West Virginia Medicaid Application for Long-Term Care: How to Apply Step by Step

Filing a Medicaid long-term care application in West Virginia means running two parallel tracks at once — a clinical evaluation proving your parent needs nursing-level care, and a financial application proving they can't afford to pay privately. Miss a deadline on either track and the entire process stalls. Here's the sequence that actually works.

Step 1: Get the Medical Necessity Evaluation Request (MNER)

Before the state will assess your parent clinically, their doctor must complete a Medical Necessity Evaluation Request form. This can be filled out by an MD, DO, physician assistant, or nurse practitioner. The form requires specific ICD-10 diagnosis codes — not just written descriptions — and any blank fields or missing codes will trigger an immediate rejection.

The MNER expires 60 days after the physician signs it. If you don't submit it to Acentra Health (the state's utilization management contractor) within that window, you have to start over with a new physician evaluation.

Step 2: Schedule the Pre-Admission Screening (PAS)

Once Acentra Health receives and verifies the MNER, they schedule an in-home clinical assessment. A registered nurse visits your parent and evaluates their ability to perform Activities of Daily Living using the standardized PAS-2000 tool.

Your parent must score at least five functional deficits across domains like eating, bathing, dressing, grooming, mobility, and toileting. This threshold is the same whether they're applying for Nursing Facility Medicaid or the Aged and Disabled Waiver (ADW) for home care.

Scheduling follows the timelines set by the Cyrus Court Decree — Acentra must complete the evaluation within 45 business days of financial pre-clearance. The scheduling process runs through the Atrezzo portal (which replaced the old CareConnection system in November 2025).

Step 3: File the Financial Application Through WV PATH

While the clinical assessment is being scheduled, file the financial application through wvpath.wv.gov — the state's online portal that replaced the legacy inROADS system. You can also submit a paper application (Form DFA-LTC-1) at your local county Department of Human Services office.

The financial application requires comprehensive documentation:

• 60 months of bank statements for every checking, savings, and investment account
• Property deeds and mortgage statements
• Vehicle titles
• Life insurance policies (face value and cash surrender value)
• Pension and Social Security benefit statements
• Any trust documents
• Records of gifts or asset transfers in the past five years

Even though WV PATH accepts electronic signatures, you'll need to physically deliver supporting documents to the county office. The county caseworker audits everything during a 30-to-45 day review window.

Step 4: Wait for the Eligibility Determination

If your parent clears both the clinical and financial evaluations, what happens next depends on which program they're entering:

• Nursing Facility Medicaid: Coverage can begin immediately (and can be backdated up to three months before the application date if your parent was eligible during that period).
• Aged and Disabled Waiver (ADW): Your parent goes on the Managed Enrollment List (MEL). The ADW is capped at roughly 8,750 active slots statewide. Average time from clinical clearance to slot release is about 44 days, with overall intake averaging 56 days.

What to Do If You're Denied

If the application is denied — clinically or financially — you have 90 days from the Notice of Decision to file a Request for Fair Hearing (Form DFA-FH-1). The hearing goes before the DoHS Board of Review Commissioner. Families who can demonstrate the caseworker miscounted assets or the clinical screener missed deficits have a real path to reversal.

Getting It Right the First Time

The biggest risk in the application process isn't denial — it's delay. An incomplete MNER wastes a month. Missing bank statements restart the financial review. A failed PAS score means rebooking the clinical assessment from scratch.

The West Virginia Medicaid Long-Term Care & Asset Protection Guide includes the complete document checklist, MNER walkthrough, and PAS preparation tips so you can file a clean application on the first attempt.

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