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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 1 Chapter 24 Long Term Care

24.1 INTRODUCTION This chapter describes the Department of Human Services' (DOHS) policies and procedures related to eligibility for long term care (LTC). LTC includes both institutional care and non- institutional Home and Community-Based Services (HCBS). • Institutional care includes nursing facilities (NF) and intermediate care facilities for individuals with intellectual disabilities (ICF/IID). • West Virginia’s HCBS include four programs. These are for people who would otherwise need institutional level of care, but have chosen to receive care in the community. West Virginia has been granted waivers by the Centers for Medicare and Medicaid Services (CMS) to provide HCBS to several target populations: o Aged or disabled people under the Aged and Disabled Waiver (ADW) o Intellectually or developmentally disabled individuals under the Intellectual Disabilities and Developmental Disabilities (I/DD) Waiver o Individuals with traumatic brain injury under the Traumatic Brain Injury (TBI) Waiver Additionally, West Virginia has opted to implement the Children with Disabilities Community Services Program (CDCSP) eligibility category, which allows for children who would otherwise need an institutional level of care to receive services in the community. This chapter covers policies relating to individuals in two different situations: • Clients who are already enrolled in or eligible for Medicaid who have a new need for LTC. • Applicants who were not eligible for Medicaid at the time of application, but who may have become eligible because of their need for LTC. All LTC programs require a determination of medical eligibility, as well as a determination of financial eligibility conducted by the Worker. This chapter also sets out policies and procedures for determining if clients found eligible for institutional care must contribute to their cost of care. This chapter is organized as follows: • Section 24.1 – 24.3 applies to all LTC programs. • Sections 24.4 – 24.15 cover information related to Nursing Facility services. • Sections 24.16 – 24.27 cover information related to ICF/IID services. • Sections 24.28 – 24.36 cover information common to the HCBS programs. • Sections 24.37 – 24.40 provide information about the ADW.