The West Virginia Bureau of Senior Services offers the Medicaid Personal Care program to state residents to help them perform at least three activities of daily living. The five activities include personal hygiene (bathing), dressing, eating, transferring (mobility), and maintaining continence. Assistance with these activities is provided by approved and 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 home, the home of other family members, and, in some instances, 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 toward the cost of room and board.
What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home care. However, those who wish to live at home, in assisted living or in adult foster care, sometimes Medicaid will pay for nursing-home-level care in those locations if it can be obtained at a lower cost than in a nursing home.
An applicant must be medically eligible for this program, which is determined by a functional assessment completed by a medical professional. In simple terms, an applicant must require assistance with at least three of their activities of daily living.
An unmarried or widowed applicant aged 65 or older is permitted a monthly income equivalent to 100% of the Federal Benefit Rate (FBR). In 2023, this means one’s monthly income cannot exceed $914. A couple, regardless of whether both spouses are applying, is allowed $1,371 in income.
An unmarried or widowed applicant, 65+, is permitted up to $2,000 in countable assets. A couple is allowed $3,000. Countable assets do not include resources such as one’s primary home, provided the value of their home equity interest is less than $688,000. 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.
Medicaid has a 60-month look-back period in which all transfers within this time frame are scrutinized. Assets are not allowed to be gifted in order to meet financial requirements, otherwise the individual will be penalized with a period of Medicaid ineligibility.
Over the Financial Limits?
West Virginia also offers an alternative pathway to Medicaid called the Medically Needy Pathway. For persons who have high medical expenses, they can still become Medicaid eligible by spending down their income on medical expenses that Medicaid does not cover. In West Virginia, the Medically Needy Income Limit is $200. This means that once the applicant has spent their income down to $200 a month for six months, they will become Medicaid eligible.
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 West Virginia Medicaid before applying for the Personal Care Program or any other WV Medicaid program. Get more information here.
Benefits and Services
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:
- Health-Related Tasks
- Medication Reminders
- Personal Hygiene
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.
How to Apply / Learn More
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, and an online pamphlet with further information can be found here.
One can also call the Bureau of Senior Services at 866-767-1575 or 304-558-3317 to learn more about the program.