Does Medicaid Pay for Memory Care in West Virginia?

The short answer is no — West Virginia Medicaid does not pay for the room-and-board portion of assisted living or memory care facilities. This surprises most families who assume that Medicaid covers any licensed care setting. The reality is more nuanced, and understanding exactly what Medicaid will and will not fund changes how families plan the financial trajectory of dementia care.

What Medicaid Does Not Cover

Memory care in West Virginia operates within licensed Assisted Living Residences. The monthly cost — averaging around $6,951 statewide — covers room, meals, personal care, dementia programming, and secured-environment supervision.

Medicaid classifies room and board in an assisted living setting as a non-covered expense. The resident or their family must pay for it out of pocket, through long-term care insurance, or through VA benefits. This applies to all assisted living facilities in the state, including those operating Alzheimer's Special Care Units under the Alzheimer's Special Care Standards Act.

The Limited Exception: Personal Care Services

West Virginia's Medicaid Personal Care Services Program can occasionally fund hands-on personal care services delivered within an assisted living or memory care setting. The critical condition is that those services must not already be included in the facility's base contract.

In practice, this exception applies narrowly. Most memory care facilities bundle personal care (bathing, dressing, toileting, mobility assistance) into their monthly rate. If the facility's contract already covers these services, Medicaid will not pay for them separately.

To access this benefit, the participant must meet Medicaid's financial eligibility requirements (countable assets of $2,000 or less for a single applicant, monthly income at or below $2,982) and receive a clinical assessment demonstrating the need for personal care services beyond what the facility provides.

What Medicaid Does Cover for Dementia Care

Medicaid covers two care settings fully:

Skilled nursing facilities (nursing homes). Medicaid pays the full cost of care in a Medicaid-certified skilled nursing facility for eligible residents. This includes room, board, nursing care, medication administration, and rehabilitation services. The average cost of a semi-private nursing home room in West Virginia is approximately $12,836 per month — all covered by Medicaid if the resident meets financial and clinical eligibility.

Home-based care through the Aged and Disabled Waiver (ADW). The ADW funds in-home personal care, respite services, adult day programming, and case management for seniors who meet a Nursing Facility Level of Care but choose to receive care at home. Under the ADW, participants keep 100% of their monthly income — a dramatic advantage over the $50 Personal Needs Allowance for nursing home residents.

The Practical Dilemma

This creates a gap that families must navigate: Medicaid will pay for a $12,836 per month nursing home but will not pay for a $6,951 per month memory care unit in an assisted living facility.

The result is a two-path system:

Path 1: Stay home as long as possible. Use the ADW for in-home care, supplemented by the Lighthouse and FAIR programs. When home care is no longer safe, skip memory care entirely and move directly to a Medicaid-funded nursing home.

Path 2: Private-pay memory care, then transition. Pay for memory care out of pocket (or through VA benefits and long-term care insurance) for as long as savings last. When assets approach Medicaid's $2,000 limit, apply for Medicaid and transition to a skilled nursing facility.

Most families with modest resources follow Path 1 by default. Families with savings between $50,000 and $200,000 often follow Path 2, using the private-pay period to provide the less institutional memory care environment while their parent's condition is in the moderate range.

The Spend-Down Calculation

If your parent has assets above Medicaid's $2,000 limit, they must spend down those assets on allowable expenses before qualifying. Medical expenses, care costs, health insurance premiums, and home modifications for disability all count toward the spend-down.

West Virginia is a medically needy state, which means income above the $2,982 monthly threshold does not automatically disqualify an applicant. Instead, the state calculates a six-month spend-down: the difference between the applicant's income and the Medically Needy Income Limit of $200 per month must be offset by documented medical expenses. Once those expenses are verified, Medicaid eligibility activates for the remainder of the six-month period.

Planning Ahead

The gap between memory care and Medicaid coverage is predictable, not inevitable. Families who understand the structure early can:

• Maximize in-home care through the ADW, Lighthouse, and FAIR programs before considering facility placement
• Apply for VA Aid and Attendance benefits (excluded from Medicaid income calculations) to supplement care costs
• Explore the West Virginia Partnership for Long-Term Care insurance program for dollar-for-dollar asset protection
• Consult an elder law attorney about spend-down strategy before assets are depleted

The West Virginia Dementia & Memory Care Guide includes a Medicaid financial planning worksheet that maps your parent's assets, income, and expected care costs across each stage — so you can see exactly when Medicaid eligibility arrives and plan the transitions accordingly.

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