Personal Options West Virginia: Get Paid To Care For A Family Member

No. West Virginia Medicaid policy prohibits "legally responsible persons" from being paid personal attendants under the Aged and Disabled Waiver, and the spouse is specifically named as a legally responsible person. A parent of a minor child who is the member, and a court-appointed legal guardian, are also barred from being paid. This is not a Personal Options quirk -- it comes straight from the ADW provider manual (Chapter 501). The good news is that almost every other family relationship qualifies: adult children, siblings, grandchildren, nieces, nephews, in-laws, and friends can all be hired. There is one nuance worth knowing: a Medical Power of Attorney, POA, or healthcare surrogate may be paid to provide care, but if the member self-directs, they must then have a separate program representative who is not that same paid person. If you specifically need a spouse paid, look into VA Veteran Directed Care for veterans, which can pay spouses in some cases.

Personal Options runs on a monthly budget rather than an open hourly rate, and the member sets the attendant's wage within that budget. The wage has to be at least West Virginia's minimum wage of $8.75 per hour and is capped by Medicaid rules; in practice most attendants take home somewhere around $10 to $14 per hour. That wage is funded out of the overall Medicaid personal-attendant reimbursement rate -- which was $6.75 per 15-minute unit, roughly $27 per hour, for one-on-one care effective October 1, 2025 -- with the rest of that rate covering employer payroll taxes and the FMS vendor's administration. Attendants are W-2 employees of the member, so Palco withholds federal and state income tax, Social Security, and Medicare, and pays by direct deposit. Your exact budget depends on the service level (A through D) the nurse assessment assigns, and rates are updated periodically by the state.

West Virginia reports an average application processing time of about 56 days once everything is submitted, plus additional time on the Managed Enrollment List when slots are full. The steps that drive the timeline are: the physician submitting the MNER form, the county DoHS office deciding financial eligibility (they cannot finalize medical eligibility until you are financially eligible), and scheduling the in-home Pre-Admission Screening by a registered nurse. Because the ADW is not an entitlement program, approval does not always mean services start right away -- you may wait for an open slot. You can speed things up by having your doctor complete the MNER promptly and by gathering your financial documents (proof of West Virginia residency, ID, Social Security card, and proof of income and assets) before the county interview so nothing stalls the file.

You do not need to be a CNA, home health aide, or any licensed professional to be a personal attendant. What is required is completing a competency-based training curriculum before you start providing care, and any annual refreshers after that. West Virginia's policy defines competency as passing a graded post-test at 70% or higher for most training. Beyond training, an attendant must be at least 18 years old, pass a fingerprint-based criminal background check, sign a confidentiality statement, and complete standard employment paperwork (I-9 and W-4). Under Personal Options, the member and worker are responsible for the cost of the training, and a resource consultant through Palco can provide the training materials and guidance. If your relative already holds a current CNA certification, they can be hired more quickly once fingerprinting, First Aid/CPR, and STP training are done.

Under Personal Options, the member is the common-law employer of the personal attendants they hire directly. That means you choose who to hire, you train and schedule them, you supervise the day-to-day care, and you can let them go if it is not working out. The Financial Management Services vendor, Palco, is explicitly not the employer -- it is a Fiscal/Employer Agent that handles the paperwork side: enrolling your workers, processing timesheets, running payroll, withholding and filing taxes, and tracking your budget. A resource consultant helps you build a spending plan and answer questions, but they are not a case manager and they do not direct your care. This split is the whole point of self-direction: the person receiving care (or their program representative) keeps control over who provides it, while the administrative burden of being an employer is handled for you.

Both are ways to receive the exact same Aged and Disabled Waiver services -- the difference is who is in charge. In the Traditional Model, a licensed home-care agency hires the personal attendant, assigns them to you, sets the schedule, supervises the care, and handles all employment matters; you usually do not choose who shows up. Personal Options flips that: you become the common-law employer, so you pick the attendant (typically a relative or friend you already trust), you train them on your specific needs, you set the schedule, and you manage a monthly budget through Palco. Personal Options is the better fit if you have a family member or friend ready to provide care and you want continuity and control. The Traditional Model can make more sense if you do not have someone available and would rather an agency manage everything. You can also transfer between the two models if your situation changes.

Your care is capped by a service level (A, B, C, or D) that a registered nurse assigns during the Pre-Admission Screening, based on assessment points. Under the Traditional Model those levels map to monthly hour ranges -- roughly 0 to 62 hours per month at Level A, up to about 125 to 155 hours per month at Level D. In Personal Options, the same service level is expressed as a maximum monthly budget instead of a fixed hour count, which gives you flexibility to balance the wage you pay against the number of hours you schedule. The state notes that maximum hours are not guaranteed unless the need is documented in your Service Plan, and if you consistently use fewer hours than approved, the reason has to be recorded. You can also spread the budget across more than one attendant -- for example two adult children splitting the week.

No. Choosing Personal Options does not change the member's eligibility for the rest of their Medicaid coverage -- doctor visits, hospital care, prescriptions, durable medical equipment, and other services all continue as before. Personal Options is simply the self-directed way of delivering one specific waiver benefit (personal attendant services) within the Aged and Disabled Waiver, and it sits alongside the rest of the Medicaid package. If the member is dually eligible for Medicare and Medicaid, Medicare keeps covering acute and short-term skilled care while the waiver covers long-term personal attendant help. One thing to keep in mind: the ADW itself requires meeting both nursing-facility level-of-care and Medicaid financial rules, and both are re-checked every year, so it is worth staying on top of the annual re-evaluation so your services do not lapse.