West Virginia Medicaid pays for in-home personal care and related services through 3 programs, including the Aged and Disabled Waiver (ADW) and the Intellectual/Developmental Disabilities Waiver (IDDW). The Bureau for Medical Services runs the waivers and Personal Care; the Bureau of Senior Services administers ADW and is the Personal Care contracted operations agency, and Acentra Health is the utilization management contractor. PCS in ADW, TBIW, IDDW and State Plan Personal Care require EVV under an open/hybrid model. Confirm the current EVV system and any managed care involvement with the Bureau for Medical Services.
Yes. The Medicaid Personal Care Services Program serves members with active WV Medicaid who have needs in at least three ADLs (assessed in-home by an Acentra Health nurse); housecleaning alone and skilled nursing are not covered.
Which West Virginia waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Aged and Disabled Waiver (ADW)
Population
West Virginia adults 18 and older who are financially eligible, meet nursing home level of care with needs in at least five daily living areas, and have an open program slot.
Services covered
personal attendant services
case management
medical adult day care
non-medical transportation
personal emergency response system
skilled nursing
environmental accessibility adaptations
pest eradication
Billing format
Traditional (agency) model or Personal Options self-direction; claims questions go to Gainwell Technologies, and personal care services are subject to EVV integrated with the state aggregator (open/hybrid model).
Residents age 3 or older with an intellectual disability or related condition that was severe before age 22, with deficits in at least three of six life areas, who choose community services over an ICF/IID.
Services covered
person-centered support
respite
behavior support
case management
skilled nursing
transportation
electronic monitoring
Billing format
Agency-provided staff or self-directed services; personal care-type services are subject to EVV.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
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