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 to return home rather than receive care in a nursing home. Services are not limited to personal care; they also 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. 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 are paid is determined by the program participant, but must be at least minimum wage for the state, and is capped by Medicaid regulation. As of 2023, minimum wage in West Virginia is $8.75.
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.
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.
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.
In 2023, the single applicant monthly income limit is $2,742. This figure equals 300% of the Federal Benefit Rate, which increases on an annual basis. For a couple when both spouses are applying, each spouse is allowed $2,742. However, the rules differ for married couples when one spouse is not also seeking Medicaid assistance.
Generally, the applicant spouse is able to transfer a portion of their income to their non-applicant spouse, also called “community spouse.” This is intended to cover the community spouse’s cost of living and is called a Monthly Maintenance Needs Allowance. That said, West Virginia 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 toward 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.
The Medicaid asset (countable resources) limit is $2,000 for a single applicant. For a couple when both spouses are applying, the limit is $3,000. 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, and 2) the value of the owner’s home equity is not greater than $688,000.
Unlike with income, the rules for married couples with a single applicant are different. Non-applicant spouses are allowed to claim half of the couple’s joint assets, up to $487,620, 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.
Over the Financial Limits?
If a candidate is over the income and / or asset limits, it is still possible to qualify for the Aged and Disabled Waiver. There are two alternative pathways to eligibility.
West Virginia offers a Medically Needy program in which an applicant’s income and medical expenses are analyzed. If it is found that their monthly, recurring medical costs require the vast majority of their income, they can qualify as “medically needy.” As of 2023, the medically needy income is $200 a month for individuals and $275 for couples.
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.
A Word of Caution
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.
Benefits and Services
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 that their needs are continuing to be met. Participants can receive:
- Case Management Services / Pre-transition Case Management
- Personal Attendant Services, such as assistance with Activities of Daily Living and homemaker services (light housecleaning, laundry, clean-up after meals, etc.)
- Skilled Nursing
- Non-Medical Transportation
- Community Transition Services (from an institutional setting, such as a nursing home, back into the community)
How to Apply / Learn More
The Aged and Disabled Medicaid Waiver is available to residents statewide. However, enrollment caps exist, and this waiver has a cap of approximately 6,400 slots. At the time of this writing, a small waiting list exists. In Medicaid language, the wait list is called the Managed Enrollment List (MEL).
To learn more or apply, visit the West Virginia Bureau of Senior Services website or call 304-558-3317 or toll-free at 877-987-3646. Please make note that the first step in the application process is to have one’s physician complete a Medical Necessity Evaluation Request (MNER) form.
The complete policy manual for this program is available for download here.