West Virginia Medicaid Guide 2026: WV PATH & LTC

West Virginia Medicaid covers long-term care with a $2,000 asset limit, a medically needy spend-down for applicants above the income standard, and no Miller Trust requirement.

West Virginia Medicaid is administered by the West Virginia Bureau for Medical Services (BMS), a division of the Department of Human Services (DoHS, formerly DHHR). For older adults, West Virginia runs both an income standard and a medically needy pathway: an applicant with income above $2,982 per month can still qualify by spending down excess income on medical and care costs rather than setting up a Miller Trust. Applications are filed through WV PATH. This guide covers the financial rules, coverage, estate recovery, and how to apply.1

What West Virginia Medicaid Covers

West Virginia Medicaid covers the mandatory federal benefit categories plus a set of state-elected optional services:

• Hospital care: Inpatient and outpatient
• Physician, clinic, and specialist visits
• Prescription drugs through the BMS pharmacy benefit
• Behavioral health: Mental health and substance use disorder services
• Home health: Skilled nursing and home health aide services
• Long-term care: Nursing facility care and HCBS waiver services for people who meet the clinical level-of-care standard
• Medicare Savings Programs (MSPs): Premium and cost-sharing assistance for dual-eligible beneficiaries
• Non-emergency medical transportation (NEMT)

For older adults, long-term care is the most financially significant benefit. West Virginia's nursing-home costs run well above the national median: a semi-private room ran about $154,030 per year and a private room about $159,140 per year in 2025, according to the CareScout 2025 Cost of Care Survey. Medicaid covers the full cost once a person is financially and clinically eligible.2

Who Qualifies for West Virginia Medicaid

West Virginia Medicaid Eligibility Overview

For seniors and people with disabilities seeking long-term care coverage, West Virginia uses a two-track approach. The key 2026 figures:1

• Asset limit: $2,000 for a single applicant; $3,000 for a married couple where both spouses are applying. Excluded assets include the primary home (subject to the equity cap), one vehicle, household goods, and prepaid burial.
• Income standard: $2,982/month (300% of the 2026 SSI Federal Benefit Rate of $994). An applicant at or below this level qualifies directly for nursing facility and HCBS waiver coverage.
• Medically needy spend-down: West Virginia also operates a medically needy program, with a Medically Needy Income Level of $200/month for one person and $275/month for a couple. An applicant with income above $2,982/month can qualify by incurring enough medical and care costs to bring net income down to the applicable medically needy standard.
• Home equity limit: $752,000, the 2026 federal minimum. The home is exempt while a spouse or dependent lives there.3
• No Miller Trust required: Because the medically needy pathway is available, an applicant with income above the standard does not need to establish a Qualified Income Trust.

For full income limits, asset rules, and the spend-down calculation, see West Virginia Medicaid Eligibility & Income Limits.

How the spend-down works: a worked example

Suppose a single applicant has $2,500/month in Social Security and a pension. That is below the $2,982 income standard, so no spend-down is needed. But a single applicant with $3,400/month in income is over the standard and must use the medically needy pathway. Because the Medically Needy Income Level for one person is $200/month, that applicant must incur about $3,200 in medical and care costs each month (roughly $3,400 minus $200) before Medicaid pays. In a nursing facility, the resident's own income covers most of the bill and Medicaid pays the remainder, so in practice this "patient liability" is the amount the resident contributes toward care.1

West Virginia Medicaid Long-Term Care

Nursing Facility Coverage

West Virginia Medicaid covers nursing facility care for eligible older adults who meet the clinical level-of-care standard. Once eligible, Medicaid pays the cost of care. A resident contributes most monthly income toward the facility's cost, keeping a Personal Needs Allowance of $50/month, plus deductions for a community spouse and certain health insurance premiums.1

HCBS Waivers

BMS administers home and community-based services waivers, including the Aged and Disabled Waiver, which funds personal care, homemaker services, and other supports for people who would otherwise require nursing facility care. Waiver eligibility uses the same income standard and asset limit as nursing facility Medicaid.1

The 5-Year Lookback

West Virginia applies a 60-month lookback to asset transfers made for less than fair market value before a long-term care application, following the federal rule under 42 U.S.C. § 1396p(c). Uncompensated transfers create a penalty period of Medicaid ineligibility for long-term care services. An undue-hardship waiver is available where the penalty would deprive the applicant of necessary care.3

Estate Recovery

After the death of a member who was 55 or older when they received long-term care services, BMS may file a claim or lien against the estate for the total Medicaid it paid, under OBRA '93 and W. Va. Code § 9-5-11c. West Virginia does not limit recovery to the probate estate by rule: the BMS Provider Manual defines the recoverable "estate" by cross-reference to the state estate-tax definition of property, which reaches beyond probate. The state imposes no recovery on an estate valued at $5,000 or less, and no lien may be placed while a surviving spouse, a child under 21, or a blind or disabled child lives in the home. An undue-hardship waiver is available.4

See West Virginia Medicaid Estate Recovery for the full rules, exemptions, and hardship process.

