West Virginia Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

West Virginia provides long-term care resources to seniors through the West Virginia Bureau of Senior Services.The Bureau provides resources for healthy aging, including information on food and fitness, as well as healthcare promotion. In addition, it oversees the LIFE program. The LIFE (Legislative Initiative for the Elderly) program is a state-funded program and part of the senior center array of services. Services vary by county but are modeled after those provided by the Older Americans Act. For more information you can contact your county aging provider (senior center).

Medicaid Waiver Program for Assisted Living and In Home Care

West Virginia Aged & Disabled Medicaid Waiver (HCBS Aged & Disabled Waiver)

Aged and Disabled Waiver Program (ADW) is a long-term care alternative that provides services that enable an individual to remain at or return home rather than receiving nursing home care. The goals and objectives of this program are focused on providing services that are person-centered, promote choice, independence, participant-direction, respect, and dignity and community integration.

Services

Services include: Case Management – Development of a service and support plan by a case management agency that reflects the wishes and preferences of the ADW member. View Case Management agencies and Case Management Selection forms; Personal Attendant – Long-term direct care and support services (assistance with personal hygiene, nutritional support, and environmental maintenance) that are necessary in order to enable an individual to remain at home rather than enter a long-term care facility. View Personal Attendant agencies and Personal Attendant Selection forms; Transportation – an ADW member may be transported by the homemaker in order to gain access to services and activities in the community; RN Assessment and Review – a registered nurse will complete assessments of the ADW member at regular intervals to ensure that the member’s plan of care is meeting his/her needs; Personal Options – ADW members have a monthly budget that they use to hire caregivers/employees and purchase needed ADW services to assist with activities of daily living. View Overview of Personal Options.

Eligibility

  1. Health: Applicants must require a Nursing Home Level of Care
  2. Financial: Applicants must meet certainincome and asset criteria to be eligible for the Medicaid long-term care benefit. For 2017, an individual cannot make more than $2,205 per month and have a maximum amount of assets of $2,000 ($3,000 for a couple). This is a strict income limit andno Miller Trust is available for planning purposes. The non-applicant spouse may keep up to $120,900 in assets and monthly allowance of $3,022.50 for expenses without it counting towards the criteria for the applicant. An applicant who has too much income may also be able to qualify for the waiver through a provision known as the “medically-needy” option, which allows an applicant to spend down their income on medical and other remedial care to access the benefit.

Practical Considerations

This waiver has a strict income limit, but does not allow for a trust vehicle to help qualify if you make too much income. The state also does not have a medically needy spend down category.

Conclusion

Medicaid Planning for West Virginia’s Aged & Disabled waiver is difficult due to the status as an SSI-criteria state which allows little flexibility in planning for long-term medicaid benefits. Further, the low enrollee cap means there is likely a wait list at any given time. The viability of assisted living and in home care provided by Medicaid long-term care benefits is low in West Virginia.