West Virginia Personal Care Services, Adult Family Care, and Personal Care Home Supplements

Personal Care Outside the IDD Waiver

Families waiting years for an IDD Waiver slot often assume their only option is the Waitlist Support Grant. But West Virginia Medicaid covers personal care services under the State Plan — a separate benefit available to anyone with Medicaid who meets the functional criteria, regardless of waiver status.

This distinction matters because the IDD Waiver waitlist can stretch a decade, and personal care services through the State Plan don't require a waiver slot at all.

State Plan Personal Care Services

West Virginia's Medicaid State Plan personal care benefit provides hands-on assistance with activities of daily living: bathing, dressing, toileting, transferring, eating, and mobility. The services are delivered in the individual's home by a trained personal care worker.

To qualify, your child must:

• Be enrolled in West Virginia Medicaid (either through the automatic SSI/1634 pathway or through a standalone disability Medicaid application)
• Have documented needs in at least three areas of Activities of Daily Living
• Have a provider complete and sign the Personal Care-Medical Necessity Evaluation Request (PC-MNER) documenting medical necessity

The key advantage of State Plan personal care is that it uses a separate medical-necessity and authorization process from the IDD Waiver. Acentra Health reviews the personal-care request, but you don't need to meet the IDD Waiver's three-standard-deviation adaptive behavior threshold or be on the managed enrollment waitlist. If your child has Medicaid and passes the personal-care medical-necessity assessment, the service can be authorized without an IDD Waiver slot.

The limitation is scope: State Plan personal care covers hands-on ADL assistance but doesn't include the broader supports available through the IDD Waiver, such as supported employment, day habilitation, or behavioral support services.

Adult Family Care Supplements

West Virginia provides a state-funded monthly supplement of $879.90 for approved adult family care homes. These are private residences where a trained caregiver provides room, board, and personal care to one or two adults with disabilities in a home-like setting.

This supplement is paid to the adult family care provider — not to the individual. It supplements the individual's SSI payment to cover the cost of care. Here's how the math works:

• The individual's SSI check goes toward room and board (the SSA reduces the payment to a personal needs allowance)
• The state supplement of $879.90/month goes to the care provider to cover the cost of supervision, meals, and personal care
• Medicaid covers any additional medical or nursing services the individual needs

Adult family care is an alternative to group homes or institutional settings. It's particularly relevant for young adults who need daily supervision but function better in a small, family-style environment than in a congregate facility.

Personal Care Home SSI Supplements

Licensed personal care homes (sometimes called board-and-care facilities) in West Virginia receive a state supplement of $1,122.32 per month for each income-eligible SSI recipient. Like the adult family care supplement, this goes to the facility rather than the individual.

Personal care homes are larger than adult family care placements — they're licensed residential facilities that provide meals, laundry, personal care assistance, and supervised living for multiple residents. They're regulated by the West Virginia Office of Health Facility Licensure and Certification.

For families considering residential placement, the financial structure looks like this:

West Virginia provides no optional state supplement for individuals living independently in their own homes or in the family home. The $994 federal benefit rate is the full amount.

How These Options Fit Together

For a young adult transitioning out of the school system, the realistic service landscape while waiting for an IDD Waiver slot typically looks like:

1. SSI + automatic 1634 Medicaid as the financial and medical foundation
2. State Plan personal care services for daily living assistance at home
3. Waitlist Support Grant for respite care, day services, and behavioral support through the Bureau for Behavioral Health
4. Adult family care or personal care home placement if the family cannot provide full-time supervision

These aren't mutually exclusive — a young adult living at home can receive State Plan personal care services and Waitlist Support Grant services simultaneously while maintaining SSI eligibility, as long as countable resources stay below $2,000 (or $100,000 with a WVABLE account).

The West Virginia SSI at 18 & Adult Disability Benefits Guide maps out each of these service pathways with application steps, contact directories, and a tracking system for coordinating across the multiple agencies involved.

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