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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 related assistance as well such as transportation and homemaker 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 and 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 $12 - $14 / hour.
Consumer direction of health and non-medical 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 like it because allows their loved ones to age in a familiar environment and receive care from persons with whom they are comfortable. For officials, it helps to control costs for the public budget. One may hear this program referred to as WV Cash and Counseling, although that name 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, then they qualify medically for the waiver.
Income – A cost of living adjustment has been made in 2017, raising the single applicant monthly income limit from $2,199 to $2,205. However, the rules differ for married couples, if the spouse is not also seeking Medicaid assistance. In this situation, the non-applicant spouse can take some of the applicant’s income to cover their own cost of living. This is called the Monthly Maintenance Needs Allowance and in 2017, the figure is set at a maximum of $3,022.50 / month.
Assets - The Medicaid Asset (Countable Resources) limit is $2,000 for single applicants. According to the asset rules, countable resources do not include the home, car or some other personal effects, such as wedding rings and furnishings. The home is not counted provided that 1) a homeowner resides in the home (therefore it is not a rental property) and 2) the value of the owner’s home equity is not greater than $560,000. As with income, the rules for married couples with a single applicant are different. Non-applicant spouses are allowed to claim up to $120,900 of joint assets as their own.
Past Asset Transfers – in order to prevent applicants from simply giving their assets to their family members in order to qualify for Medicaid, the program has created a 60-month look-back period. This means Medicaid examines all major asset transfers or gifts dating back 5 years from the date of application to ensure assets were not given away or sold for under fair-market value.
Qualifying When Over the Limits - if a candidate is over the limits, it is still possible they can qualify for the Aged and Disabled Waiver. There are two alternative pathways to eligibility.
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 as “medically needy”. As of early 2017, their income cannot exceed their expenses by more than approximately $275 each month.
2) For families who still cannot afford their cost of care, a West Virginia Medicaid planner may be able to help. They will advise applicants on how 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.
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:
In addition, beneficiaries receive a limited annual budget for miscellaneous goods and services to increase their independence and safety and/or decrease their need for other services. For example, a fall monitoring / personal emergency response service may decrease the hours that the individual requires personal care and supervision. This budget is typically in the thousand dollar range.
ADW is available to residents statewide. However, enrollment caps exist and this waiver has a cap of approximately 5,500 slots. A waiting list exists. In Medicaid language, the wait list is called the Managed Enrollment List (MEL).