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West Virginia home care payment guide
Last updated: 13 September 2026
Paying for help at home in West Virginia often means combining programs. Medicaid may cover ongoing personal care for people who meet its rules. Medicare can cover qualifying skilled home health, but it usually does not pay for long-term personal care by itself. State aging programs and veterans benefits can fill some gaps.
Bottom Line
If you need regular help with daily activities, start with the Aging and Disability Network at 1-866-981-2372. Ask whether the Aged and Disabled Waiver (ADW), Medicaid Personal Care, Lighthouse, FAIR respite, or another local service best fits your situation. If you need nursing or therapy after an illness or injury, ask your doctor about Medicare-covered home health instead.
If Home Is Not Safe Today
Call 911 for an immediate medical or safety emergency. For suspected abuse, neglect, or financial exploitation, West Virginia’s centralized intake line is 1-800-352-6513 on the state’s official hotline list. If the person is still in a facility, tell the discharge planner if a safe plan is not ready.
Start Here
- Name the care need. List tasks the person cannot safely do alone, including bathing, dressing, toileting, walking, transfers, nursing, therapy, or supervision.
- Call for a screening. Call 1-866-981-2372 to compare Medicaid and state-funded routes. Our West Virginia aging agencies guide can also help.
- Use backup routes. Ask about Personal Care, Lighthouse, FAIR, Medicare home health, VA services, or private coverage while a waiver application is moving.
| Situation | First route | Main limit |
|---|---|---|
| Needs nursing-home-level help but wants to remain at home | West Virginia Aged and Disabled Waiver | Medical and financial eligibility plus an available program slot |
| Has West Virginia Medicaid and needs hands-on help with daily activities | Medicaid Personal Care | Needs in at least three daily-living areas; not skilled nursing |
| Needs skilled nursing or therapy and is homebound | Medicare home health | Must meet Medicare home-health rules; not long-term custodial care |
| Age 60+ and does not qualify financially for Medicaid home-care services | Lighthouse | County openings can change; cost is based on income |
| Family caregiver needs respite for a person with Alzheimer’s disease or related dementia | FAIR | Written diagnosis required; hours depend on need and staff availability |
| Veteran needs personal care or home-based services | VA home and community services | Clinical need, enrollment, community-care rules, and local availability apply |
Know What Kind of Care You Need
The phrase home care can mean two very different things. Skilled home health is medical care such as nursing, wound care, physical therapy, or occupational therapy. Personal or custodial care is help with daily life, such as bathing, dressing, toileting, eating, walking, meal preparation, and supervision.
This difference affects who may pay. Medicare is mainly a skilled-care route. Medicaid and state aging programs matter more for ongoing personal care. Our home care guide explains common service types.
West Virginia Aged and Disabled Waiver
The Aged and Disabled Waiver is West Virginia’s main Medicaid home-and-community program for adults who need a nursing-home level of care but choose to receive services at home. The current Medicaid manual is effective June 1, 2026.
Who may qualify
An applicant must be at least 18, be a permanent West Virginia resident, meet Medicaid waiver financial rules, meet the program’s nursing-home-level medical standard, choose the waiver instead of nursing-home care, and have a safe setting for workers. The state’s current ADW policy says the medical assessment requires five qualifying deficits drawn from functional and other assessed needs.
2026 income rule: The ADW manual limits gross monthly income to 300% of the current maximum Supplemental Security Income (SSI) payment. The federal 2026 SSI maximum is $994 for an individual, so 300% is $2,982 per month. The Department of Human Services (DoHS) decides actual financial eligibility. Asset and spouse-protection rules are more complex, so do not give away property to try to qualify.
What ADW can pay for
Depending on the approved service plan, ADW can include personal attendants, case management, skilled nursing, non-medical transportation, emergency response service, medical adult day care, pest eradication, and certain home or vehicle accessibility changes. An assessment decides which services are authorized.
How to apply
Start with the Medical Necessity Evaluation Request (MNER) on the ADW forms page. A doctor, physician assistant, or nurse must complete and sign the initial request and submit it to:
- Acentra Health-ADW, 1007 Bullitt Street, Suite 200, Charleston, WV 25301
- Fax: 1-866-212-5053
- Application questions: West Virginia Bureau of Senior Services, 1-866-767-1575
After the MNER is received, a long-term-care Medicaid application is sent to the applicant. Current ADW policy gives the applicant 60 calendar days from receipt of that letter to return it. DoHS then has 30 calendar days after receiving the application to decide financial eligibility. Medical assessment follows financial approval.
