Medicaid Nursing Home Rates by State

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West Virginia

Medicaid nursing facility payment · Peer-group price · researched October 2026

West Virginia’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Peer-group price

Case-mix level

Resident-level

Classification

Transitioning to PDPM

Rate updates

Twice a year

Managed care (LTC)

No

Quality program

NF Quality Per Diem

Paid outside the rate

None

Bed hold

Hospital and leave

Published rates

Rates only

Assisted living

Not covered

Personal needs allowance

$50 / month

Overview

• Since 10/1/2024 West Virginia pays a component price system built on PDPM, replacing its old cost-based case-mix system.
• Direct care (priced at 112.5% of the peer-group 90th percentile, case-mix-adjusted), care-related (112.5% of the 80th percentile) and operational (105% of the 75th percentile) are peer-group prices.
• Each is cut if the home's own base-year spending falls below a floor (80%/75%/75% of the price).
• Pass-through (utilities, taxes, insurance) is paid at cost, liability insurance at cost capped by bed group, and capital by fair rental value from 7/1/2026.
• A quality per diem from a $60M pool and a phase-in adjustment are added.
• Through 6/30/2027 each home's rate is blended with its old RUG-era rate (25% old / 75% PDPM from 7/1/2026).
• The 7/1/2026 fee schedule lists 118 homes.
• At a nursing CMI of 1.0 the median rate is $380.72/day (range $313.07-$452.22).
• The direct-care price at CMI 1.0 has a median of $119.66, and the non-acuity part a median of $261.76.

What matters in West Virginia

• $380.72/day median at nursing CMI 1.0 (7/1/2026, 118 homes); each resident's claim is priced by their own PDPM nursing group.
• PDPM since 10/1/2024 replaced the WV 29-group cost-based system; old rates are blended in until 7/1/2027 (25% old now).
• Spending floors: a home spending under 80% of the direct-care price (75% for two other components) loses the gap.
• $60M quality pool (inflated yearly): four long-stay MDS measures (90%) plus a behavioral special-population share (10%), updated each January and July.
• Nursing home care is carved out of Mountain Health Trust; MCO members leave the plan after 30 days in a home.
• 5.5% gross-receipts provider tax on every home, no tiers; no supplemental or UPL payments were found.

Frequently asked

Does West Virginia Medicaid pay one nursing home rate for all residents in a facility?

No. Each claim carries the resident's PDPM nursing group, and the direct-care price is multiplied by that group's CMI. In 7/1/2026 rates, a median home ranges from about $336/day (group PA1) to $719/day (group ES3).

What happens when a West Virginia nursing home spends less than its direct-care price?

If base-year direct-care cost is below 80% of the peer-group price, the price is cut by the shortfall. The home then gets its cost plus 20% of the price. Care-related and operational components use 75% floors.

Do West Virginia Medicaid managed care plans pay for nursing home stays?

No. Long-term care is carved out of Mountain Health Trust. Members placed in a nursing facility for more than 30 days are disenrolled, and BMS pays the facility fee-for-service.

How much is paid outside the posted rate in West Virginia?

None found: quality money is inside the posted per diem, and no UPL, IGT or directed payments were found.

What does West Virginia Medicaid pay on Medicare coinsurance days?

Lesser-of: Medicaid pays coinsurance only up to the Medicaid allowed amount minus Medicare's payment, usually $0.

How is the West Virginia nursing home provider tax charged?

5.5% of gross receipts for every nursing facility; no tiers or high-Medicaid discount; no separate add-on returns it.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

West Virginia Financial and Statistical Report for Nursing Homes (Medicaid cost report) mapped to the Medicaid Chart of Accounts (MCOA), filed with OAMR (Office of Accountability and Management Reporting) using Baker Tilly software. Semiannual through the 12/31/2023 period; annual calendar-year reports since CY2024, due March 31.