West Virginia Medicare Savings Programs

West Virginia Medicaid administers three Medicare Savings Programs (MSPs) for low-income Medicare beneficiaries:5

QMB enrollees are automatically deemed eligible for Part D Extra Help (the Low-Income Subsidy), and federal law bars providers from billing a QMB enrollee for any Medicare cost-sharing. QI also has to be reapplied for every year; qualifying once does not carry you into the next year. Apply through BMS or the Social Security Administration.5

See West Virginia Medicare Savings Programs for full details.

Spousal Impoverishment Protections

When one spouse enters a nursing facility and the other remains at home, West Virginia applies federal spousal impoverishment protections.6

Key 2026 figures:

• Community Spouse Resource Allowance (CSRA): The community spouse keeps at least $32,532 and up to $162,660 in countable assets, based on a snapshot of the couple's combined assets at the time of application.6
• Minimum Monthly Maintenance Needs Allowance (MMMNA): Up to $4,066.50/month in income (effective January 1, 2026), with a floor of $2,705.00 (effective July 1, 2026).6
• Home equity limit: $752,000, the federal minimum. The home is exempt while either spouse lives there.3

See West Virginia Spousal Impoverishment Protections for how the snapshot process and income allocation work.

How to Apply for West Virginia Medicaid

Applying for West Virginia long-term care Medicaid follows a defined sequence. Gather your paperwork first, then submit through WV PATH.

See How to Apply for West Virginia Medicaid for the full step-by-step process and required documents.

If West Virginia Medicaid Denies or Cuts Your Coverage

A denial is not the end of the road. Two clocks start when the notice arrives, and the one that keeps your coverage running is far shorter than the one to file.

West Virginia's deadline is 90 days, and it runs from the effective date of the action, not from the day the notice reached you. You may ask the West Virginia Board of Review for a fair hearing, or for the optional Pre-Hearing Conference that can come first, within 90 days of the effective date of the action on your notice.7

Federal law guarantees every Medicaid applicant and beneficiary the right to a fair hearing before the state agency, whether the dispute is about eligibility or about a specific service being reduced or ended.8 The 90 days is 42 CFR 431.221(d)'s ceiling on what a state may allow, not a guarantee you will get: a state may set a shorter window, and where it does, the shorter deadline is fully enforceable against you.7 West Virginia allows the full federal maximum, so here the ceiling and the deadline are the same number. Even so, read the date off your own notice of action.

There is a second, earlier deadline that matters more if you are already enrolled. Federally, requesting the hearing before the date the action takes effect is what keeps benefits running while the appeal is decided.9 West Virginia states it the same way: ask for a Pre-Hearing Conference or Fair Hearing before the date of the proposed reduction or closure, and your benefits are not reduced or stopped pending a final decision.7 Ask after that date and the change goes through; you may still appeal inside the 90 days, but coverage will already have changed.

When an adverse notice arrives, find that effective date and request the hearing in writing before it. One route is different: if a Mountain Health Trust managed care plan denied a service, you must exhaust that plan's internal appeal before the Board of Review will hold a state fair hearing, which is a separate track from the eligibility deadline above.7 See West Virginia Medicaid Appeals and Fair Hearings for how to file, what the hearing itself involves, and what happens after a decision.

Keeping West Virginia Medicaid Once You Have It

Eligibility is re-checked on a recurring cycle, and missing that step is one of the most common ways people lose coverage they still qualify for.

Before it can ask you for anything, West Virginia Medicaid must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot.10 If it does need paperwork, it must send a renewal form and give you at least 30 days from the date of the form to return it. That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, West Virginia may offer the same windows but is not required to, so ask BMS what applies to you.10

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise).10

Keep your address current, open anything from West Virginia Medicaid, and return a renewal form the week it arrives. See West Virginia Medicaid Recertification and Renewal for the full cycle and how to recover coverage that has already closed.

Where to Get Help

West Virginia Medicaid FAQ

Learn More

Find personalized help with West Virginia Medicaid and long-term care planning 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.