West Virginia Medicaid Waivers & Home and Community Based Programs Overview
- Waiver Policy Analyst
- Dec 18, 2024
- 2 min read
Updated: Apr 2
West Virginia, known as The Mountain State, has a well-structured Medicaid Waiver and Home and Community-Based Services (HCBS) system designed to provide long-term care alternatives for seniors, individuals with disabilities, and those with chronic health conditions.
Administered by the West Virginia Department of Health and Human Resources (DHHR), Bureau for Medical Services (BMS), and the Bureau for Behavioral Health (BBH), the state’s Medicaid waiver programs allow eligible individuals to receive services in their homes or community settings rather than institutional care.
Key waiver programs include the Aged and Disabled (AD) Waiver, which provides personal care, respite, and home modifications for seniors and adults with physical disabilities, and the Intellectual/Developmental Disabilities (IDD) Waiver, which offers residential, employment, and habilitative support for individuals with intellectual and developmental disabilities (IDD).
Other significant programs include the Traumatic Brain Injury (TBI) Waiver, which supports individuals recovering from brain injuries, and the Children with Serious Emotional Disorders (CSED) Waiver, which provides intensive behavioral health services for children and adolescents with serious mental health conditions. West Virginia also offers Self-Directed Services, allowing waiver participants greater flexibility in choosing and managing their caregivers.
Regulatory oversight in West Virginia is managed through DHHR, BMS, and BBH, with additional provider licensing and compliance enforcement handled by the Office of Health Facility Licensure and Certification (OHFLAC). The state operates under both fee-for-service and managed care models, with HCBS services coordinated through West Virginia Medicaid Managed Care Organizations (MCOs) to enhance service delivery and cost-effectiveness.
West Virginia has also implemented Electronic Visit Verification (EVV) for personal care services, ensuring compliance and service integrity. Providers must navigate Medicaid enrollment, waiver-specific service authorizations, and stringent quality assurance measures to participate successfully in the state’s HCBS system.
With a strong emphasis on rural healthcare access, person-centered planning, and community integration, West Virginia’s Medicaid waiver programs ensure that individuals receive high-quality, sustainable long-term care while maintaining independence, dignity, and inclusion in their communities.
Explore Policy and Procedure manual for licensing and certification for your state Medicaid Waiver and HCBS programs here.
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