West Virginia’s Aged and Disabled Waiver: Qualifications and Services
What are Medicaid Waivers?
Medicaid pays for long term care services in nursing homes. For nursing home qualified persons that choose to live at home or in a residential community, Medicaid will pay for those services if they can be obtained at a lower cost. These are called Home and Community Based Services, Waiver Funded Services, Medicaid Waivers or simply Waivers.
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. The Aged and Disabled Waiver has a consumer-directed option called Personal Options that allows participants to select some of their own care providers. The Aged and Disabled Waiver is managed by the West Virginia Bureau for Medical Services. A 43-page booklet with detailed information about the program is available for download here
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. The ADW Personal Options program also allows participants to hire family members to provide personal care services. One may hear this program referred to as Cash and Counseling although that is not entirely accurate.
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 2013, this means the applicant's monthly income cannot exceed $2,130. 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. Find assistance qualifying for WV Medicaid
ADW Service and Benefits
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
-Transportation for Medical and Social Appointments
Availability / How to Apply
Use our Locator Tool to Find Other Options for which You're Eligible
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 Health and Human Services website
or call WV Dept. of Senior Services toll-free at 866-767-1575. An alternative exists for persons wait-listed or ineligible, read about WV In Home Services for the Elderly
Page Reviewed / Updated - Jan. 2013