West Virginia Medicaid
Eligibility Calculator

West Virginia expanded Medicaid under the Affordable Care Act, extending coverage to adults with income up to 138% of the Federal Poverty Level (roughly $20,783/year for a single person in 2024). Long-term care Medicaid — the program that pays for nursing homes and home-based care for elderly and disabled individuals — operates under separate, stricter rules regardless of expansion status.

There are two primary Medicaid programs in West Virginia that most families encounter: (1) standard Medicaid for low-income individuals and families, and (2) long-term care Medicaid (also called institutional Medicaid or nursing home Medicaid) for seniors needing sustained care. The eligibility rules, income limits, and asset tests differ dramatically between these two programs.

This page focuses on long-term care Medicaid, which is the more complex and higher-stakes determination for most families.

West Virginia Medicaid is administered by the West Virginia Department of Health and/or Human Services and is governed by federal Medicaid law as well as state-specific regulations. Key reference: W.

Va. Code § 9-5-1 et seq..

• West Virginia Medicaid is administered by the West Virginia Bureau for Medical Services (BMS). West Virginia uses managed care through Managed Medicaid MCOs (Aetna Better Health, The Health Plan, Unicare). Long-term care Medicaid uses FFS delivery for nursing facilities
• the AGED waiver provides limited HCBS. Functional eligibility is assessed using West Virginia's Medicaid Level of Care tool. West Virginia's personal needs allowance for nursing facility residents is $50/month. West Virginia uses an income cap (300% SSI)
• Miller Trust required above the limit. West Virginia's MERP has limited scope, recovering primarily from the probate estate. West Virginia's rural geography and limited HCBS provider network make nursing facility care the de facto choice for many qualifying West Virginians.

West Virginia is an "income cap" state, meaning nursing home Medicaid recipients must have monthly income at or below $2,901/month — 300% of the Supplemental Security Income (SSI) Federal Benefit Rate. In 2024, this cap is $2,829/month.

Individuals whose income exceeds this cap cannot qualify for long-term care Medicaid in West Virginia without using a Qualified Income Trust (QIT), also called a "Miller Trust." The Miller Trust funnels excess income into a trust account that is paid directly to the nursing home, effectively reducing countable income to below the cap.

All nursing home income in West Virginia — Social Security, pension payments, required minimum distributions, annuity income — counts toward the income calculation. Certain deductions may apply, including a personal needs allowance (typically $30–$60/month retained by the nursing home resident), health insurance premiums, and if a community spouse is present, a monthly maintenance needs allowance.

The community spouse's own income does not count toward the nursing home spouse's eligibility.

For married couples where one spouse needs nursing home care (the "institutionalized spouse") and the other remains at home (the "community spouse"), West Virginia applies spousal impoverishment protections. The community spouse is entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) — a monthly income floor set at $3,853.50 (2024 federal standard).

If the community spouse's own income falls below this threshold, the institutionalized spouse's income can be diverted to make up the difference, reducing what goes to the nursing home.

The individual countable asset limit for long-term care Medicaid in West Virginia is $2,000. This means a nursing home applicant must have $2,000 or less in countable assets to qualify.

Not all assets count — exemptions are critical to understanding the real planning picture.

Exempt (non-countable) assets in West Virginia include: the primary residence (subject to the home equity limit — see below), one automobile of any value, personal property and household furnishings, irrevocable prepaid burial plans and burial funds up to state limits, term life insurance (no cash value), and whole life insurance with face value under $1,500. Business property essential to self-support may also be exempt.

IRAs and retirement accounts in payout status may or may not be exempt depending on West Virginia rules.

For married couples, the Community Spouse Resource Allowance (CSRA) is the portion of the couple's combined assets the community spouse is allowed to keep. In West Virginia, the CSRA is between $29,724 and $148,620 — the federal floor and ceiling for 2024.

West Virginia uses the federal minimum as its CSRA, setting the community spouse's protection at $29,724. Combined countable assets above the CSRA plus the institutionalized spouse's $2,000 limit must be spent down before Medicaid eligibility is established.

The primary residence is exempt from Medicaid's asset test as long as the applicant or the applicant's spouse, minor child, or disabled child lives in the home, or the applicant intends to return home. However, West Virginia imposes a home equity limit of $713,000.

If the applicant's home equity — the home's fair market value minus any mortgage balance — exceeds this limit, the home loses its exempt status and must be counted as a resource.

West Virginia uses the federal standard home equity limit of $713,000. Many families in high-cost areas must be aware of this cap when planning.

Even when the home is exempt during the Medicaid recipient's lifetime, it may be subject to Medicaid Estate Recovery after death. In West Virginia, the estate recovery program has a relatively limited scope.

West Virginia limits estate recovery primarily to assets in the deceased recipient's probate estate, which means properly structured non-probate transfers — such as a life estate deed or an irrevocable trust — may avoid recovery in many cases.

Long-term care Medicaid in West Virginia covers two main settings: (1) nursing facility care (institutional Medicaid), which is an entitlement — meaning anyone who meets the financial and functional eligibility criteria must be enrolled — and (2) home and community-based services (HCBS) through waiver programs, which typically have waiting lists.

West Virginia's primary HCBS waiver for elderly individuals is the West Virginia AGED Waiver. Waiver programs allow Medicaid to pay for services that help people remain in their homes and communities rather than moving to nursing facilities.

Services may include personal care, adult day programs, home-delivered meals, transportation, and caregiver supports. Demand often far exceeds available waiver slots, resulting in wait times ranging from months to several years in West Virginia.

Functional eligibility for long-term care Medicaid requires a clinical determination that the individual needs a nursing-facility level of care — typically defined as needing substantial assistance with at least two or three Activities of Daily Living (ADLs) such as bathing, dressing, eating, toileting, and mobility. The West Virginia Medicaid agency conducts a Level of Care (LOC) evaluation, usually through a standardized assessment instrument, as part of the application process.

Medicaid planning — taking legal steps to restructure assets and income to qualify for Medicaid while preserving wealth for a spouse or heirs — is a specialized field of elder law. Common strategies used in West Virginia include Medicaid Asset Protection Trusts (MAPTs), which are irrevocable trusts that remove assets from countable resources after the 60-month look-back period; promissory notes; annuities; and the "spend-down" of excess assets on home improvements, debt payoff, or pre-paying funeral expenses.

Because West Virginia is an income cap state, a Qualified Income Trust (Miller Trust) is often required for applicants whose monthly income exceeds $2,901/month. The Miller Trust is drafted by an attorney, funded with the applicant's excess income each month, and helps ensure that income is properly directed to the nursing home while maintaining Medicaid eligibility.

Timing matters enormously in Medicaid planning. The 60-month (5-year) look-back period means that asset transfers made within 60 months of a Medicaid application are scrutinized and can result in penalty periods of Medicaid ineligibility.

Early planning — ideally 5+ years before care is needed — provides the most flexibility. An elder law attorney in West Virginia can help navigate the complex interplay between federal requirements and West Virginia-specific rules.

Medicaid eligibility is part of a broader long-term care planning picture. The West Virginia Medicaid Look-Back Period Calculator calculates potential penalty periods from prior asset transfers.

The West Virginia Long-Term Care Cost Calculator provides nursing home, assisted living, and home health cost benchmarks so you can understand the financial exposure before planning. Since many long-term care plans tie to estate strategy, the West Virginia Probate Cost Calculator helps estimate the cost of settling the estate afterward.

Connect with a West Virginia Medicaid planning attorney to review your specific situation.