Base year and rebasing

10/1/2024 rates used desk-reviewed 7/1/2022-12/31/2022 cost reports, inflated with the IHS Markit SNF-without-capital market basket. Components are 'rebased at a minimum of every two years'; non-rebase years get a July 1 inflation update. From 7/1/2026 costs are trended from the base-year midpoint to the state fiscal year midpoint. Whether the 7/1/2026 rates used CY2024 cost reports (a rebase) was not confirmed. The $4.21 pass-through add-on lasts until a rebase uses cost reports ending in CY2025 or later.

Components

Component	Method	Notes
direct care	Peer-group price = 112.50% of the 90th percentile of case-mix-normalized direct care cost per day (cost / total facility cost-report-period CMI). Cost per day uses the greater of actual days or 70% of bed days. Spending floor: if the home's normalized cost is below 80% of the price, the price is cut by the shortfall. The final direct-care per diem is multiplied by each resident's PDPM nursing CMI on the claim.	RN, LPN, nurse aides, restorative, contract nursing, and resident-specific equipment (Clinitron/low-air-loss beds, wound vacs, bariatric beds and lifts, BiPAP/CPAP, nebulizers, concentrators). Peer group definitions are not stated in Chapter 514 or SPA 24-0004.
care related	Peer-group price = 112.50% of the 80th percentile of cost per day (greater of actual days or 75% of bed days). Spending floor 75% of the price; any shortfall is deducted.	DON, supplies, non-prescription drugs, oxygen, other nursing, therapy, medical records, activities.
operational	Peer-group price = 105.00% of the 75th percentile of cost per day (greater of actual days or 85% of bed days). Spending floor 75% of the price.	Dietary, administration, maintenance, laundry and housekeeping.
pass-through	The home's own utilities and taxes and insurance cost per day (greater of actual days or 85% of bed days), inflated; no cap stated. Plus a flat $4.21/day from 10/1/2024 until the rebase using CY2025+ cost reports.	The purpose of the $4.21 add-on is not stated.
liability insurance	The home's own cost per day (greater of actual days or 80% of bed days), capped at 105% of the 75th percentile by bed group (0-90 and 91+ beds).
cost of capital	10/1/2024-6/30/2026: the Standard Appraised Value (SAV) frozen at 10/1/2022 values and inflated each July 1. From 7/1/2026: fair rental value (see capital). A capital phase-in add-on holds homes harmless to the inflated 10/1/2023 capital rate: 100% of any shortfall at 7/1/2026, 50% at 7/1/2027, ending 6/30/2028.	SPA 26-0003 (FRV) was noticed for comment 6/29-7/29/2026 'pending CMS approval' and described as cost neutral. Not on BMS's approved-SPA list as of 10/11/2026.
quality	Per diem from a $60,000,000 annual pool (as of 10/1/2024), inflated yearly by the SNF market basket. 90% goes to quality scoring metrics and 10% to special populations; recalculated semiannually. See quality_incentive.
phase-in adjustment	Blend of the imputed 10/1/2023 RUG-era rate (x 100.940%, inflated) and the PDPM rate. Old/new shares: 75/25 (10/1/2024, 1/1/2025), 50/50 (7/1/2025, 1/1/2026), 25/75 (7/1/2026, 1/1/2027), 0/100 from 7/1/2027. The difference between the blended rate and the PDPM rate is paid as its own (positive or negative) component.	Expires 6/30/2027.

Inflation

IHS Markit (S&P Global) Skilled Nursing Facility without Capital Market Basket, applied each July 1 from the base-period midpoint to the current state fiscal year midpoint. Before 10/1/2024 it was the six-month CPI change. FRV values are trended by the R.S. Means construction cost index (Charleston, WV city index, two-year moving average).

Verified October 11, 2026

Case mix

System

Transitioning to PDPM

Applied at

Resident-level

How it works

Facilities bill revenue code 0550 with each resident's 5-character HIPPS code, and the fee schedule pays a different rate for each PDPM nursing group: direct-care price x that group's CMI plus the non-acuity components (Ch. 514 §514.6.4, §514.11.1; BMS FAQ: 'case-mix adjustments ... occur at the claim level, and is resident specific').

