Memory Care in West Virginia

Table of Contents

Memory Care in West Virginia

Table of Contents

• The Cost of Memory Care in West Virginia
• West Virginia Medicaid Programs for Memory Care
• Can You Use Medicare to Pay for Memory Care in West Virginia?
• More Ways to Pay for Memory Care in West Virginia
• Memory Care Laws and Regulations in West Virginia
• Free and Low-Cost Resources for Seniors in West Virginia
• West Virginia COVID-19 Rules for Memory Care Facilities

Because of the specialized staff training and resources required to provide high-quality memory care, memory care typically costs more than other types of residential care. On average, memory care will cost 20-30% more than assisted living.

Using the average cost of living that's listed in the 2021 Genworth Cost of Care Survey, we calculated an average cost of $5,200 per month for memory care in West Virginia. This is a relatively affordable rate for care compared to the national average of $5,625. Prices in the region can get as high as $6,563 in Virginia and as low as $4,310 in Kentucky. The average rate for care in Maryland is nearly identical to Virginia, and costs in Ohio are about $169 more than the national average. Pennsylvania's memory care costs are around $75 less than West Virginia.

Within the Mountain State, average prices for memory care range from $4,594 to $7,125 per month, with Wheeling at the bottom end and Morgantown at the top end. Charleston, the state capital, has an average rate of $5,938 per month. Huntington and Parkersburg also have prices well above the state average. Weirton is about $150 more expensive than the most affordable city in the state.  

The Medicaid system in the Mountain State is operated by the West Virginia Department of Health and Human Resources, Bureau for Medical Services (BMS). The primary managed care program for Medicaid, called Mountain Health Trust, does not provide coverage for memory care. However, some services provided by Alzheimer's/Dementia Special Care Units within assisted living facilities may be covered by a waiver program.

Aged and Disabled Waiver (ADW) Program

The ADW program is designed to give older adults at risk of nursing home placement the services they need to stay in the community, including special care units in assisted living facilities. The ADW program covers:

• Case Management: Licensed professionals can help seniors who have cognitive impairments find special care units that match their needs and lifestyles.
• Personal Attendant: ADW pays for the caregivers who provide assistance with daily activities in memory care, including grooming, eating, bathing, dressing and other personal care services.
• Skilled Nursing: Skilled nurses trained in dementia care can ensure residents in memory care get the support and attention they need to thrive.
• Non-Medical Transportation: Trips outside a care setting can improve the mental health of seniors with dementia, so Medicaid covers non-medical transportation to local destinations in the community. 

To qualify for coverage within the ADW program, a registered nurse must evaluate the applicant and determine that they require at least five personal attendant services.

• Who Is Eligible: West Virginia residents and U.S. citizens who require a nursing home level of care may be eligible.
• How to Apply: Applications begin with a Medical Necessity Evaluation Request (MNER), which can be found at the Bureau of Senior Services website or requested by calling (866) 767-1575.

Medicaid Eligibility for Seniors in West Virginia 

Medicaid recipients in West Virginia are required to meet income and asset limits. A single applicant can earn up to $30,276 and own $2,000 in assets whether they are single or married. The non-applicant spouse can have up to $137,400 in assets. When two people apply for benefits in a two-person household, the income limit is $60,552 per year and the asset limit is $3,000.

2022 Medicaid Income Limits for Seniors in West Virginia

Recipients of Supplemental Security Income (SSI) are automatically eligible for West Virginia Medicaid. Adults aged 65 and older who meet the financial requirements for coverage must also:

• Be residents of West Virginia
• Be U.S. citizens, or documented immigrants
• Have a Social Security Number
• Provide information about existing health coverage

How to Get Help Applying for Medicaid in West Virginia

The following resources can help West Virginians apply for Medicaid benefits and learn more about their coverage options. 

Unfortunately, Medicare does not generally cover the cost of Memory Care. Most Memory Care Facilities are considered to be "social settings," so Medicare does not cover the cost incurred in these facilities. The only exception to that is if you are receiving memory care services in a Nursing Home. While this situation is much less common, Medicare would sometimes cover the cost, depending on a number of circumstances.

That being said, Medicare does still cover qualified doctor visits, medications, etc., as it would if you were still at home, but it will not cover the cost of care received at the Memory Care Facility.

In addition to the state programs mentioned above, those looking for resources to finance memory care may consider:

• Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. It's best to sign up for a policy early, as coverage will likely be denied if one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at longtermcare.acl.gov.
• Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loans will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
• Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs such as memory care. More information about these programs can be found on the VA website.

Memory Care Regulation

The West Virginia Department of Health and Human Resources (DHHR), Bureau for Public Health, Office of Health Facilities Licensure and Certification regulates memory care facilities as Alzheimer’s/dementia special care units, which must obtain a special license. These facilities provide services 24 hours a day that include specialized memory care programs for a state-specified number of hours a day. The department splits facilities into three categories: residential care homes can house up to three seniors with dementia, small facilities house between 4 and 16 residents, and large facilities house 17 or more residents. Seniors admitted to a residential care home must have a placement recommendation from the department. Facilities of all sizes are subject to inspection and regulation.

