For families and caregivers

How to get paid to care for a family member in West Virginia: ADW and Personal Options

By the CaregiverConnect team · Updated 2026-10-26 · Sources checked on the same date and listed at the end.

In West Virginia, the Medicaid program whose state materials spell out hiring friends or family as paid help at home is the Aged and Disabled Waiver (ADW). Under its self-directed model, Personal Options, the person who needs care hires their own personal attendant, and that attendant can be an adult child, sibling or other relative, though never a spouse or court-appointed guardian. This guide walks through eligibility, the application, the relative rules and payroll, using the state's own program pages and the policy manual in force from June 1, 2026.

A smiling caregiver with her arm around an older woman in a bright room at home

Which West Virginia programs pay a family caregiver

Two Medicaid programs cover hands-on help at home in West Virginia, and a family member can be on the payroll of either one, subject to the limits further down. A third set of state programs helps families without paying them.

Program	How a relative gets paid	Who it serves
Aged and Disabled Waiver, Personal Options	Hired directly by the member, who is the employer; payroll through the fiscal agent	Adults 18 and over who meet nursing home level of care
Aged and Disabled Waiver, Traditional	Employed by an ADW agency as a personal attendant	Same as above
Medicaid Personal Care (State Plan)	Employed by an enrolled Personal Care agency	Medicaid members with three deficits on the screening assessment
Lighthouse and FAIR	Not a paid caregiver route; they send trained staff or respite hours	People 60 and over, and people with Alzheimer's or related dementia

The ADW page states that a person can be on the ADW and State Plan Personal Care at the same time if they qualify, but cannot be on two waivers at once. It also says ADW members themselves cannot work as paid caregivers in another waiver or in the Personal Care program.

Aged and Disabled Waiver: who qualifies

According to the ADW program site run by the West Virginia Department of Human Services, the person receiving care must:

be 18 or older and live in West Virginia;
meet the Medicaid waiver financial rules, decided by the DoHS county office or the Social Security Administration. The Chapter 501 manual caps gross monthly income at 300% of the current maximum SSI payment, and protects some of a couple's assets for the spouse who stays at home;
be approved for nursing home level of care through a medical assessment done by a nurse;
have needs in at least five areas of daily living, such as eating, bathing, dressing, grooming, moving around and using the restroom;
choose the waiver instead of a nursing home, and offer a safe place for attendants, nurses and case managers to work.

Approval does not guarantee an immediate start. A funded opening has to be available. When none is, eligible applicants go on the Managed Enrollment List, ordered by the date of their completed medical request; the manual says BMS does not rank applicants by need or issue emergency slots. Medical and financial eligibility are re-established every year, and there is no limit on how long someone can stay on the program while they keep qualifying.

How to apply: the MNER form, Acentra Health and the wait

Medical request. A doctor (MD or DO), physician assistant or nurse completes and signs the Medical Necessity Evaluation Request (MNER) form and sends it to Acentra Health-ADW, 1007 Bullitt Street, Charleston, by fax to 866-212-5053. The form is linked from the ADW home page.
Financial application. Within two business days of receiving the MNER, Acentra sends the applicant a long-term care application. The manual gives the applicant 60 calendar days to complete it and return it to the DoHS Long-Term Care Unit. Financial eligibility is decided first.
Nurse assessment. Medical eligibility is then set through the pre-admission screening, which Acentra schedules (844-723-7811).
Choose a model. The member picks Traditional (an agency employs the attendant) or Personal Options (the member hires).

The ADW page reports that the whole process, from MNER to activation, averages 56 days, and that the average time on the waiting list last fiscal year was 44 days. Questions about the application go to the Bureau of Senior Services at 1-866-767-1575. While waiting, a person with suitable Medicaid coverage may be able to use the Medicaid Personal Care program.

Which relatives can be paid under Personal Options, and which cannot

The state's Personal Options brochure, published on the ADW site, says participants may advertise for an employee or hire friends or family. The limits come from the ADW page and Chapter 501 (effective June 1, 2026):

Spouse: no. Medicaid bars legally responsible persons from being paid for ADW services, and the manual defines that term as the spouse.
Court-appointed legal guardian: no. Guardians are also barred from being paid caregivers.
Adult children, siblings, grandchildren and other relatives: yes, if they meet the attendant requirements.
Medical power of attorney, power of attorney or health care surrogate: possible, with conditions. They may provide services if they work for an ADW agency, or, if the member self-directs, the member must have a separate program representative who is not that person.
Program representative: unpaid, and cannot also be the attendant. A member may name a family member or friend aged 18 or over to help run the employer side. That person cannot be paid for it and cannot be the member's paid attendant.

Every personal attendant must be at least 18, finish the initial competency-based training before starting work and the annual training after that, hold a CPR and First Aid card, and clear a fingerprint-based background check. The manual also warns that when the attendant is a relative or lives in the home, services must be for the sole benefit of the member. For example, a paid relative cannot bill for taking the member to family events or to visit the attendant's own parent.

The State Plan Personal Care manual (Chapter 517) has a slightly wider bar: spouses, parents of a minor child, court-appointed guardians and conservators cannot be paid, and a power of attorney or health care surrogate can work only if employed by a Personal Care agency.

Hours, budgets and who runs payroll

Hours. The nurse assessment scores the member's needs and places them in one of four service levels. Chapter 501 sets the monthly range of personal attendant hours for the Traditional model as follows; Personal Options members instead get an individual monthly budget based on their assessed needs.