Classification

PDPM nursing component only (the 3rd HIPPS character, 25 groups), using CMS FY2024 Final Rule Table 5 nursing CMIs (ES3 3.84 down to PA1 0.62), frozen until a rebase. Missing MDS bills HIPPS ZZZZZ at a default rate. The fee schedule shows a 'BC1' default column at CMI 0.62.

Applies to

Direct care component only (on each claim). Total facility all-payer CMI is used only to normalize direct care cost at rate setting.

Acuity measured from

Normalization uses the calendar-day-weighted all-payer CMI for the cost report year. Payment uses the resident's own most recent assessment: monthly MDS extracts create three-month claim authorizations from the ARD. If two assessments fall in one month, the second is used. Assessments transmitted after the extraction date roll to the next month.

Updated

With every claim (per resident); authorizations loaded monthly from the MDS extract.

Move to PDPM

SPA 24-0004 (effective 10/1/2024, approved 8/28/2025) replaced the West Virginia 29-class case mix grouper (RUG-III based, AAA01-AAA29). Under that system a facility nursing cap was set from the average Medicaid MDS score, plus a per-resident nursing add-on when a resident's score exceeded 2.9. BMS required the Optional State Assessment for ARDs 10/1/2023-9/30/2024 to bridge the gap after CMS stopped collecting the needed items. The old-system rate is blended in until 6/30/2027.

Verified October 11, 2026

Low-acuity residents

None. No reduced or flat rate carve-out for low PDPM groups was found in Chapter 514 (eff. 7/1/2026) or SPA 24-0004. The lowest groups (PA1, BC1 default at CMI 0.62; PA2 0.67) simply get a smaller direct-care amount. At the median home that is about $336/day vs $381 at CMI 1.0 (7/1/2026). When a member's MDS is missed or late, 'the default rate must be billed' (HIPPS ZZZZZ), which works like the lowest group.

Verified October 11, 2026

Capital

Fair rental value from 7/1/2026 (Ch. 514 §514.12.12(6); SPA 26-0003, not yet approved: as of 10/11/2026 it is absent from BMS's list of CMS-approved SPAs, whose latest entry is SPA 25-0005, approved 5/21/2026). Value = sq ft per bed (bounded 300-700) x ($296.79 + $16.60 land) + $8,919.55 per licensed bed for equipment, trended by R.S. Means. Non-land value is depreciated 1.25%/yr by weighted age, capped at 35 years (floor 56.25%), with no recapture. Initial age is imputed from the 10/1/2023 SAV. Renovations of $1,000+/bed re-age the home; mid-year requests are allowed above $15,000/bed. Rental factor = 10-year Treasury + 3%, floor 8.929875%, ceiling 12%. Value is divided by the greater of actual days or 90% of licensed capacity. A hold-harmless phase-in add-on pays 100% of any drop versus the inflated 10/1/2023 capital rate at 7/1/2026, 50% at 7/1/2027, and ends 6/30/2028. Before that came the SAV appraisal system (Marshall & Swift cost approach under a Model Nursing Facility Standard), frozen at 10/1/2022 values from 10/1/2024.

Verified October 11, 2026

Budget adjustment factor

No across-the-board budget factor. The phase-in multiplies the imputed 10/1/2023 base rate by 100.940%. The $60M quality pool is fixed (inflated yearly), so per-home quality dollars depend on statewide Medicaid days. The FRV conversion was designed to be cost neutral (SPA 26-0003 notice).

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

none

Estimate

About 0% found. The quality pool ($60M+) and all add-ons are inside the posted per diem. No NF UPL, IGT, directed-payment or managed-care supplemental programs were found, and MCOs do not pay NF care.

Components

None identified. Nurse aide training reimbursement (up to $500 per aide) is minor.

Source

https://bms.wv.gov/media/41391/download?inline

Verified October 11, 2026

Payments by owner type

Applies

no

Detail

Attachment 4.19-D-1 covers 'Non-State-Owned Nursing Facilities - Excludes State-Owned Facilities'. However, the former state long-term care homes appear on the standard 7/1/2026 fee schedule as Majestic Care of Hopemont, Manchin and Lakin. No IGT or public-only payments were found for county or hospital homes; hospital-based homes use the same schedule.

