Nursing Homes in West Virginia
When faced with a chronic condition that makes it challenging to continue living at home, exploring the possibility of transitioning to nursing home care may be beneficial. In West Virginia, nursing homes play an important role in senior care. Approximately 20.7% of West Virginia's population is aged 65 and older, and of these seniors, 8,714 reside in nursing homes throughout the state.
Currently, there are 123 licensed nursing homes in West Virginia, with over 8,000 beds available for seniors in need of care. Skilled nursing facilities provide essential services that allow seniors to live comfortably, including necessary medical services, stimulating recreational activities, nutritious meals and much more.
This guide provides an overview of nursing homes in West Virginia, including their services, costs and regulations. We will explain how Medicaid can help pay for care and provide resources for families looking for the best nursing home options for their loved ones.
Cost of West Virginia Nursing Homes
The average cost of nursing homes in West Virginia is $282 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in West Virginia?
Medicaid is a joint federal and state program that provides health insurance coverage to low-income individuals, including seniors who require long-term care. In West Virginia, the Department of Health and Human Resources oversees Medicaid, providing nursing home benefits to eligible individuals with certain income and asset requirements. As of 2022, there are over 645,172 West Virginians enrolled in Medicaid.
Medicaid can cover the cost of nursing home care, including room and board, medical services and personal care services. In addition, Medicaid provides long-term care benefits, such as in-home care and adult day care, for individuals who wish to remain in their homes and communities.
To qualify for Medicaid coverage for nursing home care in West Virginia, individuals must meet certain income and asset requirements. The state uses a "spend-down" process to determine eligibility, which involves subtracting medical expenses from an individual's income to determine their "countable income." If their countable income is below a certain threshold, they may be eligible for Medicaid coverage.
Eligibility for Medicaid in West Virginia
Medicaid coverage in West Virginia is determined based on financial need. Households must have an income within 133% of the federal poverty level to qualify for coverage. As of 2022, a single person's income limit is $17,774 and the asset limit is $2,000, whereas a two-person household's income limit is $24,040 and the asset limit is $3,000.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $17,774 | $2,000 |
| Two-Person Household | $24,040 | $3,000 |
*per year
To be eligible for Medicaid in West Virginia, seniors must also meet other requirements including:
- Citizenship or residency status: Seniors must be either U.S. citizens or legal permanent residents who have lived in the U.S. for at least five years.
- Medical necessity: Seniors must require medical care and services that are covered by Medicaid.
Applying for Medicaid in West Virginia
Applying for Medicaid in West Virginia is a relatively simple process. Several options are available for those who wish to apply, including online, in-person or by mail. To apply online, seniors can visit the state's online portal, WV PATH. Seniors can also apply in person at their local Department of Health and Human Resources (DHHR) office or by mail by sending their application to their local DHHR office.
What Information You Will Need:
- Social Security Number
- Proof of income
- Proof of assets (property tax statements, bank statements)
- Copy of birth certificate or passport
- Proof of citizenship or legal residency (if not born in the United States)
- Medical information (current medications, medical records)
- Any other supporting documents
Additional Medicaid Support & Resources in West Virginia
In addition to Medicaid benefits, there are several resources available in West Virginia to help seniors and their families navigate the Medicaid program. The following resources can assist with Medicaid enrollment and coverage.
| Contact | Service | |
|---|---|---|
| West Virginia Health Right | (304) 414-5930 | West Virginia Health Right is a nonprofit organization that provides free health care services to uninsured and underinsured individuals, including assistance with Medicaid enrollment. |
| West Virginia Aging and Disability Resource Centers | (304) 558-3317 or (877) 987-3646 | The Aging and Disability Resource Centers provide information and assistance to seniors and individuals with disabilities, including help with Medicaid enrollment, long-term care planning and other related services. |
| West Virginia Bureau for Medical Services | (304) 558-1700 | The West Virginia Bureau for Medical Services is responsible for administering the state's Medicaid program. The agency provides information on Medicaid eligibility, benefits and enrollment and can answer questions about the program. |
Can You Use Medicare to Pay for Nursing Home Care in West Virginia?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in West Virginia
Families and seniors who are looking at Medicare may wonder if it may be able to assist in covering some of the costs associated with nursing home care. Trained advisors associated with the organizations listed below may be able to provide interested parties with information that is helpful in their particular situations.
