West Virginia Medicaid Definition
In West Virginia, the West Virginia Department of Health and Human Services (DHHR), Bureau for Medical Services (BMS) is the agency that administers the state’s Medicaid program.
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. While there are several different eligibility groups, the focus of this page is strictly on Medicaid eligibility for elderly West Virginia residents, aged 65 and over. In addition, the focal point will be specifically Medicaid for long term care, whether that is at home, in an adult family care home (adult foster care), in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which West Virginia seniors may be eligible. These programs have slightly different financial (income and assets) and medical (functional) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that West Virginia offers several pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – is an entitlement program, which means anyone who is eligible will receive assistance. Benefits are provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Limited number of participants, which means wait lists may exist. Services are provided at home, adult day care, in an adult family care home, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled (ABD) – is an entitlement program, which means anyone who is eligible will receive assistance. Services are available at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from an West Virginia Medicaid program. Alternatively, persons can take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for West Virginia Medicaid. More.
|2019 West Virginia Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,313 / month||$2,000||Nursing Home||$4,626 / month (Each spouse is allowed up to $2,313 / month)||$3,000||Nursing Home||$2,313 / month for applicant||$2,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,313 / month||$2,000||Nursing Home||$4,626 / month (Each spouse is allowed up to $2,313 / month)||$3,000||Nursing Home||$2,313 / month for applicant||$2,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$771 / month||$2,000||None||$1,157 / month||$3,000||None||$1,157 / month||$3,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include cash from family and friends, Veteran’s benefits, employment wages, alimony payments, pension payments, annuity payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid nursing home care or home and community based services via a Medicaid waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse does not affect the applicant spouse’s Medicaid eligibility. However, this rule does not apply to a married couple with one spouse applying for regular Medicaid. In this case, the income of the non-applicant spouse is also counted towards the applicant spouse’s eligibility. For more information on how income is counted by Medicaid, click here.
For couples with only one spouse applying for nursing home Medicaid, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant (community) spouse is entitled to from the applicant spouse. This rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live. As of July 2019, if a community spouse has income under $2,113.75 / month (this figure will change 7/1/20), he or she is entitled to income from the applicant spouse, bringing his or her monthly income to this amount. Based on one’s shelter and utility costs, a community spouse may be entitled to a maximum monthly income of $3,160.50 (this figure changes in January of each year).
While most states also extend a minimum monthly maintenance needs allowance to the non-applicant spouse of a HCBS Medicaid waiver recipient, West Virginia does not. This is because the state allows the Medicaid recipient to retain 100% of his or her income as a personal needs allowance, which eliminates the need for income to be transferred to the non-applicant spouse. Stated differently, the applicant spouse is able to keep all of his or her income and contribute it towards household expenses, eliminating worry that the non-applicant spouse will have too little income from which to live. (On the contrary, nursing home Medicaid recipients are only permitted to keep $50 as a personal needs allowance).
It is also important to mention that the MMMNA does not apply to the non-applicant spouse of a regular Medicaid applicant.
What Defines “Assets”
Countable assets are assets that can easily be converted to cash to help cover the cost of long-term care and include the following: Cash, stocks, bonds, investments, credit union, savings, and checking accounts, pension funds, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt, or said another way, 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 one’s primary home, given the Medicaid applicant or his or her spouse lives in the home and the home is valued under $585,000 (in 2019). For married couples, as of 2019, the community spouse can retain half of the couples’ joint assets, up to a maximum of $126,420, as the chart indicates above. If the couple has assets equal to $25,284 or under this figure, the community spouse is able to retain 100% of the couples’ assets. This, in Medicaid speak, is known as the Community Spouse Resource Allowance (CSRA). Unlike the MMMNA, the CSRA applies to non-applicant spouses of both nursing home Medicaid and HCBS Medicaid wavier recipients. To be very clear, the CSRA does not apply to non-applicant spouses of regular Medicaid applicants.
One should be aware that West Virginia has a Medicaid Look-Back Period. This is a period of 60 months (5 years) that backdates from one’s Medicaid application date. During this time frame, Medicaid checks all past asset transfers to ensure no assets were sold or given away under fair market value. This also includes asset transfers a Medicaid applicant’s non-applicant spouse may have made. There is a look back period so one does not give away assets in an attempt to meet Medicaid’s asset limit. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will result.
Qualifying When Over the Limits
For West Virginia elderly residents (65 and over) who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – In West Virginia, the Medically Needy Pathway, also called a Spenddown Program, allows seniors who would otherwise be over the income limit to qualify for Medicaid if they have high medical expenses. In simple terms, one may still qualify for Medicaid services by “spending down” his or her income to the income limit. One can do this by paying excess income (the income over the income limit) on health insurance premiums, unpaid medical bills, and medical expenses that Medicaid does not cover. Once one has spent his or her income down to the income limit, Medicaid will kick in for the remainder of the spend-down period, which is six months in West Virginia.
Unfortunately, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirement for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in reducing their assets to meet the asset limit. However, one can “spend down” assets by spending excess assets on non-countable assets, such as home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. As mentioned previously, when spending down assets, it’s important that one does not give away assets or sell them for less than their value. This is because in West Virginia, Medicaid has a “Look-Back” period of 5 years, and if one is in violation, there will be a period of Medicaid ineligibility.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific West Virginia Medicaid Programs
1) West Virginia Medicaid Personal Care – Available via the WV state Medicaid plan, assistance with daily living activities, such as bathing, dressing, mobility, and eating, is provided for those who functionally need it. Assistance can be provided in one’s home, the home of a relative, an assisted living residence, or an adult foster care home.
2) West Virginia Aged and Disabled Waiver (ADW) – Provides benefits for elderly and disabled individuals to assist them in living independently in their homes. Available services may include personal care and homemaker assistance, skilled nursing, and non-medical transportation. There is an option for self-direction, which means program participants are able to choose their own caregivers, including select family members.
How to Apply for West Virginia Medicaid
To apply for Medicaid in West Virginia, elderly applicants can so online at inROADS, in person at their local DHHR field office, or submit a competed application to their local DHHR field office. There is both an “Application for Health Coverage & Help Paying Costs” and a “Supplement to Application for Health Coverage”. Another application option is call 877-716-1212 to reach the Customer Service Center and apply for benefits over the phone. Seniors might also wish to contact their local Area Agency on Aging for questions regarding Medicaid and / or for application assistance.
Prior to submitting a Medicaid application for long-term care in West Virginia, it is very important that applicants are certain that they meet all eligibility requirements (in detail above). 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. For general information about the long-term care Medicaid application process, click here.