Funding

None.

Source

https://bms.wv.gov/media/40779/download?inline

Verified October 11, 2026

Quality program

Active

Yes

Program

Quality component of the PDPM rate (Ch. 514 §514.12.12(7); 'Quality Scoring Metrics and Special Population Determination', eff. 7/1/2026).

Funding

New money built into the rate system with the 10/1/2024 PDPM move (SPA 24-0004 estimated +$22.6M FY2025 and +$35.3M FY2026 for the whole change). It is a fixed pool, not a withhold.

Size

$60,000,000 per year as of 10/1/2024, inflated annually by the SNF market basket. 90% ($54M base) goes to quality scoring metrics and 10% ($6M base) to special populations.

Paid as

Per-diem add-on inside each home's posted rate, recalculated semiannually.

Measures

Measure	Source	Weight	How points are earned
Long-stay residents with an indwelling catheter	MDS QM (CMS Care Compare)	25 points	Tier cut points: <=0.33% 25 pts; <=0.88% 20; <=2.00% 15; <=4.51% 10; >4.51% 5
Long-stay residents with a urinary tract infection	MDS QM (CMS Care Compare)	25 points	<=1.64% 25; <=2.77% 20; <=5.00% 15; <=7.00% 10; >7.00% 5
Long-stay residents who received an antipsychotic medication	MDS QM (CMS Care Compare)	25 points	<=9.00% 25; <=13.01% 20; <=20.03% 15; <=28.03% 10; >28.03% 5 (cut points updated 7/1/2026)
Long-stay residents with depressive symptoms	MDS QM (CMS Care Compare)	25 points	<=0.00% 25; <=1.50% 20; <=5.00% 15; <=13.50% 10; >13.50% 5
Special population: Medicaid-primary residents coded 1-3 on behavioral symptoms (E0200A-C), rejection of care (E0800) or wandering (E0900)	MDS	10% of pool	Share of statewide qualifying Medicaid assessments x Medicaid days

Scoring period

July rates use the April Care Compare release; January rates use the October release (four quarters, one period in arrears). The special population uses the two most recent MDS quarters (Q4+Q1 for July; Q2+Q3 for January). Benchmarks were set from Q1-Q2 2023 statewide performance.

Payment formula

Quality dollars = pool x (home's score/100 x Medicaid days) / statewide sum. Special population dollars = pool x (home's share of qualifying assessments x Medicaid days) / statewide sum. Both are divided by the home's annualized Medicaid days to get the per diem. Missing data or a home not in Care Compare gets Tier 3 (15 points) for that measure.

Eligibility

All Medicaid NFs on the standard method. New providers get set 'new provider' points, with Medicaid days imputed at statewide average occupancy. No survey-based disqualifier was found.

Cadence

Scored and paid semiannually (January 1 and July 1).

Scores published

Per-facility scores and quality per diems were not found on the BMS site; rate letters are mailed or emailed to administrators.

Notes

Staffing HPRD and high-risk pressure ulcers appear on the scorecard for information only. The old system's efficiency incentive (up to $2.00/day) ended 9/30/2024.

Verified October 11, 2026

Provider tax

Charged

% of net patient revenue

Standard amount

5.5% of gross receipts (amounts received or receivable from patients, third-party payors and others for NF services, net of previously taxed bad debts) - W. Va. Code §11-27-11(b).

Lower for high-Medicaid homes

no

Returned in the rate

No dedicated add-on or pass-through for the tax was found. Facility taxes flow through the 'taxes and insurance' cost center, which is paid at the home's own cost in the pass-through component (with a 2022 base year and an 85% occupancy floor). Confirm that the provider tax is reported there.

Source

https://code.wvlegislature.gov/11-27-11/

Verified October 11, 2026

Provider tax notes

Health care provider tax on nursing facility services (W. Va. Code §11-27-11): 5.5% of gross receipts from all payers, all NFs except ICF/IID. Not returned through a specific add-on. Taxes are part of the 'taxes and insurance' cost center paid in the uncapped pass-through component, but whether the provider tax is an allowable cost there was not confirmed.

