West Virginia
What is West Virginia Medicaid for Long-Term Care?
West Virginia Medicaid provides health coverage for individuals with limited income and resources. For seniors aged 65 and older, it can cover a range of long-term care services, including nursing home care, in-home assistance, assisted living, and adult foster care. There are three types of long-term care Medicaid programs available to older West Virginians.
What is Institutional or Nursing Home Medicaid?
This is an entitlement program, meaning eligible applicants are guaranteed services. Benefits are only available in Medicaid-approved nursing facilities.
What Are Home and Community Based Services (HCBS) or Medicaid Waivers?
These waivers are not guaranteed—there are a limited number of spots and waitlists may apply. They offer in-home care, adult day services, and care in assisted living or adult family homes to help seniors avoid institutional placement.
What is Regular Medicaid for the Aged, Blind, or Disabled (ABD)?
This is also an entitlement. Eligible individuals may receive services such as personal care and assistance with daily activities through in-home support or adult day care programs.
What Are the 2025 Financial Eligibility Requirements for West Virginia Long-Term Care Medicaid?
What Are the Simplified Criteria for Single Applicants?
To qualify for Nursing Home Medicaid in 2025, a single applicant must:
- Have a monthly income below $2,901
- Own countable assets worth less than $2,000
- Require a Nursing Home Level of Care
What Are the Income and Asset Limits by Medicaid Program and Marital Status?
| Type of Medicaid | Single | Married (Both Applying) | Married (One Applying) |
|---|---|---|---|
| Institutional / Nursing Home | $2,901 income / $2,000 assets | $5,802 income / $3,000 assets | $2,901 income (applicant) $2,000 (applicant) + $157,920 (non-applicant) |
| HCBS Waivers | $2,901 income / $2,000 assets | $5,802 income / $3,000 assets | $2,901 income (applicant) $2,000 (applicant) + $157,920 (non-applicant) |
| Regular Medicaid / ABD | $967 income / $2,000 assets | $1,450 income / $3,000 assets | $1,450 income / $3,000 assets |
*Most of a beneficiary’s income must go toward nursing home costs, with exceptions like a $50 personal needs allowance.
What Counts as Income for Medicaid Eligibility in WV?
What Types of Income Are Counted?
Most income sources count, such as wages, pensions, Social Security, annuities, and investment earnings. Exceptions include Holocaust restitution and VA Aid & Attendance benefits.
How Is Income Handled for Married Couples?
When only one spouse applies, only their income is considered. The non-applicant spouse may receive income up to $2,643.75/month to avoid impoverishment. If shelter expenses exceed $793.13, more may be transferred, but total income cannot exceed $3,948/month. For HCBS Waivers in WV, income transfers aren’t needed since the applicant keeps all income.
What Assets Are Considered for Medicaid Eligibility?
Which Assets Are Countable?
Countable assets include cash, bank accounts, investments, real estate (not lived in), and retirement accounts. Exemptions include one vehicle, household items, life insurance under $1,500, burial funds, and the applicant’s primary home (with conditions).
How Are Assets Treated for Married Applicants?
All joint assets are counted, but the non-applicant spouse may keep up to $157,920 in 2025. If half the couple’s assets are less than $31,584, the non-applicant may keep the full amount up to that limit. Regular Medicaid has no spousal asset protection.
What Is the Medicaid Look-Back Period in West Virginia?
The state enforces a 5-year (60-month) look-back period to identify asset transfers below fair market value. Violations may result in a penalty period of ineligibility. The federal gift tax allowance ($19,000 in 2025) does not apply to Medicaid rules.
Are Homes Always Protected from Medicaid?
What Makes a Home Exempt?
The home is exempt if the applicant or their spouse lives in it, or if the applicant has an “Intent to Return.” If no spouse resides there, the applicant’s equity interest must be under $730,000 in 2025. This limit does not apply to Regular Medicaid.
What Happens to the Home After Death?
Even if exempt during the applicant’s lifetime, Medicaid can recover care costs from the home through its Estate Recovery Program. Planning ahead can help preserve the home for heirs.
What Are the Medical Requirements for Long-Term Care Medicaid?
Applicants must demonstrate a need for care. A Nursing Home Level of Care is required for institutional and waiver services, while Regular Medicaid may only require assistance with basic daily activities.
Can You Still Qualify If Over the Limits?
What Is the Medically Needy or Spenddown Program?
Seniors with high medical costs can qualify by spending down income above $200/month (single) or $275/month (couple) over a 6-month period. The asset limits remain $2,000 (single) and $3,000 (couple).
How Can Assets Be Spent Down?
Excess assets can be spent on non-countable items like home modifications, funeral arrangements, or debt repayment. Keep detailed records to avoid issues with the Look-Back Period.
What Is Medicaid Planning?
When seniors are over the limits but still can’t afford care, working with a Medicaid planner can help them qualify legally and protect assets, including the home.
What Long-Term Care Programs Does WV Medicaid Offer?
Personal Care Program
Through the State Plan, this program provides in-home help with daily activities like bathing, dressing, and housekeeping for those who qualify based on functional needs.
Aged and Disabled Waiver (ADW)
This waiver supports seniors with in-home services such as personal care, skilled nursing, and transportation. Participants may choose their caregivers, including relatives.
Money Follows the Person (Take Me Home)
This program assists Medicaid recipients in moving from nursing homes back to their homes or community settings with the help of support services.
How Can Seniors Apply for Medicaid in West Virginia?
Applications can be submitted:
- Online: WV Path
- By Phone: 877-716-1212
- In Person: At a local DHHR field office
Applicants can also complete and submit printed application forms. Before applying, seniors should ensure they meet all eligibility criteria. Those with income or assets over the limit may benefit from consulting a Medicaid planner.