Reality Check: A Slot Must Be Available
Meeting the financial and medical rules does not guarantee immediate enrollment. If no funded slot is available, eligible applicants go on the Managed Enrollment List. Current policy says placement is based on the date of the completed MNER; the program does not create emergency priority rankings. Ask what services can be used while you wait.
Can a family member be paid?
ADW offers a participant-directed option called Personal Options. The member can hire personal attendants and receives payroll support. Current policy bars a spouse and a court-appointed legal guardian from being paid as that member’s ADW attendant. Other relatives still must meet worker and representative-role rules. See our paid caregiver guide.
| Question | Aged and Disabled Waiver | Personal Care |
|---|---|---|
| Care threshold | Nursing-home level of care; five qualifying deficits in the assessment | Needs in at least three activities of daily living |
| Financial route | Medicaid waiver financial eligibility | Must have active Medicaid coverage for Personal Care |
| Main help | Broader long-term services, including personal attendants and case management | Hands-on personal care and daily-living assistance |
| Enrollment issue | Funded slot must be available; Managed Enrollment List may apply | Assessment and provider availability still matter |
West Virginia Medicaid Personal Care
The Personal Care Services Program can be a better fit for a Medicaid member who needs hands-on help but does not meet the ADW nursing-home-level standard. A registered nurse evaluates the person at home. The program says an applicant needs help in at least three areas of activities of daily living, such as eating, bathing, transferring, walking, or dressing.
Covered tasks can include bathing, grooming, mobility, toileting, and eating. Personal Care does not cover skilled nursing, medication administration, wound care, injections, or housecleaning as the only service.
To apply, complete the PC-Medical Necessity Evaluation Request and have a doctor, physician assistant, or registered nurse complete and submit it. The current Personal Care forms are on the state program site. For initial applications, the program lists Acentra Health-PC, 1007 Bullitt Street, 2nd Floor, Charleston, WV 25301; toll-free 1-866-385-8920; fax 1-844-794-6729.
If you are not sure which Medicaid category you have, use the Medicaid long-term care page or contact your county DoHS office. Our WV benefits portal guide can also help you understand WV PATH and other state benefit routes.
Lighthouse and FAIR Can Fill Gaps
West Virginia also has state-supported programs that can help when Medicaid does not fit or while a waiver application is waiting.
Lighthouse
Lighthouse is for people age 60 or older who need basic help at home but whose income or assets disqualify them from Medicaid services. The state-funded program is available through all counties for personal care, mobility, nutrition, and environmental help. Openings vary by county, and cost is based on income.
FAIR respite
Family Alzheimer’s In-Home Respite (FAIR) is available across West Virginia for people with a written diagnosis of Alzheimer’s disease or a related dementia. The state’s ADW program FAQ says family caregivers may receive up to 16 hours of respite per week based on need and on the availability of hours and trained staff. The fee depends on the income of the person with dementia.
Call the Aging and Disability Network at 1-866-981-2372 to ask what is available in your county. County staffing matters, so a program can exist statewide without an immediate worker opening in every community.
When Medicare Can Pay for Home Health
Medicare can help after an illness, injury, or health decline when home-health rules are met. Medicare’s home health coverage includes part-time or intermittent skilled nursing, therapy, medical social services, and some aide care when skilled care is also being received.
A clinician must certify the qualifying skilled need and homebound status, and a Medicare-certified agency must provide the care. Medicare lists a $0 patient cost for covered home health services; covered durable medical equipment generally has 20% coinsurance after the Part B deductible.
What Medicare usually will not do: It does not become a long-term personal-care benefit just because someone needs help every day. If bathing, dressing, meal help, supervision, or homemaker help is the only need, look first at Medicaid, state aging services, VA benefits, long-term care insurance, or private pay. If Medicare premiums are straining the household budget, our West Virginia Medicare savings guide may help free money for other care costs.
Home-Care Help for Veterans
Veterans enrolled in VA health care should ask a VA social worker about home and community-based services. VA Homemaker and Home Health Aide services can help with daily activities for eligible veterans when the service is clinically needed and available locally. VA also offers Veteran-Directed Care in locations where it is available; this can give an eligible veteran a service budget and more control over hiring workers, which may include a family member or neighbor.
Veterans or surviving spouses who qualify for VA pension and need daily help should also check Aid and Attendance. It can increase a qualifying pension; it is not direct payment to a home-care agency.
