Medicaid Waiver Guide – West Virginia

Understanding West Virginia Medicaid Waivers

West Virginia currently has four Medicaid waivers/programs that can serve children, including a TEFRA program and three home and community based 1915(c) waivers. This includes a newer program for children with Serious Emotions Disorder that was started in 2020. The TEFRA program is based only on child income without regard to parent income, while the DD and TBI waivers do count parent income. For more information, see West Virginia’s Medicaid Waivers page.

Types of Waiver Programs

Children with Disabilities Community Service Program

• Description: Provides Medicaid coverage only.
• Online State Information: Children with Disabilities Community Service Program and brochure
• How to Apply: Contact the Program at 304-776-7230 or apply through PCA Solutions

Intellectual and Developmental Disability Waiver

• Description from medicaid.gov: Provides facility based day hab, home-based agency person-centered support, in-home respite,  prevocational, service coordination, supported employment, dietary therapy, OT, PT, speech therapy, participant-directed goods and services, behavior support professional, crisis intervention, crisis site person-centered support, electronic monitoring, environmental accessibility adaptations, family person-centered support, job development, licensed group home person-centered support, out-of-home respite, skilled nursing by a LPN, skilled nursing a RN, transportation, unlicensed residential person-centered support for individuals with ID/DD, ages 3 – no max age.
• Online State Information: Intellectual/Developmental Disabilities Waiver
• Official Federal Information
• How to Apply: Contact at 304-558-1700 or follow these application instructions. Evaluation is through Kepro.

Traumatic Brain Injury (TBI) Waiver

• Description from medicaid.gov: Provides case management, personal attendant services, community transition services, pre-transition case management, and transportation to individuals with brain injuries, ages 3 – no max age.
• Online State Information: Traumatic Brain Injury Waiver and this brochure
• Official Federal Information
• How to Apply: Contact 304-558-1700 or follow these application instructions. Evaluation is through Kepro.

Children with Serious Emotional Disturbance Waiver

• Description from medicaid.gov: Provides wraparound facilitation, in-home family support, independent living/skills building, job development, respite care (in-home), supported employment-individual, assistive equipment, community transition, family therapy, mobile response, non-medical transportation, peer parent support, respite care (out-of-home), and specialized therapy services to individuals with mental illness ages 18-21 years and individuals with serious emotional disturbance ages 3-17 years who meet a hospital level of care.  This waiver operates with a concurrent 1915(b)(1) and 1115 authority.
• Online State Information: Children with Serious Emotional Disturbance Waiver
• Official Federal Information
• How to Apply: Contact the program at 844-HELP4WV​ or follow the instructions on this page. Evaluation is performed by Kepro.

Other online resources for West Virginia:

A guide to accessing services in West Virginia.
Find specialized services providers for autism near you using this map
West Virginia Parent Training and Information Inc

Telephone Resources:

Contact West Virginia for Medicaid Services at (304) 558-1700 for a good place to get started on this process.

Ordering Goally with a Medicaid Waiver

Talk with your case manager to see if the waiver program you have will cover Goally. If so, have your case manager email us at: [email protected] to place an order on your behalf.