Why This Matters When Care Needs Grow
Many families are surprised to learn how much of the cost of long-term care they may have to pay on their own. For many West Virginians, Medicaid ends up paying for those care services once savings run low. It is a federal and state program, and the rules vary by state, so what you read about another state may not apply here.
The state's program pays for nursing facility care for people who are aged, blind or disabled and who meet both medical criteria and financial requirements. West Virginia also offers a Home and Community-Based (HCB) Waiver for people who need the same level of care but choose to receive it at home. The financial eligibility requirements are where planning makes the biggest difference.
Income and Asset Limits: How WV Counts What You Own
To qualify for Medicaid coverage of that care, an applicant's countable assets must be within the state's limit. The current asset limit for an individual is $2,000.
Not everything you own counts. In West Virginia, exempt assets include:
- Your primary residence
- One vehicle
- A life insurance policy up to $1,500
- Income-producing properties
Bank accounts and many investments, on the other hand, are generally counted. Which category something falls into, and how it is owned, can change the outcome.
The Five-Year Look-Back Period
This is where well-meaning families get into trouble. There is a five-year look-back period. When you apply, the state reviews the previous five years for:
- Uncompensated transfers, or transfers for less than fair market value
- Gifts of real property
- Payments to family caregivers without a formal contract
If a violation is found, the state imposes a penalty period, a stretch of time during which the person cannot receive Medicaid benefits. That can leave a family paying for care out of pocket at the worst possible time. Before you give property away, pay a relative for care or change ownership of an account, get advice about what that decision could mean for you.
Protecting the Spouse at Home (the Community Spouse)
When one spouse needs facility care and the other stays home, West Virginia follows rules meant to keep the at-home spouse, called the community spouse, from being impoverished.
The asset assessment. The West Virginia Department of Human Services (DoHS) completes an assessment of the couple's combined assets as of the beginning of the first continuous period of institutionalization. The assessment can be requested before you apply, and it is done one time.
The community spouse's share. The community spouse generally keeps half of the couple's combined countable total, but no less than $32,532 and no more than $162,660. If the couple's total is $32,532 or less, all of it is attributed to the community spouse. The remaining assets are attributed to the spouse receiving care, whose share must be within the $2,000 limit.
Income. The current minimum monthly maintenance needs allowance (MMNA) is $2,705, and it can go up to $4,066.50 if certain criteria are met. In plain terms: if the at-home spouse's own income is under $2,705 a month, that spouse can receive some of the other spouse's income.
These rules can preserve a meaningful part of what a couple has built, but timing and ownership matter. This is one of the most important conversations we can have before an admission, not after.
Medicaid Asset Protection Trusts (MAPT)
A Medicaid asset protection trust, sometimes called a MAPT, is an irrevocable type of trust. You, the grantor, transfer assets into the trust, and a trustee manages them under its terms. Because you give up direct control of the assets transferred, they can be shielded so they are not counted against you when you later need to qualify for Medicaid.
This tool is not right for everyone. It requires planning ahead, it limits your access to what you place in it, and it has to be drafted and funded correctly to do what you expect. I prepare these trusts for clients when one fits their goals, and we can talk through whether it makes sense for you.
Revocable Trusts Are Different
A revocable living trust is a common planning tool that you can change or cancel, and you keep control. A revocable living trust does not protect assets from Medicaid. Transferring assets into an irrevocable trust works differently. Many people use both: a will or revocable arrangement to pass property to family, and a separate plan for care. Learn more on our Estate Planning page.
Planning Ahead vs. Crisis Planning
The best time for planning for long-term care is before care is needed. When you plan ahead, there are more options and more time to make thoughtful choices about your home, your savings and your family.
But many families call when a parent is already in the hospital, moving to assisted living or about to enter a facility. That is crisis planning, and it is still worth doing. Crisis planning is complex. In West Virginia, the two main tools are a spousal annuity and a specialized type of life insurance. Whether either fits depends on your situation, so please call to talk it through.
Either way, it helps to look at the whole picture: where the person will live, who will help, how care and other medical expenses will be paid, and whether the right powers of attorney are in place so someone can legally act.
What Happens After Death: WV Estate Recovery
After a Medicaid recipient dies, Medicaid generally seeks to recover the money it paid toward that person's care. In West Virginia, it seeks recovery from the probate estate only, so keeping assets out of probate is ideal. Tools such as a transfer on death deed and other planning strategies can help keep property from passing through probate.
Applying for Long-Term Care Medicaid in WV
Applications go through the West Virginia Department of Human Services. The application asks for detailed information about income, assets and ownership, and missing documents can delay a decision. I help clients with their applications, from gathering what's needed to understanding how your remaining assets are likely to be viewed.
I also coordinate with the people already helping you, including financial planners, accountants, insurance agents and real estate professionals. If a loved one can no longer manage their own affairs and the right documents aren't in place, we can also talk about guardianship and conservatorship.
How Good Grief Law Can Help
A care decision is never just a financial one. Your preferences, your family responsibilities, your home and your legal documents all need attention alongside the cost of care. When we work together, I will:
- Listen to the whole situation, including health, housing, family and finances
- Explain how the state is likely to view what you own and how to protect your assets
- Talk through ways to protect a spouse at home
- Help with the application
- Review your will and powers of attorney so they fit your care plan
- Coordinate with your other advisers and with aging support services when a move or care change is coming
Consultations for matters other than estate planning carry a consultation fee that depends on what you need, so please call to discuss.
Frequently Asked Questions
How do I shield what I own from Medicaid spend-down?
It depends on your situation. Options may include the community spouse protections, using exempt assets, reviewing how property is owned, and in some cases trust planning. Get advice before you give away or retitle anything.
What is the look-back period?
The state reviews the five years before you apply for transfers for less than fair market value, gifts of real property and family caregiver payments without a formal contract. A violation leads to a penalty period without benefits.
How much can a spouse keep when the other needs facility care?
Generally half of the couple's combined counted assets, but not less than $32,532 or more than $162,660. The at-home spouse may also receive part of the other spouse's income if their own income is under $2,705 a month.
Does a revocable living trust protect assets from Medicaid?
No. A MAPT is a different tool, and I can prepare one when it fits.
Can you help me apply?
Yes. I help clients with their applications.
Do I need an attorney to protect my assets?
You are not required to have one, but the rules are detailed and mistakes can be costly. An experienced elder law attorney can help you avoid transfers that create problems and make sure your documents work together.