Verified October 11, 2026

Supplemental payments

None found. Chapter 514 (eff. 7/1/2026), SPA 24-0004 and the MHT contract show no NF upper-payment-limit, IGT-funded, or MCO directed payments. The 2019 MACPAC compendium also found none. COVID-era add-on: a $20 per patient day increment ended for dates of service on or after 5/1/2022 (BMS letter 4/29/2022).

Verified October 11, 2026

Other add-ons

(1) $4.21/day added to the pass-through per diem from 10/1/2024 until the rebase using CY2025+ cost reports. (2) Phase-in adjustment (old/new blend) through 6/30/2027. (3) FRV capital hold-harmless add-on through 6/30/2028. (4) Special-population (behavioral) share of the quality per diem. (5) Nurse aide training reimbursement up to $500 per aide ($400 training + $100 competency), paid outside the rate. No ventilator, bariatric or other condition add-ons; resident-specific equipment (e.g., bariatric beds, BiPAP) sits in direct care cost. The $20 COVID increment ended 5/1/2022.

Verified October 11, 2026

Units paid separately

Hospital-based NFs are paid on the same fee schedule (e.g., Roane General, Hampshire Memorial, War Memorial, Weirton Medical Center) and may form their own peer group (not confirmed). State-owned NFs are excluded from Attachment 4.19-D-1. The former state homes (Hopemont, John Manchin Sr., Lakin) appear as 'Majestic Care of ...' on the standard 7/1/2026 schedule. No separate ventilator, brain-injury or behavioral unit rates were found. Hospice residents: BMS pays the hospice 95% of the NF rate including the resident's acuity adjustment; the hospice pays the home room and board.

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

no

Detail

Mountain Health Trust carves out long-term care and NF services ('Not covered' in the 2026 MHT contract benefit grid). MCO enrollees placed in a NF for more than 30 consecutive days are disenrolled. During that month the MCO covers other medical costs and BMS pays the facility. Mountain Health Promise (foster/kinship youth, Aetna) does not cover NF care either.

Verified October 11, 2026

Who pays

fee_for_service. Mountain Health Trust (MHT), the risk-based managed care program covering about 87% of WV Medicaid members (Aetna Better Health, The Health Plan, Highmark Health Options, Wellpoint), carves out long-term care. The 2026 MHT contract lists 'Nursing Facility Services ... Not covered'. Members in continuous nursing facility placement for more than 30 days are disenrolled, and BMS pays the facility's bundled payment directly. All NF days are paid fee-for-service by BMS through Gainwell.

Verified October 11, 2026

Managed care rate floor

Not applicable: MCOs do not pay nursing facility per diems (2026 MHT contract).

Verified October 11, 2026

Included in the daily rate

All-inclusive rate (Ch. 514 §514.7): nursing and restorative care; rehabilitative therapy (PT, OT, speech, respiratory, psychological/psychiatric rehab); OTC drugs and all diabetic supplies; medical supplies and standard equipment (beds, wheelchairs, lifts, nebulizers, air mattresses); room and board; laundry; dietary including tube feedings; activities; social services; and non-emergency medical transportation (the home must provide or contract it). Paid separately as ancillary services: prescription drugs (pharmacy), prosthetics/orthotics, dental, vision, podiatry, lab/x-ray by certified hospitals or labs, and emergency ambulance.

Verified October 11, 2026

Bed hold

Hospital stays

Paid, within a combined 18 days per resident per calendar year for all leave types, at the facility's non-acuity adjusted rate (all components with no case-mix adjustment). Rev code 0185 covered, 0189 non-covered.

Leave days

Same combined 18-day annual limit and non-acuity rate.

Occupancy rule

None since 10/1/2024 (the 95% occupancy + waiting list requirement was eliminated).

