Page Reviewed / Updated - Apr. 2019
This West Virginia Aged and Disabled Medicaid waiver is designed to help the elderly by providing services that enable them to remain living 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, such as non-medical 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 also allows participants to hire family members (excluding legal guardians and spouses, but not ex-spouses) to provide attendant care services. The amount caregivers can be paid is determined by the program participant, but must be at least minimum wage for the state, and is capped by Medicaid regulation. One should expect the cap to be somewhere between 60% and 75% of the state hourly average for home care, or approximately $9.00 - $13.25 / hour.
Consumer direction of health and non-medical care services is a relatively new concept that is gaining in popularity since families and state officials prefer it, albeit for different reasons. Families like it because it 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 income and assets. All applicants must be residents of West Virginia.
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 – A cost of living adjustment has been made in 2019, raising the single applicant monthly income limit from $2,250 to $2,313. This figure equals 300% of the Federal Benefit Rate, which increases on an annual basis. However, in most states, the rules differ for married couples, if one spouse is not also seeking Medicaid assistance. Generally, applicant spouses are able to transfer a portion of their income to their non-applicant spouses, also called community spouses. This is intended to cover the community spouses' cost of living and is called a Monthly Maintenance Needs Allowance. That said, WV is unique in that 100% of an applicant's income is protected as their personal needs allowance, which means they do not have to contribute towards their cost of care. Instead, they are able to retain all of their income to be used for the household as necessary, which eliminates the need for a spousal allowance.
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, a car, and some other personal effects, such as wedding rings and home furnishings. Please note, 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 $585,000. Unlike with income, the rules for married couples with a single applicant are different. Non-applicant spouses are allowed to claim half of joint assets, up to $126,420, as their own. This is known as the Community Spouse Resource Allowance. Applicant spouses are still allowed to retain up to $2,000 in assets.
Past Asset Transfers – in order to prevent applicants from simply giving away 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. If one is found to be in violation of this look-back period, a period of Medicaid ineligibility may ensue.
Qualifying When Over the Limits - if a candidate is over the income and / or limit(s), 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 an applicant's 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 2019, their income cannot exceed their expenses by more than approximately $209 each month. This figure is equivalent to 20% of the Federal Poverty Level.
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 called the Medical Necessity Evaluation Request to determine their care requirements at the onset of their enrollment. In addition, participants will be medically reviewed periodically thereafter to validate their needs continue to be met. Participants can receive:
The Aged and Disabled Medicaid Waiver is available to residents statewide. However, enrollment caps exist and this waiver has a cap of approximately 6,100 slots. A waiting list exists. In Medicaid language, the wait list is called the Managed Enrollment List (MEL).