Every answer was written and checked ahead of time, with the official document next to it. Nothing is made up on the spot.
Do I need a license to run a non-medical home care agency in West Virginia?
A Certificate of Need for a new Medicaid personal care agency; for private pay, our documents don't settle it.
We found no separate state license for non-medical home care agencies. West Virginia's CON law requires a Certificate of Need from the Health Care Authority, whatever the cost, for "providing personal care services". It defines these as personal hygiene, dressing, feeding, nutrition, environmental support and health-related tasks provided by a personal care agency, which it defines as "an entity that provides personal care services approved by the Bureau of Medical Services." So a new Medicaid Personal Care agency needs a CON, as Chapter 517 also says. The law doesn't say whether an agency that serves only private-pay clients is covered, and we don't hold §16-2D-10, one of the law's two exemptions sections. To bill Medicaid you also need program certification: Personal Care agencies are certified by the operating agency after the CON, and Aged and Disabled Waiver agencies are certified by the operating agency. The waiver application lists that certification in the 'License' field for personal attendant agencies. Ask the Health Care Authority before you serve private-pay clients.
Written and checked September 23, 2026
How do I become a Medicaid Personal Care provider?
Get a Certificate of Need first.
Chapter 517 says any new Personal Care provider must go through the Certificate of Need (CON) process with the West Virginia Health Care Authority. After the CON, send a Certification Application to the operating agency, which does an onsite review before you enroll with the BMS fiscal agent. Adding counties later needs a new CON.
Written and checked September 23, 2026
How does an agency get certified for the Aged and Disabled Waiver?
Through the operating agency.
Send a Certification Application to the operating agency (the Bureau of Senior Services). It checks items such as a West Virginia business license, FEIN, written policies and a staffed West Virginia office, and schedules an onsite review. The onsite review may be waived for licensed behavioral health centers and current Personal Care, TBI Waiver or IDD Waiver providers. Certification is renewed every year.
Written and checked September 23, 2026
Do live-in caregivers have to use EVV in West Virginia?
Not in the ADW or TBI Waiver.
The Aged and Disabled Waiver and TBI Waiver manuals say personal attendants who live in the member's home are not required to use EVV. In its 2026 answers to public comments, BMS said agencies may choose to require EVV for all in-home caregivers or only those who don't live with the member. A live-in attendant does not need an NPI to bill for the member they live with, but does for other members.
Written and checked September 23, 2026
Can I use my own EVV system instead of HHAeXchange?
Yes, if it sends data to HHAX.
West Virginia uses an 'open' EVV model: you can use the free HHAeXchange system or your own. If you use your own, it must send visit data to HHAX in real time, capture the six data elements the 21st Century Cures Act requires, and you must complete HHAX's attestation and testing. You can't use both systems at the same time for services under one provider number.
Written and checked September 23, 2026
Do my aides need their own NPI?
Yes, for services that need EVV.
EVV requires each personal attendant to have their own National Provider Identifier (NPI) to link the worker to the member. BMS told ADW, IDD Waiver, TBI Waiver and Personal Care agencies that, from November 1, 2022, EVV claims must include the caregiver's NPI and be sent to Gainwell through HHAX. Home health and private duty nursing workers also need NPIs.
Written and checked September 23, 2026
Can a new hire start work while the WV CARES check is pending?
Not personal care workers.
The WV CARES rule allows provisional employment for up to 60 days after fingerprints, with direct on-site supervision by a cleared employee and a signed statement that the worker has no disqualifying offense. But that section does not apply to applicants who will be personal care workers or the equivalent, whatever their job title. The Aged and Disabled Waiver manual also says ADW does not allow provisional employees. BMS Chapter 700 (2018) describes provisional hiring without that exception; this page follows the 2025 rule.
Written and checked September 23, 2026
How do we report suspected abuse or neglect?
Call Centralized Intake right away.
The ADW manual says anyone serving a member who suspects abuse, neglect or exploitation must call West Virginia Centralized Intake at 1-800-352-6513, 24 hours a day, seven days a week. Follow up with a written report to the local DoHS office within 48 hours for Adult Protective Services or 24 hours for Child Protective Services, and record the referral number in the incident system (WV IMS).
Written and checked September 23, 2026
What does Medicaid pay for ADW personal attendant services?
$6.75 per 15 minutes.
Since October 1, 2025, ADW personal attendant services (S5130, and S5130 UK for live-ins) pay $6.75 per 15-minute unit, up from $6.36. Personal Care direct service (T1019) pays the same. BMS asked agencies to update the rates in their billing systems and in HHAX.
Written and checked September 23, 2026
Do Medicaid health plans pay for home care in West Virginia?
Not for waiver services.
Members enrolled in home and community-based waivers (except the children's CSED waiver) are not enrolled in a Mountain Health Trust plan, and waiver claims go to Gainwell, BMS's fiscal agent. For home health, a member in a plan follows the plan's coverage and prior authorization rules. HHAeXchange's 2022 slides list Aetna Better Health of West Virginia, Unicare and The Health Plan as plans for home health and private duty nursing; we don't hold a newer plan list.
Written and checked September 23, 2026