Table of Contents
West Virginia Medicaid Long-Term Care Definition
Medicaid is a health care program for low-income individuals of all ages. While there are various coverage groups, the focus here is on long-term care Medicaid eligibility for elderly West Virginia residents, aged 65 and over. In addition to nursing home care, assisted living services, and adult foster care / adult family care services, West Virginia Medicaid pays for many non-medical support services that help frail seniors remain living in their homes. There are three categories of Medicaid long-term care programs for which WV seniors may be eligible.
1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; the number of participants is limited and waiting lists may exist. Services are intended to delay and / or prevent nursing home admissions and may be provided at home, adult day care, an adult family care home, or assisted living. More on Waivers.
3) Regular Medicaid / Aged, Blind or Disabled (ABD) – An entitlement; anyone who is eligible will receive assistance. Various long-term care benefits, such as personal care assistance or adult day care, may be available.
While Medicaid is jointly funded by the state and federal government, each state administers its program within federally set parameters. In WV, the West Virginia Department of Health and Human Services (DHHR), Bureau for Medical Services (BMS) is the administering agency.
Income & Asset Limits for Eligibility
The three categories of long-term care programs have varying financial (income and assets) and medical (functional) eligibility criteria. Further complicating eligibility is that the financial criteria change annually, vary with marital status, and that West Virginia offers several pathways towards eligibility.
West Virginia seniors must have limited income and assets, and a medical need to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) Income under $2,829 / month 2) Assets under $2,000 3) Require a Nursing Home Level of Care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a West Virginia Medicaid program. Alternatively, persons can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for WV Medicaid. More.
|2024 West Virginia Medicaid Long-Term Care Eligibility for Seniors
|Type of Medicaid
|Married (both spouses applying)
|Married (one spouse applying)
|Level of Care Required
|Level of Care Required
|Level of Care Required
|Institutional / Nursing Home Medicaid
|$2,829 / month*
|$5,658 / month ($2,829 / month per spouse)*
|$2,829 / month for applicant*
|$2,000 for applicant & $154,140 for non-applicant
|Medicaid Waivers / Home and Community Based Services
|$2,829 / month
|$5,658 / month ($2,829 / month per spouse)
|$2,829 / month for applicant
|$2,000 for applicant & $154,140 for non-applicant
|Regular Medicaid / Aged, Blind or Disabled
|$943 / month
|Help with ADLs
|$1,415 / month
|Help with ADLs
|$1,415 / month
|Help with ADLs
Income Definition & Exceptions
Countable vs. Non-Countable Income
Nearly any income that a Medicaid applicant receives is counted towards Medicaid’s income limit. This includes cash from family and friends, employment wages, alimony payments, pension payments, annuity payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in WV, the VA Aid & Attendance and Housebound Allowances, which are above and beyond the Basic VA Pension, do not count as income.
Treatment of Income for a Couple
When only one spouse of a married couple applies for Medicaid nursing home care or a Medicaid Waiver, only the income of the applicant is counted. Furthermore, for Nursing Home Medicaid, the non-applicant spouse, also called the community spouse, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) / Community Spouse Maintenance Allowance (CSMA) from their applicant spouse. The MMMNA is a Spousal Impoverishment Rule and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid poverty.
In WV, the MMMNA is $2,465 (eff. 7/1/23 – 6/30/24). If a non-applicant spouse’s income is under $2,465 / month, income can be transferred to them from their applicant spouse, bringing their income up to this level. A non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $739.50 / month (eff. 7/1/23 – 6/30/24). However, in 2024, a Spousal Income Allowance cannot put a non-applicant’s income over $3,853.50 / month. This is the Maximum Monthly Maintenance Needs Allowance. More on how this allowance is calculated.
While most states also extend a Minimum Monthly Maintenance Needs Allowance to the non-applicant spouse of a Medicaid Waiver applicant, West Virginia does not. This is because the state allows Medicaid Waiver recipients to retain 100% of their income as a Personal Needs Allowance. This eliminates the need for income to be transferred to the non-applicant spouse. The applicant spouse will still have their income to contribute towards household expenses, eliminating worry that the non-applicant spouse will become impoverished. On the contrary, Nursing Home Medicaid recipients are only permitted to keep $50 / month as a Personal Needs Allowance.
Income is counted differently when only one spouse applies for Regular Medicaid; the income of both the applicant and non-applicant spouse is calculated towards the applicant’s income eligibility. Furthermore, there is no Monthly Maintenance Needs Allowance for a non-applicant spouse. More on how Medicaid counts income.
