West Virginia Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. This article focuses on West Virginia Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.

Last Updated: Jan 02, 2024

West Virginia Medicaid Long Term Care Programs Nursing Home Care Care at Home via HCBS Waivers Care at Home via ABD Medicaid Eligibility Criteria Nursing Homes HCBS Waivers ABD Medicaid How Medicaid Treats the Home Applying Choosing a Nursing Home

West Virginia Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

West Virginia Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited West Virginia seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
Skilled nursing care
Physician’s visits
Prescription medication
Medication management
Mental health counseling
Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

West Virginia Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $50/month (as of 2023), which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

West Virginia Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

A Nursing Home Alternative – West Virginia’s Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through West Virginia’s Money Follows the Person program (MFP). This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. In West Virginia, Money Follows the Person is called Take Me Home.

Home and Community Based Services (HCBS) Waivers

West Virginia Home and Community Based Service (HCBS) Waivers will pay for long-term care services and supports that help financially limited West Virginia seniors who require a Nursing Facility Level of Care remain, or return to, living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for West Virginia residents who live in their home or the home of a loved one. While West Virginia HCBS Waivers may cover long-term care benefits in those settings, it will not pay for room and board costs like mortgage payments, rent, utility bills or food expenses.

The HCBS Waiver relevant to West Virginia seniors is the Aged and Disabled Waiver.

Aged and Disabled Waiver
West Virginia’s Aged and Disabled Waiver (ADW) provides long-term care services and support to West Virginia seniors who live in their own home or the home of a loved one. The ADW can also be used to help West Virginia Medicaid recipients who reside in a nursing home transition from the facility and return to living in their own home or the home of a loved one. The ADW will not provide benefits to seniors living in adult foster care or assisted living residences.

To determine if ADW applicants require a Nursing Facility Level of Care, West Virginia uses the Pre-Admission Screening (PAS) tool. PAS takes into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), to administer their own medications and to leave a building in case of emergency. PAS also considers any medical needs that require skilled care, and decubitus ulcers (bedsores), when determining the level of care needed.

ADW benefits include skilled nursing supervision, case management, non-medical transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, laundry). These benefits are made available depending on each program participant’s needs and circumstances. For ADW beneficiaries who are moving from a nursing home and returning to the community, ADW will cover transition expenses like movers, utility set-up fees, security deposits and essential furnishings.

Like most HCBS Waivers, the West Virginia’s Aged and Disabled Waiver is not an entitlement. Remember, entitlement means guaranteed by law. So, even if an applicant is eligible for the ADW, they are not guaranteed to receive the benefits. Instead, there are a limited number of enrollment spots (7,912 per year as of 2023), and once those spots are full, additional applicants will be placed on a waitlist.

Aged, Blind, and Disabled Medicaid

West Virginia’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare and long-term care services and supports to financially limited West Virginia residents who are aged (65 or over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.

The state will conduct an assessment of West Virginia ABD Medicaid beneficiaries to determine what type of long-term care services and supports they need and the state will cover. These long-term care benefits can be delivered through the state’s Personal Care Services Program or the Program of All-Inclusive Care for the Elderly (PACE).

1. Personal Care Services Program
West Virginia’s Personal Care Services Program, which is also called the Personal Care Program or PC Services, provides long-term care benefits to ABD Medicaid recipients who need daily in-home living assistance. PC Services program participants can live in their own home or the home of a loved one. PC Services program benefits are usually not available to ABD Medicaid recipients who live in adult foster care or assisted living residences, but some exceptions are made, as long as personal care services are not already being provided by the residence.

PC Services program benefits allow for up to 210 hours per month of assistance with the following – prescription medication, transportation, the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, laundry). The amount of assistance available will depend on each beneficiary’s needs and circumstances.

PC Services applicants will be assessed to see if they have a medical need for these benefits. West Virginia Medicaid uses the Pre-Admission Screening (PAS) tool to make the assessment. PAS takes into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), to administer their own medications and to leave a building in case of emergency, as well as any medical needs that require skilled care, and decubitus ulcers (bedsores).

2. Program of All-Inclusive Care for the Elderly (PACE)
PACE coordinates medical, social service and long-term care coverages into one comprehensive plan and delivery system for ABD Medicaid recipients, including Medicare benefits for those who are “dual eligible.” PACE also administers vision and dental care, and PACE day centers provide adult day care, meals, social activities and regular health checkups. PACE program participants are required to need a Nursing Facility Level of Care, but they must live in their home or somewhere else in the community. Although West Virginia does not have a PACE program of its own as of Jan. 1, 2024, four of its bordering states have programs – Ohio, Virginia, Pennsylvania and Kentucky. While seniors can not use PACE programs (or receive any kind of Medicaid benefits) in other states, or transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in a new state without any waiting period if they relocate. To learn more about PACE, click here.

