West Virginia Medicaid for Senior Care
Complete guide to Medicaid eligibility, coverage, and application process for nursing homes, assisted living, and home care in West Virginia.
7.6 million Medicaid long-term care recipients nationwide
West Virginia Department of Health and Human Resources - Bureau for Medical Services
Processing Time
30-45 days for standard Medicaid; A&D Waiver applications take 60-90 days. Waiting lists may exist depending on capacity.
West Virginia Medicaid Eligibility Requirements (2026)
To qualify for Medicaid long-term care in West Virginia, applicants must meet both financial eligibility criteria (income and assets) and medical criteria (level of care needs). West Virginia follows federal Medicaid guidelines with some state-specific variations.
Income Limits
Individual Applicant
$2,982/month
Married Couple (One Applying)
$5,964/month
Income includes Social Security, pensions, annuities, interest, dividends, and rental income.
Asset Limits
Individual Applicant
$2,000
Community Spouse (At-Home Spouse)
$3,000
Primary residence, one vehicle, personal belongings, and prepaid burial arrangements are exempt from asset limits.
5-Year Look-Back Period
West Virginia Medicaid reviews all financial transactions for the 60 months prior to application. Asset transfers or gifts during this period can result in a penalty period of Medicaid ineligibility. The penalty is calculated by dividing the transferred amount by $8,156/month average (semi-private), $8,950/month (private) (the average monthly nursing home cost in West Virginia).
Medical Eligibility
Applicants must demonstrate need for nursing facility level of care through a state assessment. This typically requires assistance with 2-3 Activities of Daily Living (bathing, dressing, toileting, transferring, eating) or cognitive impairment requiring supervision.
Assessments are performed by state-designated evaluators (nurses or social workers) and typically take 45-90 minutes. The assessment can occur at home, in a hospital, or at the care facility.
What Medicaid Covers in West Virginia
Nursing Home Care
Medicaid pays 100% of nursing home costs in West Virginia once eligibility is established. The average monthly cost is $8,156/month average (semi-private), $8,950/month (private). Recipients contribute most of their monthly income toward care costs, keeping only $50-75 for personal needs.
Coverage includes room, board, 24-hour nursing care, meals, medications, therapy services, and all medical care provided at the facility.
Assisted Living Coverage
Aged and Disabled Waiver - Personal Care Home Services: West Virginia's A&D Waiver includes services for individuals residing in licensed personal care homes (West Virginia's term for assisted living). Medicaid covers personal care services, medication administration, and care coordination through the waiver. Room and board costs are not covered—residents must pay housing costs from their monthly income or private resources.
Note: This program covers personal care services but does not cover room and board costs. Residents need approximately $1,500-$2,500/month from Social Security or other income to cover housing expenses.
Home and Community-Based Services (HCBS) Waivers
West Virginia offers 2 HCBS waiver programs that provide in-home care and community services as an alternative to nursing facility placement.
Aged and Disabled (A&D) Waiver
Serves individuals age 65+ or adults with disabilities who meet nursing facility level of care. Provides adult day care, assistive technology, case management, environmental accessibility adaptations, home-delivered meals, homemaker services, personal care, personal emergency response systems, respite care, and skilled nursing. Approximately 6,000 participants statewide.
Program Details →Title XIX (TED) Waiver
Serves individuals with traumatic brain injury or similar conditions. Some elderly individuals qualify following stroke or accident.
Program Details →How to Apply for Medicaid in West Virginia
West Virginia Medicaid applications typically take 30-45 days for standard Medicaid; A&D Waiver applications take 60-90 days. Waiting lists may exist depending on capacity.. Starting the process early and submitting complete documentation helps avoid delays.
Application Methods
You can apply for Medicaid in West Virginia through:
- Online at dhhr.wv.gov/bcf (Apply for Benefits portal)
- Phone: 1-877-716-1212 (WV Medicaid)
- Download application and mail to local DHHR office
- In-person at Department of Health and Human Resources office (55 county offices)
Step 1: Gather Required Documents
Before starting your application, collect:
- •Birth certificate and Social Security card
- •Proof of citizenship (passport, naturalization)
- •5 years of bank statements
- •Investment and retirement account statements
- •Property deeds and mortgage statements
- •Life insurance policies
- •Social Security award letter
- •Pension benefit statements
- •Medicare card
- •Doctor's statement of care needs
Step 2: Submit Your Application
Complete and submit your application through one of the methods listed above. If applying online or by mail, keep copies of all submitted documents.
Step 3: Medical Assessment
A state assessor will evaluate level of care needs. This assessment typically takes 45-90 minutes and covers functional abilities, medical needs, cognitive status, and safety concerns.
Step 4: Financial Review
Medicaid staff review all financial documents and investigate any transfers or gifts made in the past 60 months. They may request additional documentation during this process.
Step 5: Receive Determination
You'll receive written notification of approval or denial. Approved applications include the effective date of coverage (often retroactive up to 3 months), patient responsibility amount, and covered services.
Get Free Application Help
Free Medicaid application assistance is available in West Virginia from:
- •Area Agency on Aging: Call 1-800-677-1116 (Eldercare Locator) to find your local office
- •SHIP counselors: Free Medicare/Medicaid counseling
- •Nursing facility social workers: In-facility application support
- •Elder law attorneys: Paid help for complex financial situations ($2,000-$5,000)
West Virginia-Specific Programs and Resources
Medicare Savings Programs (QMB/SLMB/QI)
QMB pays Medicare premiums, deductibles, and coinsurance. SLMB pays Part B premiums. QI pays Part B premiums (limited funding).
Learn MoreMountain Health Trust (Medicaid Managed Care)
West Virginia's Medicaid managed care program covering most beneficiaries through contracted health plans.
Learn MoreBureau for Senior Services Programs
State aging agency providing case management, nutrition programs, and caregiver support.
Learn MoreNeed Help with West Virginia Medicaid?
Contact West Virginia Department of Health and Human Resources - Bureau for Medical Services for specific questions about eligibility, application status, or covered services.