Facility Scope of Care

Memory care facilities in West Virginia may provide board and care, as well as routine caregiver services for their residents. In addition to basic services, facilities may also provide limited nursing care from a staff or visiting nurse. Residents who need more intensive nursing care may remain in the residential care facility for up to 90 days, provided their condition is temporary and expected to improve.

Other types of non-medical care may be provided for residents of special care units. These services include transportation outside of the facility, meal service in the community dining area and leisure activities, including memory-specific activities relating to dementia care.

Admission Requirements

The State of West Virginia imposes restrictions on who can and cannot be admitted to a facility that provides memory care services. Guidelines are issued by the DHHR, and provided to all licensed care facilities, regardless of the level of care provided.

Residents Who May Be Admitted

Seniors with a medical condition that imposes a disability requiring 24-hour care, including:

• Alzheimer’s disease/dementia
• Developmental disabilities
• Traumatic brain injury
• Mental health conditions

Residents Who May NOT Be Admitted

Children under the age of 18, as well as those adults who:

• Require nursing care in a dedicated post-acute facility or nursing home
• Have medical conditions outside of the scope of a residential care facility
• Demonstrate disruptive, violent, self-harming or other behaviors that cannot be managed with medication and non-medication interventions
• Cannot self-evacuate in case of fire or other emergency

Care Plan Requirements

Incoming residents at all West Virginia memory care facilities must be provided with a detailed care plan prior to admission. Care plans must include an exposition of all likely and continuing costs, as well as an explanation of extra services and the expenses they add to the cost of care. Care plans are drafted in consultation with the resident’s physician, who includes specific diagnoses and plans for continuing physical and mental health therapy services. Special care units must also include written policies relating to the facility’s pre-admission screening process and procedures for admission, transfer and discharge. The written care plan must also include an explanation of the level of care the facility’s license permits. Included in the terms must also be a written statement describing the conditions under which the resident may be transferred or discharged.

Medication Management Requirements

Alzheimer’s/dementia special care units may administer medication as needed within their licensure category. Facilities must follow the published state guidelines for administering psychotropic and behavior-modifying medications. Guidelines must also be followed for non-medical behavior modification strategies. Before administering behavior-modifying medications, the facility must ensure that the resident’s diagnosis justifies the use of the medication and that daily checks are performed for adverse side effects that must be reported to the resident’s physician. Dosage amounts must be based on age recommendations and measures must be taken to gradually reduce the amount of medication needed over time. Residents who receive medication must be evaluated on a monthly basis by a practitioner-level health provider, and a doctor must review the care plan at least once every six months.

Facility Requirements

Facilities may provide private and shared rooms. No more than two residents are allowed to occupy a room together. Facilities must have at least one sink and toilet for every six residents and one bathtub or shower per floor, or for every 10 residents.

All licensed facilities must provide personal care services and help with administration of prescription medication. Staff must be able to assist residents follow planned diets and activity regimens. Facility staff are responsible for booking medical and dental appointments for residents as needed. Alzheimer’s and dementia care units must also provide behavior management services tailored to the needs of each resident in order to prevent self-harm and harm to other residents.

Staffing Requirements

Special care units are required to employ both administrators and caregiver staff. If nursing care services are provided at the facility, the establishment is required to employ a registered nurse. The state of West Virginia does not mandate specific caregiver-to-resident ratios, but all facilities are required to employ enough full-time staff to take care of residents’ physical and therapeutic needs. Facilities with more than four residents that provide memory care services must have at least one member of staff awake and ready to respond 24 hours a day.

Medicaid Policy

West Virginia does not provide Medicaid funds for any type of residential care or memory care services. Supplemental payments are not generally available, though a special benefit is available for seniors who qualify for SSI but cannot, for whatever reason, receive SSI benefits. State benefit amounts can be as high as $879.90 a month for eligible seniors, plus an additional $1,122.32 a month to eligible residential care facilities.

Reporting Abuse

Suspected cases of elder abuse or neglect can be reported to local law enforcement. Call 911 if an emergency is in progress. West Virginia Adult Protective Services may be reached by phone at 800-352-6513, or by mail at:

350 Capitol Street, Room 730 Charleston, WV 25301

West Virginia families can learn more about their memory care options and other programs related to dementia diagnostics and care by contacting the following resources. 

Note: The following information was compiled and most recently updated on 2/15/2022. Since COVID-19 is a rapidly evolving crisis, be sure to contact your Memory Care Facility or local Area Agency on Aging for the most up-to-date information.

*Note: This information was not available for this state, contact your local area agency on aging or senior living facility for more information.