Notes

Medicaid must be primary payer when the resident leaves; no bed hold if the MDS shows return not anticipated. After the days run out, a home may charge the family only when there are no vacancies and a waiting list. The PNA may pay for a hold only with written consent. Before 10/1/2024: 12 medical + 6 therapeutic days at the base rate, only at 95%+ occupancy with a waiting list. CY2024 was pro-rated to 18 total days.

Source

https://bms.wv.gov/media/41391/download?inline

Verified October 11, 2026

Personal needs allowance

Per month

50

Effective

Income Maintenance Manual §24.7.3.A.1 (binder effective 10/5/2026); long-standing amount, start date not found

Notes

$90 for residents getting the reduced $90 VA pension. $30 for SSI recipients in the facility at least three months. Not COLA-indexed. Facilities must hold resident funds above $50 in an interest-bearing account.

Source

https://bfa.wv.gov/media/40005/download?inline

Verified October 11, 2026

Medicare coinsurance days

Method

lesser_of

Rule

BMS Chapter 600 (§640 TPL/crossover, revised 2006): Medicaid pays the Medicare deductible and coinsurance 'up to WV Medicaid fee schedule'. When a third party has paid, it pays the lesser of (Medicaid allowed amount minus the primary payment) or the coinsurance plus deductible due. Chapter 600 also says Medicaid does not reimburse HMO/capitation-related co-pays and deductibles, and the member is not liable. How this applies to Medicare Advantage SNF cost-sharing today is not confirmed.

Effect

Medicare's SNF day-21+ payment usually exceeds the WV Medicaid per diem for the resident's group, so the home usually receives $0 of the coinsurance.

Source

https://bms.wv.gov/media/32826/

Verified October 11, 2026

Required care spending

Applies

yes

Rule

Prospective spending floors (Ch. 514 §514.12.12; SPA 24-0004). Direct care: if base-year normalized direct care cost per day is below 80% of the peer-group price, the price is cut by the shortfall, so the home gets cost + 20% of the price. Care-related and operational components use 75% floors, the same way. This cuts the rate going forward based on base-year spending, with no year-end recoupment. Pass-through and liability insurance are paid at cost.

Source

https://bms.wv.gov/media/41391/download?inline

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

Cost per day uses the greater of actual resident days or a minimum share of bed days: direct care 70%, care-related 75%, liability insurance 80%, operational and pass-through 85%, FRV capital 90% of licensed capacity. Homes below these levels lose that share of cost. New providers' quality-day counts also use the minimum occupancy. Before 10/1/2024: a 90% minimum on all cost centers (relaxed to 70% during COVID; 70% continued from 5/1/2022).

Source

https://bms.wv.gov/media/41391/download?inline

Verified October 11, 2026

MDS accuracy penalties

Late or missing MDS: the default rate must be billed (HIPPS ZZZZZ, lowest group). MDS transmitted after the monthly extraction date is not loaded until the next month, and authorizations are not loaded manually. Under the OSA period (ARDs 10/1/2023-9/30/2024), a missing OSA could mean the lowest case mix score. OAMR desk and field audits disallow unsupported costs as overpayments. No MDS-audit-based recoupment program was found.

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

semiannual

When

January 1 and July 1. Each July 1: inflation update (or rebase) of the cost components, capital (FRV) recalculation and re-aging, quality per diem and phase-in step. Each January 1: quality and special-population per diems are recalculated and the phase-in blend is reapplied. Per-resident case mix changes the payment on every claim with each new assessment. Before 10/1/2024, rates were set for six-month periods starting April 1 and October 1.

Verified October 11, 2026

When rates change

January 1 and July 1 (state fiscal year starts July 1). The PDPM system started 10/1/2024; the next periods were 1/1/2025, 7/1/2025, 1/1/2026, 7/1/2026 and 1/1/2027. A new owner after 10/1/2024 keeps the prior owner's rate until its own cost report (six months or more) is used, starting the following July 1. New providers get statewide average component rates for their bed group, except capital and quality.

