West Virginia's Medicaid program does pay for home and community-based services (HCBS), and it does so through one main 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.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV
To qualify for the ADW, a person has to be approved for a nursing-home level of care, which a nurse confirms through a medical assessment, and then meet West Virginia Medicaid's financial rules.
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 deliver these services under a federal authority called a 1915(c) HCBS waiver, which lets a state "waive" some ordinary Medicaid rules so it can serve people at home who would otherwise qualify for institutional care.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV
West Virginia keeps this simple compared with some states. For older adults and adults with physical disabilities, there is one main waiver to know: the Aged and Disabled Waiver. It is the state's primary 1915(c) HCBS program for this population, and the rest of this guide focuses on how it actually works.
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.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV
The waiver is administered by the West Virginia Bureau for Medical Services, the agency that runs Medicaid in the state, while the day-to-day work of enrolling people is handled through West Virginia's Bureau of Senior Services. That split matters when you apply: the medical and financial eligibility rules come from Medicaid, but the people you talk with about getting on the program sit on the senior-services side.
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.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV
The first 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 generally need help in at least five areas of daily living, such as eating, bathing, dressing, grooming, getting around your home and community, and using the restroom.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV
The second is the financial test. Because the ADW is long-term-care Medicaid, West Virginia uses its long-term-care income rules rather than the ones for ordinary Medicaid. The income standard is the 300%-of-SSI "special income level": your countable monthly income has to be at or below 300% of the maximum federal SSI benefit for one person, which is $994 in 2026, so the ceiling works out to roughly $2,982 a month.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV 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:Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV
- 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 and pre-transition services 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, training, and supervising your own attendant.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV 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.
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.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV
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.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV
A physician, physician's assistant, or nurse fills out a Medical Necessity Evaluation Request (MNER) form and submits it to the ADW enrollment contractor. That form is what triggers the nursing-home level-of-care review. 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.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV
Alongside the medical side, you will need to have West Virginia Medicaid financial eligibility established, since the waiver is a Medicaid program. 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 when eligibility is based on a disability.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf
Frequently Asked Questions
Do you have to be 65 or older to qualify for the ADW?
No. The Aged and Disabled Waiver (ADW) serves adults age 18 and older. People 65 and older qualify on age, while adults ages 18 to 64 qualify based on a physical disability. Either way, you still have to be approved for a nursing-home level of care through a nurse's medical assessment.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV
Can a family member be paid to provide the care?
Yes, within limits. The ADW offers a self-direction option (Personal Options), under which you hire and supervise your own personal attendant instead of using a traditional agency, and that attendant can be many family members. The exception is that your attendant cannot be your spouse or your legal guardian.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV
How is the waiver different from nursing-home Medicaid?
Both are long-term-care Medicaid, but the setting is the difference. Nursing-home Medicaid pays for care inside a facility, while the ADW pays for home and community-based services (HCBS) so you can receive comparable support in your own home. To use the waiver, you still have to be approved for a nursing-home level of care, the same clinical bar, delivered in a different place.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV
Can the ADW help someone move out of a nursing home?
Yes. Along with the services that keep a person safely at home, the ADW covers community-transition and pre-transition services, which are designed to help someone move from a nursing facility back into their own home and community.Centers for Medicare & Medicaid Services. (n.d.). West Virginia Waiver Factsheet - Medicaid.gov (WV Aged and Disabled Waiver, 0134.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/WV
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.