Conflict-Free Case Management in West Virginia: What IDD Waiver Families Need to Know
Why "Conflict-Free" Matters for Your Child's Waiver Services
Under the federal Home and Community-Based Services (HCBS) final rule, every state running a 1915(c) Medicaid waiver must address conflicts of interest between case management and direct service delivery. West Virginia's conflict-free framework is designed to keep the person managing your child's service plan independent from the entity delivering and billing for those services.
The logic is straightforward: if the agency writing your child's person-centered plan also provides and bills for the services on that plan, there's a financial incentive to recommend more of their own services rather than what your child actually needs. Separating the two functions removes that incentive.
How It Works in Practice
Before the conflict-free requirement, many West Virginia IDD Waiver participants had a single provider agency handling everything — writing the service plan, delivering day habilitation, providing respite care, and billing Medicaid for all of it. The case manager worked for the same organization that profited from the services they authorized.
Under the current structure:
- Case management (service coordination, person-centered planning, care monitoring) is intended to be performed independently from direct-service delivery for the same individual
- Service providers (day programs, supported employment agencies, respite care providers, residential support) deliver the services outlined in the plan but should not determine their own service needs or authorize their own services
- The case manager's job is to advocate for the individual's needs, coordinate across agencies, and ensure services match what was agreed upon in the person-centered plan
For families, this means your child's case manager should be asking "what does your child need?" without a financial stake in the answer.
What to Watch For
The structural separation doesn't eliminate every problem. Some things to monitor:
Provider networks are thin in rural counties. West Virginia's rural geography means some areas have very few qualified case management agencies. If your county has only one or two options, the "choice" component of conflict-free case management becomes nominal. Ask Acentra Health for the full list of case management agencies serving your county before accepting the first one assigned.
Case managers still vary in quality. A conflict-free case manager who doesn't know the IDD Waiver service menu, doesn't understand the three-standard-deviation eligibility threshold, or doesn't follow up on authorization delays is structurally independent but practically useless. You have the right to request a different case manager or case management agency.
The person-centered plan is only as good as the conversation. The case manager should be interviewing your child (not just you) about their preferences, goals, and daily routines. If the planning meeting feels like a paperwork exercise with checkboxes rather than a genuine conversation about your child's life, push back. The person-centered planning requirement under the HCBS final rule means your child's voice — however they communicate — is supposed to drive the plan.
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How This Connects to the Broader Waiver System
Case management is one of the services funded under the IDD Waiver. Once your child has an active waiver slot, their case manager coordinates:
- Annual person-centered plan reviews and updates
- Service authorization requests to Acentra Health (the state's utilization management contractor)
- Transitions between service levels (e.g., moving from day habilitation to supported employment)
- Coordination with outside agencies like the Division of Rehabilitation Services and Social Security
If your child is still on the managed enrollment waitlist, they won't have a waiver-funded case manager yet. During the wait, the Bureau for Behavioral Health's Developmental Disabilities Division (304-356-4811) coordinates interim supports, but that coordination is less structured than what comes with an active waiver slot.
Your Rights in the Case Management Relationship
You can:
- Request a list of all conflict-free case management agencies serving your county
- Switch case management agencies at any time (notify Acentra Health in writing)
- Attend and participate in every person-centered planning meeting
- Request a copy of the finalized person-centered plan after the meeting and keep the version you receive
- File a complaint with the Bureau for Medical Services if you believe the case manager is not adequately representing your child's needs
The West Virginia SSI at 18 & Adult Disability Benefits Guide includes an agency communication log and contact directory designed for tracking case management interactions, service authorizations, and plan review dates across all the agencies involved in your child's care.
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