West Virginia Medicaid HCBS Waivers: The ADW Guide

West Virginia's Medicaid program does pay for home and community-based services (HCBS). For older adults and adults with physical disabilities, it does so mainly through one waiver: the Aged and Disabled Waiver, or ADW. The ADW is built for people who would otherwise need nursing-home care but want to stay in, or return to, their own home.1

To qualify for the ADW, a person has to meet West Virginia Medicaid's waiver financial rules first, and then be approved for a nursing-home level of care, which a nurse confirms through a medical assessment.1

In This Guide

• What Are West Virginia Medicaid HCBS Waivers?
• The Aged and Disabled Waiver in Detail
• Who Qualifies for West Virginia Medicaid HCBS Waivers?
• What the Aged and Disabled Waiver Covers
• How Enrollment Works and Why There Can Be a Wait
• How to Apply for the Aged and Disabled Waiver

What Are West Virginia Medicaid HCBS Waivers?

Home and community-based services, or HCBS, is the umbrella term for the long-term care Medicaid pays for outside of an institution, in your own home or your community, rather than in a nursing facility. States can deliver these services through a 1915(c) HCBS waiver, which serves people at home who would otherwise need the level of care of a hospital, a nursing facility, or an intermediate care facility for individuals with intellectual disabilities.2

For older adults and adults with physical disabilities in West Virginia, there is one main waiver to know: the Aged and Disabled Waiver. It is the state's main Medicaid HCBS program for older adults, and the rest of this guide focuses on how it actually works.1

The Aged and Disabled Waiver in Detail

The Aged and Disabled Waiver (ADW) is West Virginia's home-care alternative to the nursing home. The idea behind it is straightforward: rather than move into a facility, an eligible person receives Medicaid-funded care and support where they already live, so they can stay in the community.1

The waiver runs under the West Virginia Department of Human Services (DoHS), while application questions, enrollment, hearings, and self-direction are routed through West Virginia's Bureau of Senior Services, and Acentra Health is the ADW's utilization management contractor. That split matters when you apply: your financial eligibility is decided by the DoHS county office or the Social Security Administration, but the people you talk with about getting on the program sit on the senior-services side.1

Who Qualifies for West Virginia Medicaid HCBS Waivers?

Qualifying for the ADW comes down to two separate tests, and you have to clear both. Here is how each one works.1

One is the functional test, which asks whether your care needs are serious enough. To meet it, you must be age 18 or older, live in West Virginia, and be approved for a nursing-home (nursing-facility) level of care through a medical assessment that a nurse completes. The assessment also looks at daily activities, and you must have needs in at least five areas of daily living, such as eating, bathing, dressing, grooming, getting around your home and community, and using the restroom. You also have to choose the ADW instead of entering a nursing home, and have a home that is safe for the aides, nurses, and case managers who will work there.1

The other is the financial test, and West Virginia settles it first: you must apply and be found financially eligible before your medical eligibility is determined. You have to meet the West Virginia Medicaid waiver financial eligibility rules, as decided by the DoHS county office or the Social Security Administration. The state's ADW program page does not publish a dollar income limit for the waiver, so ask your DoHS county office which income standard applies to you.1 For West Virginia's asset limits and how income and assets are counted for long-term-care Medicaid, see our West Virginia Medicaid income and asset limits guide.

What the Aged and Disabled Waiver Covers

The point of the waiver is to pull together the mix of help that keeps someone safely at home. Under the ADW, that covered set includes:1

• Personal attendant services, the hands-on daily help with activities like bathing, dressing, and meals
• Case management to coordinate your care and services
• Medical adult day care
• Skilled nursing
• Environmental accessibility adaptations, meaning modifications to your home and vehicle
• Non-medical transportation
• A personal emergency response system, or PERS, the wearable device that calls for help
• Pest eradication
• Community transition services and pre-transition case management for people moving from a facility back into the community

One feature worth understanding is self-direction. Instead of receiving personal attendant services through a traditional agency, you can self-direct them under the ADW's self-direction option (Personal Options), hiring and supervising your own attendant.1 This gives families real control over who provides the care. There is one limit to keep in mind: under this self-direction option, the attendant you hire cannot be your spouse or your legal guardian.3

How Enrollment Works and Why There Can Be a Wait

Getting approved and starting services are two different milestones, and the gap between them is the part that surprises families most.1

The ADW is capacity-limited. That means once you have been approved as eligible, you can begin receiving waiver services only when an opening in the program is available. If every slot is currently filled, an approved applicant waits until one opens up. So it is worth starting the process early, even before care feels urgent, because your approval does not by itself guarantee an immediate start.

How to Apply for the Aged and Disabled Waiver

Applying for the ADW does not start with a stack of paperwork you fill out alone. It starts with a medical form that a health professional completes on your behalf. Here is the sequence.1

A doctor (MD or DO), physician's assistant, or nurse completes, signs, and submits a Medical Necessity Evaluation Request (MNER) form to Acentra Health-ADW in Charleston. That form starts the application. If you have questions about the process or want to get started, you can reach West Virginia's Bureau of Senior Services at 1-866-767-1575.1

You will also need West Virginia Medicaid financial eligibility established, and the state settles that before it determines medical eligibility.1 If you are not already enrolled, our guide to applying for West Virginia Medicaid walks through that step. Federal rules set an outside limit on how long the state can take to decide a Medicaid application: no more than 45 days for most applicants, and up to 90 days for applicants who apply for Medicaid on the basis of disability. Which limit applies turns on the basis you applied under, not on whether a disability determination happens to arise along the way, so an ADW applicant who applied on the basis of age is on the shorter 45-day standard. Those are the longest the agency may take, and every applicant is entitled to a decision within them, except in unusual circumstances, for example a delay caused by the applicant or by an examining physician, an emergency beyond the agency's control, or the 30-calendar-day period an applicant has to answer a community-engagement notice of noncompliance. If the agency does run late, it must document the reasons in your case record, and it may not use the time limit as a waiting period or as a reason to deny you.4

Learn More

Find personalized help understanding West Virginia Medicaid HCBS waivers at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.