West Virginia’s Aged and Disabled Waiver: Qualifications and Services

Page Reviewed / Updated - Mar. 2014

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Waiver Description

This West Virginia Medicaid waiver is designed to help the elderly by providing services which enable individuals to remain at home or return home, rather than receive care in a Nursing Home.  Services are not limited to personal care but include non-care assistance as well such as transportation and homemaker services. 

 Under this program, WV allows family members to receive payment for providing personal care services.

The Aged and Disabled Waiver (ADW) has a consumer-directed option called Personal Options that allows participants to select some of their own care providers.  The ADW Personal Options program also allows participants to hire family members (excluding spouses, but not ex-spouses) to provide personal care services.   The amount caregivers can be paid is determined by the program participant but is capped by Medicaid regulation.  One should expect the cap to be somewhere between 60% - 75% of the state hourly average for home care or approximately $10 - $12 / hour.

Consumer direction of health care services is a relatively new concept that is gaining in popularity since it is preferred by families and state officials, albeit for different reasons. Families because it allows their loved ones to age in a familiar environment and officials because it is less costly to the state.  One may hear this program referred to as WV Cash and Counseling although that name is not entirely accurate.

 Residents of West Virginia can receive free quotes on bathroom safety modifications.  Seniors can get bids on walk-in tubs replacements for showers to enable aging in place.  Learn more.

 

Eligibility Guidelines

ADW considers the applicant's age and level of impairment as related factors as well as their financial income and assets.

Age and Impairment - applicants 18 - 64 years must be disabled as determined by the Social Security Administration. Applicants 65 and older are medically reviewed and if they are found to be in need of nursing home level care, they qualify medically for the waiver.

Income and Assets - applicants for the Aged and Disabled Waiver must meet the financial requirements for West Virginia institutional (nursing home) Medicaid. The income limit is 300% of the FPL. In 2014, this means the applicant's monthly income cannot exceed $2,163. The Medicaid Asset (Countable Resource) limit is $2,000. Countable resources do not include the home, car or some other personal effects such as wedding rings.

Qualifying If Over the Limits - if a candidate is over the limits, it is still possible they can qualify for the Aged and Disabled Waiver. They have two options.

1) WV offers a Medically Needy program in which their income and medical expenses are analyzed. If it is found their monthly, recurring medical costs require the vast majority of their monthly income they can qualify.

2) For families who still cannot afford their cost of care, Medicaid planning professionals can help applicants to qualify by re-adjusting their financial holdings so that they become Medicaid complaint. This involves the conversion of countable assets into exempt assets and the portioning off of excess income into Medicaid compliant trusts.   Read more about this option.

 

Benefits and Services

Waiver participants are given a medical review to determine their care requirements at the onset of their enrollment and periodically thereafter to validate their needs continue to be met. Participants can receive:

  • Assistance with Activities of Daily Living
  • Case Management Services
  • Environment Maintenance
  • Homemaker Assistance
  • Nutritional Counseling
  • Personal Care
  • Transportation for Medical and Social Appointments

In addition, beneficiaries receive a limited annual budget for miscellaneous goods and services which increase independence and safety or decrease their need for other Medicaid provided services.   For  example, a fall monitoring / personal emergency response service may decrease the hours which the individual requires personal care and supervision.   This budget is typically in the thousand dollar range. 

 

How to Apply / Learn More

ADW is available to residents statewide however enrollment caps for may be in effect and therefore a waiting list may exist. To learn more or apply, visit the WV Dept. of Senior Services website or call toll-free at 866-767-1575.   A 43-page booklet with detailed information about the program is available for download here.