West Virginia Personal Options Program: Self-Directed Medicaid Home Care

The Personal Options model is West Virginia's self-directed alternative under the Aged and Disabled Waiver (ADW). Instead of receiving care from a home health agency, your parent becomes the employer — choosing, hiring, and managing their own caregivers, including adult children. It's the most flexible option in the state's long-term care system, but it comes with real administrative responsibilities.

How Personal Options Differs from Agency Care

Under the standard ADW model, a licensed home care agency assigns caregivers, manages scheduling, and handles payroll. Your parent gets the services but has limited control over who provides them and when.

Personal Options flips this. Your parent (or their authorized representative, if cognitive decline prevents self-management) acts as the common-law employer. They decide who to hire, set the schedule, and direct the daily work. The trade-off is that they take on employer responsibilities — timekeeping, training verification, and working within an approved care budget.

Hiring Family Members as Paid Caregivers

This is the primary draw for most families. Under Personal Options, your parent can hire adult children, grandchildren, siblings, nieces, nephews, and other relatives as paid caregivers. The state pays them through an approved care budget — giving families a legitimate way to compensate the unpaid care they've already been providing.

There are two hard restrictions:

• Spouses cannot be paid caregivers. This rule has no exceptions under the ADW.
• Court-appointed legal guardians cannot serve as paid caregivers for the person they have guardianship over.

Everyone else — including adult children who live with the parent — is eligible.

Caregiver Requirements

Before a family member (or anyone else) can start providing paid care, they must:

1. Pass a criminal background check (CIB) — the state runs this through West Virginia's criminal records system
2. Complete basic training — covering topics like personal care assistance, safety protocols, and emergency procedures
3. Register through the Atrezzo portal — Acentra Health's platform that replaced the older CareConnection system in November 2025

The caregiver doesn't need a nursing certification, home health aide license, or medical training. The role is personal attendant care — helping with daily activities like bathing, dressing, meal preparation, medication reminders, and mobility — not skilled nursing.

How Payroll Works Through PALCO

West Virginia uses PALCO as its designated Fiscal Employer Agent. PALCO handles all the employer-side paperwork that would otherwise fall on your parent:

• Tax withholding (federal and state income tax, FICA)
• Workers' compensation insurance
• Payroll processing on a biweekly cycle
• W-2 generation at year end

Caregivers submit their hours through electronic timesheets on the Atrezzo platform — the Personal Attendant Log (PAL). PALCO processes payment based on the approved hours and rate. The caregiver rate varies by county and service type but is generally comparable to local home health aide market rates.

The Income Retention Advantage

One significant financial benefit of the ADW (including Personal Options) compared to nursing home Medicaid: waiver enrollees keep 100% of their monthly income as a personal needs allowance. In a nursing facility, the resident keeps only $50/month — the rest goes to the facility as patient liability.

The catch — as covered in the spousal impoverishment rules — is that because the applicant retains all their income, no spousal income transfer (MMMNA) is permitted under the waiver. Families where the applicant holds most of the household income need to calculate whether this trade-off works for the community spouse.

The Waitlist Reality

Personal Options is part of the ADW, which means it's subject to the same capacity limits. The program is capped at approximately 8,750 active slots statewide. When all slots are filled, eligible applicants go on the Managed Enrollment List (MEL). Average wait time from clinical clearance to slot release is roughly 44 days, with the overall intake process averaging 56 days.

While waiting, the Lighthouse Program (up to 60 hours/month of state-funded in-home assistance) can bridge the gap.

Getting Started

To access Personal Options, your parent must first qualify for the ADW — meaning they need to pass both the clinical assessment (five functional deficits on the PAS-2000) and the financial eligibility determination (under the $2,982 income standard or through the medically needy spend-down pathway, with assets at $2,000 or less).

The West Virginia Medicaid Long-Term Care & Asset Protection Guide covers the full ADW eligibility process, the Personal Options enrollment steps, and the documentation you need to set up a family member as a paid caregiver through PALCO.

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