Availability varies by VA location and clinical need. Our West Virginia veterans guide can help with state and local veteran contacts.
If You Want to Return Home From a Facility
Do not wait until the last day of a nursing-facility stay to ask how home care will be arranged. West Virginia’s Take Me Home program helps certain Medicaid members in qualifying long-term-care facilities plan a move back to a home or apartment in the community. It is tied to home-and-community Medicaid eligibility, including ADW or the Traumatic Brain Injury Waiver.
Referrals can be made through the Aging and Disability Resource Center at 1-866-981-2372 or Take Me Home at 1-855-519-7557. Ask the discharge planner to coordinate equipment, medicines, transportation, and staffing.
Private Pay, Insurance, and Family Help
Private insurance may cover some gaps. If you have long-term care insurance, ask what triggers benefits, whether there is an elimination period, whether a licensed agency is required, and what daily or monthly cap applies.
If paying privately, compare an agency with hiring a worker directly. Agencies may handle screening, backup staffing, taxes, supervision, and workers’ compensation, while an independent worker may offer more scheduling control. Our agency versus caregiver guide explains the tradeoffs.
If the person needs near-constant supervision or two-person transfers, compare the full cost and safety of home care with other settings. Our home care comparison can help frame that decision. A move is not automatically cheaper, but round-the-clock paid care at home can become expensive quickly.
How to Start Without Wasting Time
- Make a care log. Record needed help, including night needs and safety supervision.
- Gather medical information. List diagnoses, falls, mobility or memory limits, medicines, devices, and the clinician’s contact information.
- Call the aging network. Ask 1-866-981-2372 which state, Medicaid, respite, transportation, nutrition, and caregiver programs fit the person’s county and age.
- Start the right Medicaid form. ADW uses the MNER; Personal Care uses the PC-MNER. Do not assume a general Medicaid application alone starts the medical assessment.
- Track every deadline. Keep submission dates, confirmations, notices, and fax reports.
- Ask for a backup. If a slot or worker is unavailable, ask about Personal Care, Lighthouse, FAIR, another provider, or temporary family support.
Documents and information to gather
- Medicaid, Medicare, and insurance cards
- Photo identification and proof of West Virginia residence
- Social Security, pension, and other income records
- Bank and asset information requested by DoHS
- Medical diagnoses, clinician contacts, and discharge papers
- A list of daily tasks the person cannot do safely alone
- Names and schedules of unpaid helpers
- Copies of applications, notices, fax confirmations, and appeal letters
| Need | Contact | Ask |
|---|---|---|
| Compare aging and home-care programs | Aging and Disability Network: 1-866-981-2372 | “Which programs serve my county and care needs?” |
| ADW application | Bureau of Senior Services: 1-866-767-1575 | “Has my MNER been received, and what happens next?” |
| Personal Care application | Acentra Health-PC: 1-866-385-8920 | “Is my PC-MNER complete, and when will the assessment be scheduled?” |
| Medicaid financial eligibility | Your county DoHS office | “Which income and asset records do you need for long-term-care Medicaid?” |
Reality Checks Before You Plan a Budget
A program approval is not a promise of 24-hour care. Authorized hours are based on the program, assessment, service plan, and available workers.
Staffing can change. Approval does not mean an agency has workers for every authorized hour.
Do not rely on an old income figure. ADW uses 300% of the current maximum SSI payment. The 2026 calculation is $2,982 per month, not the 2025 figure still shown on some older state materials.
Do not give away assets to qualify. Medicaid transfer and spouse-protection rules can have serious effects. Get qualified advice before moving major assets.
ADW can involve estate recovery. West Virginia’s estate recovery policy covers certain Medicaid home-and-community waiver services received at age 55 or older. Spouse, child, and other protections can affect recovery, so ask how the rule applies before making estate or property decisions.
Common Mistakes to Avoid
- Assuming Medicare pays long-term aides: Medicare home health is built around qualifying skilled care, not unlimited custodial help.
- Waiting on ADW alone: Ask about Personal Care, Lighthouse, FAIR, VA help, and local aging services while a waiver application or enrollment list is pending.
- Submitting the wrong form: ADW and Personal Care use different medical-necessity request forms.
- Missing the ADW financial deadline: Once the long-term-care Medicaid application is sent, current policy gives the applicant 60 calendar days from receipt to return it.
- Hiding family help: Tell the assessor what unpaid caregivers do and what happens if they are unavailable.
