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, this page is focused on Medicaid eligibility for elderly West Virginia residents, aged 65 and over. Specifically, Medicaid for long term care is covered. 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.
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 varying financial (income and assets) and medical (functional) eligibility requirements, as well as benefits. Further complicating eligibility is that the criteria vary with marital status and that West Virginia offers several pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who is eligible will receive assistance. Benefits are provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – This is not an entitlement program; The number of participants is limited and wait 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) – This is an entitlement program; Anyone who is eligible will receive assistance. Various long-term care benefits, such as personal care assistance or adult day care, may be available.
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 the criteria does not mean one is ineligible or cannot become eligible for WV Medicaid. More.
|2022 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||$2,523 / month*||$2,000||Nursing Home||$5,046 / month ($2,523 / month per spouse)*||$3,000||Nursing Home||$2,523 / month for applicant*||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,523 / month||$2,000||Nursing Home||$5,046 / month ($2,523 / month per spouse)||$3,000||Nursing Home||$2,523 / month for applicant||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Aged, Blind or Disabled||$841 / month||$2,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs|
What Defines “Income”
Any income that a Medicaid applicant receives is counted. 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. Coronavirus stimulus checks and Holocaust restitution payments are not counted as income by Medicaid and do not impact eligibility.
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. This means the income of the non-applicant spouse, also called a community spouse, does not impact the applicant spouse’s Medicaid eligibility. However, a non-applicant spouse of a nursing home Medicaid applicant 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. The MMMNA is $2,178 (effective 7/1/21 – 6/30/22). If a non-applicant spouse’s income is under $2,178 / month, income can be transferred from their applicant spouse, bringing their income up to this level.
In West Virginia, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $653.25 / month (effective 7/1/21 – 6/30/22). However, in 2022, in no case can a spousal income allowance put a non-applicant’s income over $3,435 / month. This is the Maximum Monthly Maintenance Needs Allowance. More on how the spousal 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. This is because 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 as a personal needs allowance).
Income is counted differently when only one spouse applies for Regular Medicaid; The income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. More on how Medicaid counts income.
What Defines “Assets”
Countable assets are assets that can easily be converted to cash to help cover the cost of long-term care. Examples include cash, stocks, bonds, investments, credit union, savings, and checking accounts, pension funds, and real estate in which one does not reside. Medicaid also considers many assets to be exempt. This means 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. For home exemption, the Medicaid applicant must live there or have intent to return and their home equity interest must not be greater than $636,000 (in 2022). Home equity interest is the amount of the home’s value owned by the applicant. The home is also exempt, regardless of where the applicant spouse lives and their home equity interest, if a spouse lives in it.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, the non-applicant spouse of a Medicaid nursing home or Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain 50% of the couples’ joint assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets is under $27,480, 100% of the assets, up to $27,480 can be retained by the non-applicant.
West Virginia has a 60 month (5 year) Medicaid Look-Back Period 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 dissuade applicants from giving away assets to meet Medicaid’s asset limit. If one violates the look-back period, even unintentionally, a period of Medicaid ineligibility will be determined.
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 – West Virginia has a Spenddown Program that allows seniors who are over the income limit to qualify for Medicaid if they have high medical expenses. Via this pathway, seniors “spend down” their income on health insurance premiums, unpaid medical bills, and medical expenses that Medicaid does not cover. The amount one must spend down is the difference between one’s monthly income and the medically needy income limit. In 2022, the medically needy income limit 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 eligible for the remainder of the period. The medically needy asset limit 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 qualify 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 the look back rule was not violated.
3) 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 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. 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 / Regular Medicaid, 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 assistance, homemaker services, 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
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 both an “Application for Health Coverage & Help Paying Costs” and a “Supplement to Application for Health Coverage”. One can also apply for benefits 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.
Before applying for long-term care Medicaid in West Virginia, it is vital that applicants be certain 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.