designated EVV aggregator. All visit data—regardless of which EVV system is used—must be transmitted to Therap before claims can be processed.
Claims in Kentucky must align with approved EVV data in Therap. Missed or mismatched visits can lead to rejections, making real-time EVV reconciliation a critical part of the billing workflow.
Rates
How much does Medicaid pay for home care per hour in Kentucky?
Reimbursement typically ranges from $26-30 per hour. Some services (like respite or specialized supports) may be reimbursed differently. Overtime and holidays are not automatically reimbursed and usually require pre-approval in the plan of care.
Payers
While six MCOs provide health coverage in Kentucky, home and community based services and waivers are excluded from the managed care agreements, meaning personal care providers must go directly through the state.
Home health providers may go either to the state or to the managed care organizations, but all utilize an open billing model.
MCOs
- Aetna Better Health of Kentucky
- Anthem Blue Cross Blue Shield
- Humana Healthy Horizons in Kentucky
- Passport Health Plan by Molina Healthcare
- UnitedHealthcare Community Plan
- WellCare of Kentucky
Rates
Payers
MCOs
Frequently Asked Questions
Most states operate Medicaid waiver or community-based care programs that allow reimbursement for non-skilled services such as personal care, homemaker services, respite care, and attendant care. These programs are often administered through Home and Community-Based Services (HCBS) waivers, aging programs, disability waivers, or managed long-term services and supports (MLTSS) programs. Eligibility criteria, covered services, and billing requirements vary by state.
In many states, yes. Enrolling with the state Medicaid program is typically the first step, but agencies may also need to complete separate contracts, credentialing applications, or network enrollment with individual Medicaid MCOs before claims can be submitted for reimbursement. Requirements vary by state and payer, largely depending on whether the state operates an MLTSS (Managed Long Term Services and Supports Program).
Credentialing timelines vary by state and payer, but most home care agencies can expect the Medicaid enrollment and credentialing process to take anywhere from 60 to 180 days. Delays are often caused by incomplete applications, missing ownership documentation, background check issues, or required site visits. Agencies seeking participation with Managed Care Organizations (MCOs) should also account for additional contracting and payer credentialing timelines.
You must first enroll through the Kentucky Medicaid Partner Portal Application (KY MPPA) and apply to provide services under one or more of the state’s Home and Community-Based Services (HCBS) waivers such as the Michelle P. Waiver or the Supports for Community Living (SCL) Waiver. Enrollment with any MCOs takes place as separate processes. Paradigm manages both the state enrollment and MCO contracting on your behalf.
You must first enroll through the Kentucky Medicaid Partner Portal Application (KY MPPA) and apply to provide services under one or more of the state’s Home and Community-Based Services (HCBS) waivers such as the Michelle P. Waiver or the Supports for Community Living (SCL) Waiver. Enrollment with any MCOs takes place as separate processes. Paradigm manages both the state enrollment and MCO contracting on your behalf.
You must first enroll through the Kentucky Medicaid Partner Portal Application (KY MPPA) and apply to provide services under one or more of the state’s Home and Community-Based Services (HCBS) waivers such as the Michelle P. Waiver or the Supports for Community Living (SCL) Waiver. Enrollment with any MCOs takes place as separate processes. Paradigm manages both the state enrollment and MCO contracting on your behalf.
You must first enroll through the Kentucky Medicaid Partner Portal Application (KY MPPA) and apply to provide services under one or more of the state’s Home and Community-Based Services (HCBS) waivers such as the Michelle P. Waiver or the Supports for Community Living (SCL) Waiver. Enrollment with any MCOs takes place as separate processes. Paradigm manages both the state enrollment and MCO contracting on your behalf.
How Paradigm can Help
Paradigm offers a combination of tech and highly skilled people to bridge the gaps in:
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
& Eligibility
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
Credentialling
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
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The coaching helped us stop reacting to the business and start running it strategically with measurable goals, consistent accountability, and clearer operational focus.
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“I’ve been using Paradigm for our home care billing for two years now. They are very helpful with my VA billing and have EXCELLENT customer service. I highly recommend them.”
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