Verified October 11, 2026

Posted rates

Home-level rates published

Yes

Where

https://bms.wv.gov/providers/west-virginia-medicaid-fee-sched…

Format

pdf (linked as 'Excel Document'): one row per facility with a per diem for each of 26 nursing HIPPS codes (A-Y plus BC1 default)

Cadence

Semiannual (1/1-6/30 and 7/1-12/31).

History

Only the current and prior period are posted (7/1/2026-12/31/2026 and 1/1/2026-6/30/2026). A 7/1/2024-9/30/2024 RUG-era rate file is linked on the Long-Term Care Services page.

Home identifier

Facility name only (no NPI, CCN or Medicaid number).

Verified October 11, 2026

Rate build-ups

Published

No

Where

Rate letters go to each home's administrator by mail or email (cost report memo 2/13/2026). BMS posts methodology, a cost component crosswalk, quality metrics and recorded trainings at https://bms.wv.gov/long-term-care-services but no per-facility build-up.

What they show

Fee schedule: final per diem by PDPM nursing group only. The direct-care price at CMI 1.0 and the non-acuity remainder can be backed out because rates are linear in CMI. Components, prices, floors, quality and phase-in amounts are not shown.

Format

pdf

Example file

https://bms.wv.gov/media/41376/download?inline

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

no

Program

None. The Aged and Disabled Waiver (1915(c), Ch. 501 eff. 6/1/2026) states 'ADW services may not be provided in assisted/independent living residences or group residential facilities'.

What is paid

Nothing for assisted living services. State plan Personal Care (Ch. 517) generally may not be provided in assisted living residences. Exceptions need BMS approval and only cover services beyond what the residence must provide by law.

Limits

Not applicable.

Source

https://bms.wv.gov/media/41402/download?inline

Verified October 11, 2026

Sources

1. BMS Provider Manual Chapter 514 Nursing Facility Services (effective 7/1/2026) · agency page
2. SPA WV 24-0004, Attachment 4.19-D-1 (PDPM transition, eff. 10/1/2024, approved 8/28/2025) · state plan
3. SPA 24-0004 public notice (fiscal impact) · agency page
4. SPA 26-0003 public notice (fair rental value capital, eff. 7/1/2026) · agency page
5. BMS Nursing Facility Fee Schedule 7/1/2026-12/31/2026 · rate file
6. BMS Nursing Facility Fee Schedule 1/1/2026-6/30/2026 · rate file
7. BMS Nursing Facility Fee Schedules page · agency page
8. BMS Long-Term Care Services page (methodology documents, trainings, memos) · agency page
9. Quality Scoring Metrics and Special Population Determination (eff. 7/1/2026) · agency page
10. West Virginia Case Mix Reimbursement System FAQ (Myers and Stauffer, 9/12/2024) · agency page
11. Payment and Billing Procedures eff. 10/1/2024 · agency page
12. PDPM Case Mix Classification Sheet eff. 10/1/2024 · agency page
13. OAMR memo: Bed Holds reporting and billing clarification (2/20/2025) · agency page
14. OAMR memo: Financial and Statistical Reports ended 12/31/2025 (2/13/2026) · agency page
15. BMS letter: Amended Nursing Facility Services Rate Clarification (4/29/2022; $20 COVID increment ends, 70% occupancy kept) · agency page
16. BMS memo: Long-Term Care Rate Setting Update (2/18/2021; SAV appraisals) · agency page
17. BMS Provider Manual Chapter 600 Reimbursement Methodologies (TPL/crossover) · agency page
18. W. Va. Code §11-27-11 (tax on nursing facility services) · statute
19. Mountain Health Trust (Managed Care) page · agency page
20. 2026 Mountain Health Trust MCO contract · agency page
21. WV Income Maintenance Manual (binder eff. 10/5/2026), §24.7.3.A.1 PNA · agency page
22. BMS Provider Manual Chapter 501 Aged and Disabled Waiver (eff. 6/1/2026) · agency page
23. BMS Provider Manual Chapter 517 Personal Care Services (eff. 1/1/2018) · agency page
24. MACPAC Nursing Facility Payment Policies compendium (2019 baseline, out of date) · secondary

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