West Virginia Medicaid for seniors and long-term care
Last verified: June 2026
Long-term care Medicaid rules are complex
WV long-term care Medicaid is separate from Mountain Health Trust managed care
What West Virginia Medicaid covers for long-term care
West Virginia Medicaid covers nursing facility care for eligible seniors and disabled individuals who require that level of support. The state also funds an extensive network of home and community-based services through its waiver programs — designed to allow people to remain in their homes and communities rather than enter nursing facilities.
- Skilled nursing facility (nursing home) care
- Personal care attendant services at home
- Home health aide visits
- Adult day health services
- Assisted living through HCBS waiver
- Respite care for family caregivers
- Home modifications (ramps, grab bars, widened doorways)
- Assistive technology and medical equipment
- Transportation to medical appointments
- Behavioral health and substance use disorder services
Source: West Virginia BMS HCBS waiver documentation; BFA Income Maintenance Policy Manual.
Financial eligibility for West Virginia long-term care Medicaid (2025)
West Virginia long-term care Medicaid uses income and asset tests separate from MAGI-based expansion coverage. The income standard for nursing facility care is 300% of the Social Security Federal Benefit Rate. Asset limits and spousal impoverishment protections apply under federal law (42 U.S.C. § 1396r-5).
| Financial figure | 2025 amount (approximate) |
|---|---|
| Income limit (300% FBR) | ~$2,901/mo |
| Individual resource (asset) limit | $2,000 |
| Community spouse minimum CSRA | ~$30,828 |
| Community spouse maximum CSRA | ~$154,140 |
Source: West Virginia BFA Income Maintenance Policy Manual; federal spousal impoverishment rules. Figures are approximate — verify with BMS, BFA, or a West Virginia elder law attorney.
HCBS waivers: staying at home instead of a nursing facility
West Virginia operates several Home and Community-Based Services (HCBS) waivers under Section 1915(c) of the Social Security Act. These waivers allow Medicaid-eligible individuals who meet nursing facility level of care to receive long-term services in their home or community setting. Key waivers include the Aged and Disabled Waiver and specialized waivers for individuals with intellectual and developmental disabilities and acquired brain injury.
West Virginia also has a Substance Use Disorder (SUD) Waiver — a distinct program announced by BMS to address the state's ongoing opioid crisis. West Virginia has one of the highest overdose mortality rates in the nation, and the SUD Waiver expands access to residential and outpatient treatment services for Medicaid members with substance use disorders.
HCBS waiver slots may be limited and wait lists can exist. Contact BMS at 1-877-716-1212 or visit bms.wv.gov/photo-call-out/home-and-community-based-services-hcbswaivers to learn about current waiver availability.
West Virginia Medicaid estate recovery
West Virginia operates a Medicaid estate recovery program. The state may seek reimbursement from the estate of a member who received nursing facility care or certain long-term services at age 55 or older. West Virginia's 60-month look-back period applies to asset transfers before a long-term care Medicaid application. Consult a licensed West Virginia elder law attorney before making asset transfers if a family member may need long-term care Medicaid.
Medicaid as the primary payer for long-term care
Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.
Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. West Virginia's share of that population is administered through West Virginia Medicaid. The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.
Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.
Nursing facility coverage
West Virginia Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.
Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.
If income exceeds the institutional Medicaid limit, West Virginia may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether West Virginia uses this approach with West Virginia Medicaid.
Home and community-based services (HCBS)
HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through West Virginia Medicaid differs from what's available in neighboring states.
Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.
Contact West Virginia Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.
Asset limits for long-term care Medicaid
Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.
Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.
Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult West Virginia Medicaid or a Medicaid planning attorney before transferring assets.
Spousal protections
When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.
The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. West Virginia's current CSRA is set by West Virginia Medicaid and published on their website.
The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).
Estate recovery applies to long-term care recipients age 55 and older
What long-term care Medicaid typically covers
- Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
- Physical, occupational, and speech therapy provided in a nursing home
- Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
- Home health aide visits for those receiving care at home
- Adult day health care programs
- Respite care to give family caregivers temporary relief
- Durable medical equipment prescribed by a physician
- Transportation to and from medical appointments