Eligibility Criteria For West Virginia Medicaid’s Long Term Care Programs

To be eligible for West Virginia Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

Just For You: The easiest way to find the most current West Virginia Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

West Virginia Nursing Home Medicaid Eligibility Criteria

Financial Requirements
West Virginia residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through West Virginia Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for West Virginia Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, West Virginia Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $50/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through West Virginia Medicaid is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for West Virginia Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, West Virginia has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through West Virginia Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. West Virginia uses the Pre-Admission Screening (PAS) tool to determine level of care requirements for Medicaid purposes. PAS takes into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), to administer their own medications and to leave a building in case of emergency. PAS also considers any medical needs that require skilled care, and decubitus ulcers (bedsores), when determining the level of care needed.

West Virginia Medicaid Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
West Virginia residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in West Virginia is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for West Virginia HCBS Waivers for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in West Virginia is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for West Virginia HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, West Virginia has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through West Virginia Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. To determine if HCBS Waiver applicants require a Nursing Facility Level of Care, West Virginia uses the Pre-Admission Screening (PAS) tool. PAS takes into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), to administer their own medications and to leave a building in case of emergency. PAS also considers any medical needs that require skilled care, and decubitus ulcers (bedsores), when determining the level of care needed.

West Virginia Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
West Virginia residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for West Virginia ABD Medicaid for a single applicant is $943/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants, the 2024 asset limit for West Virginia ABD Medicaid is a combined $3,000, and the income limit is a combined $1,415/month. This applies to married couples with both spouses applying or with just one spouse applying.

Plan Ahead: There are alternative pathways to eligibility for ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While West Virginia has a Look-Back Period of five years for Nursing Home Medicaid and HCBS Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid or HCBS Waivers, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirements for receiving basic healthcare coverage through West Virginia ABD Medicaid are being aged (65 or over), blind or disabled. For ABD Medicaid recipients who need long-term care services and supports, the state will administer an assessment using the Pre-Admission Screening (PAS) tool to see what kind of long-term care benefits the state will cover. PAS takes into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), to administer their own medications and to leave a building in case of emergency, as well as any medical needs that require skilled care, and decubitus ulcers (bedsores).

How Medicaid Treats the Home

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

West Virginia Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in West Virginia and how you can protect your home from it, click here.

Applying For West Virginia Medicaid Long Term Care Programs

The first step in applying for West Virginia Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for West Virginia Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the West Virginia Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, West Virginia residents can apply for Medicaid online at WV Path, or they can apply in person at their local Department of Health and Human Resources office. They can also apply online by calling the Customer Service Center at 877-716-1212.

For a comprehensive guide that will take you through the application process for all three types of Medicaid Long Term Care, click on the program you want: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing a West Virginia Medicaid Nursing Home

After being approved for nursing home coverage through West Virginia Medicaid, you or your loved ones have to choose which Medicaid-accepting nursing home best meets your needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do may not have available space. Finding the right facility can be a challenge, especially if you’re looking in a specific location.

West Virginia has about 125 total nursing homes, and nearly 120 of them accept Medicaid. There are roughly 15 facilities within 25 miles of Charleston, and seven more in Huntington. The Morgantown area has about a dozen nursing homes, and there are eight facilities around Parkersburg and eight more in the Wheeling area.

Residents in many West Virginia communities regularly cross state lines for personal and business reasons, including healthcare. But Medicaid coverage does not cross state lines. So, someone with West Virginia Medicaid would not be covered for nursing homes in Ohio, Pennsylvania or any other state, even if the facilities in those places are well-suited and convenient for the West Virginia resident.

TOOLS: West Virginia residents can use this West Virginia Health Care Association facility finder, which includes an interactive map, to locate a nursing home in their area. They can also use Nursing Home Compare, a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country.

When you’ve found nursing homes that meet your needs and accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you are another great source of information. You can also contact your local Area Agency on Aging to find more information about nursing homes in West Virginia.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: How does the facility handle dental and vision care? Does it offer social activities? What is the food like? Who are the staff doctors? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data reveals the nursing homes in West Virginia averaged 33.5 health deficiencies per facility from 2019-2022, which is more than the national average of 25.7 during that same time span. However, 4.6% or residents in West Virginia nursing homes had depressive symptoms, which was much better than the national average of 8.1%.