- Planning around maximum hours: Build your budget from the actual written service plan, not a program’s theoretical ceiling.
If You Are Denied, Delayed, or Overwhelmed
Read the notice before making another application. The reason for denial tells you whether the problem is financial eligibility, medical eligibility, missing paperwork, or another rule.
For ADW medical eligibility, the June 2026 ADW policy says a Medicaid Fair Hearing request must reach the Board of Review within 90 calendar days of receiving the Notice of Decision. To continue existing services during an appeal, a member generally must file within 13 calendar days of the date on the notice. Follow your own notice.
If a worker shortage or waitlist is the problem rather than eligibility, call the Aging and Disability Network and ask for a temporary or alternate route. For a broader view of public assistance in the state, our West Virginia senior benefits guide can help you check food, medical, housing, utility, and other supports that may reduce the household’s costs while care is being arranged.
Phone Scripts You Can Use
Aging and Disability Network
“I am helping a West Virginia resident who needs regular help with bathing, dressing, walking, or meals. Can you screen us for ADW, Personal Care, Lighthouse, FAIR, and other services available in our county? What should we apply for first?”
ADW application
“I am applying for the Aged and Disabled Waiver. Has the MNER been received? Has the long-term-care Medicaid application been sent? What deadline applies to my next step, and is there anything missing?”
Personal Care
“I have West Virginia Medicaid and need hands-on help with several daily activities. I want to apply for Personal Care. Where should my clinician send the PC-MNER, and when should I expect the home assessment?”
VA social worker
“I am an enrolled veteran and need help with daily activities at home. Please check Homemaker and Home Health Aide, respite, skilled home health, and Veteran-Directed Care in my service area. Which options am I clinically eligible to be assessed for?”
Resumen en Español
En West Virginia, una buena primera llamada para ayuda en el hogar es la Red de Envejecimiento y Discapacidad al 1-866-981-2372. Pregunte por el programa Medicaid Aged and Disabled Waiver (ADW), Personal Care, Lighthouse y FAIR.
Para ADW, la persona debe cumplir reglas médicas y financieras y puede tener que esperar un cupo del programa. En 2026, el manual de ADW usa un límite de ingreso bruto mensual de 300% del pago máximo de SSI, que equivale a $2,982 al mes. DoHS toma la decisión financiera final y las reglas de bienes pueden ser más complicadas para personas casadas.
Medicare puede pagar servicios de salud en el hogar cuando se necesita atención especializada y se cumplen las reglas de Medicare, pero normalmente no paga cuidado personal de largo plazo cuando esa es la única necesidad. Si hay una denegación, lea la carta de decisión de inmediato y siga la fecha límite de apelación indicada.
Frequently Asked Questions
Does Medicare pay for long-term home care in West Virginia?
Usually not. Medicare can cover qualifying skilled home health for a homebound person who needs part-time or intermittent skilled services. It generally does not pay for ongoing personal care when that is the only need.
What is the 2026 income limit for West Virginia ADW?
The June 2026 ADW policy uses 300% of the current maximum SSI payment. For 2026, that is $2,982 in gross monthly income. DoHS makes the final financial decision, including how income and spouse protections apply.
Can I get Personal Care while waiting for ADW?
Possibly. Medicaid Personal Care may help while a person waits for an ADW slot if the person has the right Medicaid coverage and meets Personal Care’s medical rules. Ask the state network to screen your situation.
Can a family member be paid to provide care?
Sometimes. ADW’s Personal Options model lets an eligible member hire personal attendants, but the current policy does not allow a spouse or court-appointed legal guardian to be paid as the member’s ADW attendant. Other family members may be possible if they meet program and worker requirements.
What if ADW has no open slot?
An applicant who meets the financial and medical rules can be placed on the Managed Enrollment List when a funded slot is not available. Ask about Medicaid Personal Care, Lighthouse, FAIR respite, VA services, and other local aging supports while waiting.
Who should I call first for West Virginia home-care help?
Call the West Virginia Aging and Disability Network at 1-866-981-2372. Describe the person’s care needs, Medicaid status, age, county, veteran status, and any dementia diagnosis.
About This Guide
Sources: This guide uses official federal, state, local, and other high-trust nonprofit and community sources linked in the article.
Editorial note
This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections
Despite careful verification, errors may occur. Readers may email info@grantsforseniors.org with corrections.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, funding, and availability can change. Readers should confirm current details directly with the responsible official program before acting.
Last updated: 13 September 2026 · Next review: 13 December 2026
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