Acentra Health and the West Virginia Medicaid Waiver Process

When you apply for the Aged and Disabled Waiver in West Virginia, your application does not stay with one agency. It moves through a chain of three separate organizations, each handling a different piece of the eligibility determination. The most common source of confusion — and delay — is not understanding who has your parent's application at any given moment and what each agency needs from you.

Here is the full sequence and where Acentra Health fits in.

The Three-Agency Process

Step 1: Local Department of Human Services (Financial Screening)

The process starts at your county Department of Human Services (DoHS) office. A caseworker conducts the initial financial eligibility screening using information from the DHS-2 application form.

The DHS-2 is the state's standard Medicaid application. It collects income documentation (Social Security statements, pension letters, bank statements), asset information, and household composition data. For long-term care Medicaid, the caseworker verifies that your parent's countable assets are at or below $2,000 (single applicant) and monthly income is at or below $2,982.

Once financial eligibility is preliminarily confirmed, the county office generates a yellow DHS-2 form and transmits the case to the next agency.

Common delay point: Missing documentation. If bank statements are incomplete, income verification is unclear, or asset transfers need explanation, the county office will request additional paperwork. Respond quickly — documentation requests often have 10-day deadlines, and missing them can restart the clock.

Step 2: Acentra Health (Clinical Evaluation)

Acentra Health serves as West Virginia's Utilization Management Contractor for the Medicaid waiver program. Once the financial screening is complete, Acentra Health takes over the clinical evaluation process.

Acentra Health's role:

Processing the Medical Necessity Evaluation Request (MNER). This is the formal request for a clinical assessment to determine whether your parent meets the medical criteria for the Aged and Disabled Waiver.

Scheduling the Pre-Admission Screening (PAS). Acentra Health arranges for a registered nurse to conduct an in-home clinical evaluation. The nurse assesses your parent across multiple activities of daily living — eating, bathing, dressing, grooming, mobility, toileting, and cognitive function. To qualify for the waiver's Nursing Facility Level of Care, your parent must demonstrate at least five functional deficits.

The "good day" problem. The PAS is a single-point-in-time evaluation. Dementia symptoms fluctuate — your parent may be more alert, more cooperative, and more functional during the nurse's visit than they are on an average day. This can result in a denial that does not reflect the daily reality of care.

To counter this: keep a detailed log of incidents, behavioral episodes, falls, wandering attempts, and ADL assistance needs for the 30 days leading up to the assessment. Present this documentation to the evaluating nurse. Written evidence of chronic patterns is harder to dismiss than a single-day snapshot.

Step 3: Bureau of Senior Services (Enrollment and Waitlist)

After Acentra Health confirms clinical eligibility, the case returns to the West Virginia Bureau of Senior Services (BoSS), which manages the programmatic allotments for the waiver and maintains the Managed Enrollment List (MEL).

The MEL is the state's waiver waitlist. Even after both financial and clinical eligibility are confirmed, your parent may not receive services immediately. Average wait times have been approximately 44 days on the MEL, with an additional 56 days for full enrollment once a slot opens — roughly 100 days total from clinical approval to services starting.

During the wait, your parent receives no waiver-funded services. If they need immediate care, you must arrange private-pay home care or rely on non-Medicaid programs like the Lighthouse Program or FAIR respite care to bridge the gap.

What to Do While Waiting

Apply for Lighthouse and FAIR immediately. Both programs have no asset limits and require only two ADL deficits for eligibility (compared to the waiver's five). They can provide up to 60 hours of monthly in-home care (Lighthouse) and 16 hours of weekly respite (FAIR) while the waiver application is processed.

Ask about State Plan Personal Care. Some applicants who are Medicaid-eligible but waiting for a waiver slot may qualify for State Plan Personal Care services as an interim benefit. Ask the case manager at BoSS about this option.

Keep documentation current. If your parent's condition changes during the waiting period — a hospitalization, a fall, a significant cognitive decline — notify Acentra Health. Changes in clinical status may affect the care plan once the waiver is activated.

Tracking Your Application

The most frustrating aspect of this process is that no single phone number gives you status on the entire application. You may need to contact:

• The county DoHS office for financial eligibility status
• Acentra Health for clinical evaluation scheduling and results
• The Bureau of Senior Services for MEL position and enrollment timeline

Keep a log of every call — date, agency, representative name, and what they told you. This log becomes invaluable when contradictory information surfaces, which is common when three agencies are handling overlapping pieces of the same case.

The West Virginia Dementia & Memory Care Guide maps the complete waiver application process with an agency-by-agency timeline, the documentation checklist for each stage, and the specific questions to ask at each call to cut through the administrative confusion.

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