West Virginia Bureau of Senior Services offers the Medicaid Personal Care program to state residents to help them perform the Activities of Daily Living. The five activities include personal hygiene (bathing), dressing, eating, transferring (mobility), and maintaining continence. Assistance with these activities are provided by approved, licensed home care aides and agencies. A complete list of providers is available here. However, one should not contact providers directly until they have been admitted to the Medicaid program.
Services are offered to individuals in their place of residence, be that in their own homes, the homes of other family members, and in some instances, in assisted living facilities, or in adult family care homes (adult foster care). If the care is provided in an assisted living residence or adult family care home, no funds from this program can be put towards the cost of room and board.
Medicaid Personal Care is offered under West Virginia’s regular Medicaid program (sometimes called “State Plan”). However, personal care is also a benefit under the state’s Aged and Disabled Waiver. The eligibility requirements differ for the two programs. What follows is current for Medicaid Personal Care under the state plan for 2020. It is relevant to WV residents aged 65 or older or those who are designated as disabled.
Functional – an applicant must be medically eligible for this program, which is determined by a functional assessment completed (formally called the Personal Care Medical Necessity Evaluation Request) by someone in the medical field. In simple terms, an applicant must require assistance with a minimum of three activities of daily living.
Income – an unmarried or widowed applicant aged 65 or older is permitted monthly income equivalent to 100% of the Federal Benefit Rate (FBR). In 2020, this means one’s monthly income cannot exceed $783. WV also offers an alternative pathway into Medicaid called the Medically Needy pathway. For persons who have recurring medical expenses that require the vast majority of their monthly income (all but $200), they can still be Medicaid eligible. As an example, if one has monthly income of $5,000, but each month pays $4,800 out-of-pocket for care, medical procedures, and prescription medications, they will be eligible.
Assets – an unmarried or widowed applicant, 65+ years of age is permitted up to $2,000 in countable assets. Countable assets do not include resources, such as one’s primary home and property, provided the value of their home equity interest is less than $595,000. In addition, the applicant or their spouse must live in the home. Also, exempt from the total countable resources is the value of the applicant’s vehicle, burial plot, and various other personal effects.
Asset Transfers – past asset transfers for 5 years prior to the date of application are eligible for review by WV Medicaid. This is to make sure the applicant did not give away or transfer assets under market value with the goal of qualifying for this program. This is called the Medicaid Look-Back Period, and if one is found to be in violation of this rule, a period of Medicaid ineligibility may result.
Persons who have income and / or assets over the eligibility limits or those with some hesitation regarding their eligibility are advised to find assistance qualifying for WV Medicaid before applying for the Personal Care Program or any other WV Medicaid program. More information.
Each beneficiary is reviewed and provided with a different set of approved services. One can receive up to 210 hours of assistance per month, which can include help with the following:
West Virginia residents are eligible to receive assistance from this program regardless of their geographic location in the state. However, they must be able to find a care provider who is willing to travel to their home or community to provide them with care services. One option when difficulty finding a provider arises is for a family member or friend who lives in the area to become a licensed home care aide. However, spouses and legal guardians cannot become paid caregivers. In order to be a paid caregiver, one must be a licensed personal attendant and must be hired by one of the provider agencies. A current list of providers can be found here.
To apply for Medicaid Personal Care, one should contact their local WV Area Agency on Aging. One should expect an approximate 60-day review time after the completed application has been submitted.
This program is under the administration of the West Virginia Bureau of Senior Services. They maintain a webpage about the program. However, little additional information is provided at this page. One can also call the Bureau of Senior Services at 866-767-1575 or 304-558-3317 to learn more about this program.