| Contact | Service | |
|---|---|---|
| West Virginia State Health Insurance Assistance Program (SHIP) | (877) 987-4463 | Provides free, unbiased and confidential counseling and education to assist beneficiaries with their Medicare-related questions and concerns. |
| West Virginia Bureau of Senior Services | (877) 987-3646 | Offers various programs and services to help seniors in West Virginia, including counseling and assistance with Medicare-related issues. |
| Medicare Savings Programs | (800) 642-8589 | Can help pay Medicare premiums, deductibles, coinsurance and copayments for eligible individuals with limited income and resources. |
| Medicare Prescription Drug Plans (Part D) | (800) 633-4227 | Those who are eligible for Medicare can receive financial assistance from this program to help cover the cost of prescription drugs. |
| West Virginia Aging & Disability Resource Centers (ADRCs) | (866) 987-2372 | Provide information, referral and assistance to seniors and individuals with disabilities, including Medicare counseling and enrollment assistance. |
Other Financial Assistance Options for Nursing Home Care in West Virginia
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in West Virginia
| Licensing Requirements | Nursing homes must be licensed by the West Virginia Department of Health and Human Resources (WVDHHR) to operate. The licensing process ensures that nursing homes meet the state's minimum standards for quality of care. The license is renewed every two years, and nursing homes must maintain compliance with state regulations to keep their license. |
| Staffing Requirements | Nursing homes are required to have enough staff to meet the needs of their residents. The number of staff and their qualifications depend on the size of the nursing home and the residents' needs. Adequate staffing is essential to ensure that residents receive quality care and attention. |
| Staff Training Requirements | All staff members who provide direct care to residents in West Virginia nursing homes must complete a minimum of 12 hours of continuing education annually. The training is intended to ensure that staff members are knowledgeable and competent in providing care to residents. |
| Admission Restrictions | Nursing homes are not allowed to admit individuals who require a level of care that the nursing home cannot provide. This is to ensure that residents receive necessary care and that nursing homes are not overwhelmed with residents. |
| Care Planning Requirements | Nursing homes are required to develop individualized care plans for each resident within 14 days of admission. The care plan is based on the resident's needs and must be reviewed and updated periodically to ensure that it remains appropriate. |
| Dietary and Nutritional Services Requirements | Nursing homes must provide residents with three meals daily and snacks consistent with their individual dietary needs. Proper nutrition is essential to maintaining residents' health and well-being. |
| Specialized Rehabilitative Services | Nursing homes must provide specialized rehabilitative services to residents who require them. These services are designed to help residents recover from illness, injury or surgery and may include physical therapy, occupational therapy or speech therapy. |
| Medication and Pharmaceutical Services | Nursing homes must have policies and procedures for managing and administering medications. This includes ensuring that medications are properly stored, labeled and administered to residents according to their individual needs. |
| Activities Requirements | Nursing homes must provide activities that promote physical, mental and social well-being. These activities may include games, exercise programs, social events and other activities that fit residents' needs and interests. |
| Infection Control Requirements | Nursing homes must have infection control programs in place to prevent the spread of infectious diseases. This includes ensuring that staff members follow appropriate hygiene protocols, that residents receive appropriate vaccinations and that measures are taken to control outbreaks of infectious diseases. |
| Medicaid Coverage | Medicaid covers nursing home care for eligible residents who meet the program's financial and medical requirements. This coverage helps to ensure that residents have access to necessary medical care and services. |
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