Asset Definition & Exceptions
Countable vs. Non-Countable Assets
Countable assets are counted towards Medicaid’s asset limit. This includes cash and assets that can easily be converted to cash to help cover the cost of long-term care. Examples include stocks, bonds, investments, bank accounts (credit union, savings, and checking), pension funds, and real estate in which one does not reside. In West Virginia, an applicant’s IRA / 401K is countable. Medicaid also considers many assets to be exempt; they are not counted towards Medicaid’s asset limit. Exemptions include personal belongings, household goods / furnishings, an automobile, life insurance policies (up to a combined face value of $1,500), burial plots, burial funds (up to $1,500), and generally one’s primary home. In WV, a non-applicant spouse’s IRA / 401K is exempt.
Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. There is, however, a Community Spouse Resource Allowance (CSRA) for the non-applicant spouse (community spouse) of a Medicaid nursing home or Waiver applicant. The CSRA protects a larger portion of the couple’s assets for the non-applicant spouse. In 2024, the non-applicant spouse can retain 50% of the couples’ joint assets, up to a maximum of $154,140. If the non-applicant’s half of the assets is under $30,828, 100% of the assets, up to $30,828 can be retained by the non-applicant. There is no CSRA for Regular Medicaid.
Medicaid’s Look-Back Rule
West Virginia has a 60 month (5 year) Medicaid Look-Back Period for Nursing Home Medicaid and Medicaid Waivers that immediately precedes one’s date of Medicaid application. During this period, Medicaid checks all past asset transfers to ensure no assets were gifted or sold under fair market value. This includes asset transfers a Medicaid applicant’s spouse has made. The Look-Back Rule is intended to discourage applicants from giving away assets to meet Medicaid’s asset limit. If one violates this rule, even unintentionally, a period of Medicaid ineligibility will be determined.
The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows one to gift up to $18,000 per recipient without having to file a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.
West Virginia Medicaid Home Exemption Rules
For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of the home’s equity that is owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live in it, the applicant must have Intent to Return. There is no home equity interest limit for Regular Medicaid. Other exemptions exist.
While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, West Virginia’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance
Medical / Functional Need Requirements
An applicant must have a medical need for long-term care Medicaid. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Home Level of Care (NHLOC) is required. Some program benefits may require additional eligibility criteria be met, For instance, for skilled nursing, an inability to live independently at home without this service might be required. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NHLOC is not necessarily required.
Qualifying When Over the Limits
For West Virginia elderly residents (aged 65 and over) who do not meet the financial eligibility requirements above, there are other ways to qualify for long-term care Medicaid.
1) Medically Needy Pathway – West Virginia has a Spenddown Program that allows seniors who are over the income limit to still become income-eligible for Medicaid if they have high medical expenses. Seniors “spend down” their income on health insurance premiums, unpaid medical bills, and medical expenses that Medicaid does not cover. The spend down amount is the difference between one’s monthly income and the Medically Needy Income Limit (MNIL). In 2024, the MNIL in WV is $200 / month for a single applicant and $275 / month for a couple. Once the “spend down” is met, which is calculated for a 6 month period, one will be Medicaid income-eligible for the remainder of the period. The asset limit for this program is $2,000 for an individual and $3,000 for a couple.
2) Asset Spend Down – Seniors who have assets over Medicaid’s asset limit can still become asset-eligible for Medicaid by spending down extra assets on non-countable ones. Examples include making home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. One must exercise caution when spending down assets to avoid violating Medicaid’s “Look-Back” Period of 5 years. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.
Specific West Virginia Medicaid Programs
In addition to paying for nursing home care, West Virginia Medicaid offers the following programs relevant to the elderly that helps them to live in their homes and communities.
1) West Virginia Medicaid Personal Care – Available via the WV State Medicaid Plan / Regular Medicaid, in-home assistance with daily living activities is provided for those who functionally need it. Assistance may be provided with bathing, dressing, mobility, eating, preparing meals, and light housework.
2) West Virginia Aged and Disabled Waiver (ADW) – Provides benefits for individuals who are elderly and disabled to assist them in living independently in their homes. This includes personal care assistance, homemaker services, skilled nursing, and non-medical transportation. There is an option for self-direction, allowing program participants to choose their own caregivers, including select family members.
3) Money Follows the Person (MFP) – Also called Take Me Home (TMH) in West Virginia. This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.
How to Apply for West Virginia Medicaid
Elderly applicants can apply for Medicaid in West Virginia online at WV Path, in person at their local DHHR field office, or by submitting a competed application to their local DHHR field office. There is an “Application for Health Coverage & Help Paying Costs” and a “Supplement to Application for Health Coverage”. Additionally, one can apply over the phone by calling the Customer Service Center at 877-716-1212. One’s local Area Agency on Aging might be helpful in answering Medicaid related questions and / or providing application assistance. The application process may vary based on the program for which one is applying.
Before applying for long-term care Medicaid in West Virginia, it is vital that applicants be certain they meet all eligibility requirements. Seniors who have income and / or resources in excess of the limit(s) should consider Medicaid planning for the best chance of acceptance into a Medicaid program. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.