Long-Term Care Medicaid in West Virginia: 2026 Guide
In West Virginia, Medicaid is run by the Bureau for Medical Services (BMS), and eligibility is decided by the Bureau for Family Assistance (BFA) in the Department of Human Services. Long-Term Care Medicaid can pay for nursing facility care and for care at home through the Aged and Disabled Waiver (ADW). This guide explains the 2026 rules in plain language.
At a glance: West Virginia 2026 figures
| Item | 2026 figure |
|---|---|
| Income limit (applicant) | $2,982 a month (300% of the SSI rate); spenddown above that |
| Asset limit (single applicant) | $2,000 |
| Asset limit (couple, both applying) | $3,000 |
| Home equity limit | $752,000 |
| Spouse at home: resource allowance (CSRA) | Minimum $32,532 / maximum $162,660 |
| Spouse at home: monthly income allowance | Minimum $2,705 / maximum $4,066.50 |
| Personal needs allowance (nursing home) | $50 a month |
| Look-back period | 60 months (5 years) |
| Penalty divisor | $11,903 a month ($396.76 a day) |
Figures last updated for 2026. Sources are listed at the end of this page.
Figures change periodically. Double-check current amounts with the West Virginia Bureau for Family Assistance before relying on them.
What Long-Term Care Medicaid covers in West Virginia
Nursing home care. Medicaid pays for care in a certified nursing facility. You pay most of your income toward the cost each month, and Medicaid pays the rest.
Aged and Disabled Waiver (ADW). For West Virginians 18 and older who meet Medicaid financial rules, need a nursing home level of care, choose the waiver over a nursing home and can provide a safe setting for staff. Services include personal attendant care, case management, skilled nursing, transportation, personal emergency response, home and vehicle accessibility changes and medical adult day care.
Other programs.
How Medicare fits in. Medicare Part A covers skilled nursing facility care only for a limited time. You generally need a medically necessary inpatient hospital stay of at least 3 days in a row first (time under observation or in the emergency room does not count), and you must need daily skilled nursing or therapy. In 2026, Medicare charges nothing for days 1 to 20 after the Part A deductible ($1,736) is met, $217 a day for days 21 to 100, and nothing after day 100, when you pay all costs. Medicare limits this coverage to 100 days in each benefit period. Medicaid can be a way to pay for long-term nursing home care after Medicare coverage ends.
Who qualifies
A person generally must:
- be 65 or older, or blind or disabled;
- live in West Virginia and be a U.S. citizen or qualified non-citizen;
- meet a nursing facility level of care, based on a medical necessity evaluation;
- meet the income and asset rules below, as decided by BFA.
Income rules
West Virginia’s income limit is 300% of the SSI rate, $2,982 a month in 2026. BFA says that above it, a spenddown against the facility rate can apply.
Once you are on Medicaid in a nursing facility, most of your income goes to the facility. You keep a personal needs allowance of $50 a month, and money can be set aside for a spouse at home and for health insurance premiums.
Asset rules
In 2026, a single applicant can have up to $2,000 in countable resources, and a couple $3,000.
Countable resources include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.
Usually exempt:
- Your home (equity up to $752,000) if you live there or plan to return, or a spouse or dependent relative lives there
- One vehicle
- Household goods and personal belongings
- Burial plots and limited burial funds, within BFA rules
Spousal protections
- Assets: The spouse at home can keep at least $32,532 and up to $162,660 in 2026, using a half-split method, plus the home, one car and belongings.
- Income: The spouse at home keeps their own income. If it is below $2,705 a month, part of the applicant’s income can go to them, up to $4,066.50 a month.
Look-back and penalties
When you apply, West Virginia looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.
Common examples of transfers that can cause a problem:
- Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
- Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
- Selling a house or car to a relative for much less than it is worth.
- Paying a family member for care without a written agreement made at the time.
Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.
How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($11,903 a month ($396.76 a day)).
Example: Suppose you gave your daughter $50,000 three years before applying. $50,000 divided by $11,903 is about 4.2 months without Medicaid payment for long-term care.
The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.
Estate recovery in West Virginia
West Virginia’s estate recovery program is run by the state.
- What is recovered: Medicaid paid for long-term care and related services received at age 55 or older, and for some people of any age in a nursing facility.
- When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
- Hardship waivers: the state must have a way to waive recovery when it would cause undue hardship. Ask BFA for the current rules.
- Family members and personal representatives can contact BFA with questions.
How to apply
- For Medicaid eligibility: apply with BFA.
- For the ADW: a physician, physician assistant or nurse submits a Medical Necessity Evaluation Request. Financial eligibility is decided first, then medical eligibility. See the ADW program site and Apply Now for a Medicaid Waiver.
Applying for a spouse or parent. If you are applying for someone else, you may need legal authority to act for them, or you can be named as an authorized representative on the application. Gather statements for every account, not just the main one, and write down when the person’s care needs began. If the person is already in a nursing home, ask the facility’s business office or social worker which Medicaid forms they need from you and when, and tell the agency if any requested document is hard to get, since agencies can often give extra time when you ask before the deadline.
After you apply. BFA will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing (appeal). The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive, and report changes in income, assets or address when they happen.
Gather what you can before you apply. The caseworker may ask for:
- Photo ID, Social Security card and Medicare card
- Proof of age and of U.S. citizenship or immigration status
- Proof that you live in the state (for example, a utility bill or lease)
- Proof of all income: Social Security award letter, pension statements, annuity statements
- Bank, credit union and investment statements (often for the full 60-month look-back period)
- Deeds, property tax bills and the value of any real estate
- Life insurance policies (showing cash value) and prepaid funeral or burial contracts
- Vehicle titles
- Health insurance cards and long-term care insurance policies
- Power of attorney or guardianship papers, if someone is applying for you
- For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start
If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.
Free public help in West Virginia
- BFA and BMS: eligibility and program questions.
- Aging and Disability Resource Centers: local information on long-term care options.
- SHIP (State Health Insurance Assistance Program): free Medicare counseling.
- Long-Term Care Ombudsman Program: free advocates for residents of nursing homes and other long-term care settings.
Recent and upcoming changes
A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including West Virginia:
- Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
- Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). West Virginia’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect West Virginia’s limit.
The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.
State programs
Each program below has its own page with who qualifies, services, how to apply and waiting lists:
Frequently asked questions
What is the ADW? West Virginia’s Medicaid waiver for care at home for adults 18 and older who need a nursing home level of care.
How do I start an ADW application? A physician, physician assistant or nurse submits a Medical Necessity Evaluation Request for you.
How much can my spouse keep? In 2026, at least $32,532 and up to $162,660 in assets, plus the home, a car and belongings, and income of at least $2,705 a month.
How long is the penalty for a gift? Divide the gift by $11,903 to get the number of months. A $20,000 gift would mean about 1.7 months without Medicaid payment for long-term care.
Will the state take my home after I die? BFA can seek repayment for long-term care paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.
Figures change periodically. Double-check current amounts with the West Virginia Bureau for Family Assistance before relying on them.
Sources
- BFA, Medicaid for Long Term Care eligibility sheet
- WV Income Maintenance Manual 11.3
- WV Income Maintenance Manual (long-term care)
- BMS, Aged and Disabled Waiver manual (Chapter 501)
- ADW program
- Medicare.gov, Skilled nursing facility care
- CMS, 2026 SSI and spousal impoverishment standards
- Public Law 119-21 (2025)
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.