Service level	Assessment points	Hours per month (Traditional)
A	5-9	0-62
B	10-17	63-93
C	18-25	94-124
D	26-44	125-155

The manual is clear that the top of a range is not guaranteed if the need is not identified. The Personal Care program allows up to 210 hours a month based on assessed need.

Payroll. Under Personal Options the member is the common law employer; the fiscal/employer agent (F/EA) is not. The F/EA processes timesheets, withholds and files federal and state employment taxes, runs payroll, helps with I-9 forms and background checks, and handles year-end tax reporting. The member reviews and signs the attendant's timesheets, sets the schedule, trains and supervises. The Personal Options brochure on the state site names Palco as the financial management service (1-866-710-0456), and Palco's own West Virginia page says it has served the program since 2024.

How much a family caregiver earns in West Virginia

No official page we found publishes a set hourly wage for Personal Options attendants. The Palco brochure says the member decides employees' rates of pay within federal and state limits and the approved budget. These figures are reference points, not program wages:

Agency billing rate. The ADW rate chart effective April 1, 2026 pays Traditional agencies $6.75 per 15-minute unit of personal attendant service. That is what Medicaid pays the agency, which also covers its costs; it is not the attendant's wage.
Market wage. Federal OEWS estimates for May 2025 put 18,890 home health and personal care aides on West Virginia payrolls. Half earned less than $13.47 per hour, and the average was $13.35.
Minimum wage. The state's $8.75 floor covers employers with at least six non-exempt workers at one location, the Division of Labor explains; below that threshold, the federal minimum governs.

Other routes: VA programs, taxes and private hiring

Veterans. If the person you look after served, two VA options exist. PCAFC, the VA's comprehensive family caregiver program, sends a monthly stipend to whoever is designated Primary Family Caregiver. To qualify, the veteran must hold a VA rating (individual or combined) of at least 70%, have VA health care enrollment, and need six or more months of continuous hands-on help in person. On your side, you must be an adult who is a relative, step-relative or extended family member, or who lives full time with the veteran or is willing to. One primary and two secondary caregivers can be named, and the joint application is online or on VA Form 10-10CG. The other option, Veteran Directed Care, hands the veteran a spending budget plus a counselor, and the workers hired with it may be relatives or neighbors. It is not offered everywhere, so raise it with the veteran's VA social worker.

Taxes. The ADW is a Medicaid waiver, so IRS Notice 2014-7 can apply: the IRS treats qualifying 1915(c) payments as difficulty-of-care payments left out of gross income, provided attendant and member live under one roof. A relative who drives over from their own house each day does not get the exclusion, according to the IRS questions and answers. Families paying a helper out of pocket fall under IRS Topic 756 instead. For 2026, $3,000 in cash wages to one household worker is the point where Social Security and Medicare withholding generally starts, with carve-outs for your spouse, your own child under 21 and, unless an exception applies, your parent.

Paying privately. Families who do not qualify, or who need more hours than the waiver covers, can hire directly. You become the household employer and set the pay. See how to hire a private caregiver and Medicaid programs for family caregivers for how other states compare.

Where to get help in West Virginia

West Virginia Aging and Disability Network: 1-866-981-2372, for long-term care options for people 60 and over or adults with a physical disability, including Lighthouse (state-funded help for people 60 and over whose income or assets are above Medicaid limits) and FAIR (up to 16 hours a week of in-home respite for families caring for someone with Alzheimer's or a related dementia).
Bureau of Senior Services: 1-866-767-1575 for ADW questions.
Abuse, neglect or exploitation of an adult: DoHS Centralized Intake, 1-800-352-6513, or the online report form. Anyone may report; state law gives mandated reporters no more than 48 hours.

How CaregiverConnect fits

CaregiverConnect cannot sign anyone up for the ADW or Personal Options. It is a marketplace, not a Medicaid provider, home care agency or fiscal agent. Families describe the help they need in a free post and then hire a caregiver themselves, which makes the family the employer. Caregivers create profiles free of charge and answer posts. We do not do background checks, though caregivers can attach proof of their own. If a Personal Options member wants a wider pool of applicants, a post can surface candidates, but the hire, the training and the payroll still run through the program and Palco. Families around Clarksburg can browse caregivers in Clarksburg. Read how it works or see optional plans. Caregivers can start with how to write a caregiver profile.

Frequently asked questions

Can I get paid to take care of my mom in West Virginia?

Yes, if your mother qualifies for the Aged and Disabled Waiver and chooses Personal Options, she can hire you as her personal attendant, or an ADW or Personal Care agency can employ you. You must be 18 or older, complete the required training, CPR and First Aid, and pass a fingerprint background check. You cannot also be her program representative, and if you hold her power of attorney a different person must serve as representative.

Is a husband or wife allowed to be the paid caregiver in West Virginia?

No. Both the ADW page and the Chapter 501 manual exclude spouses, and the Personal Care manual does too. Court-appointed legal guardians are also excluded.

How do I apply for the Aged and Disabled Waiver in West Virginia?

Have a doctor, physician assistant or nurse complete the MNER form and fax it to Acentra Health at 866-212-5053. You then complete a long-term care financial application with DoHS, followed by a nurse assessment. Call the Bureau of Senior Services at 1-866-767-1575 with questions.

Is there a waiting list for the West Virginia ADW?

There can be. Eligible applicants go on the Managed Enrollment List when no funded slot is open, in order of their completed MNER date. The state reports an average wait of 44 days last fiscal year and about 56 days on average for the full process from MNER to activation.

Who pays the caregiver under Personal Options?

The fiscal/employer agent, Palco, runs payroll from the member's budget after the member signs the timesheets, and withholds employment taxes. The member, not Palco, is the legal employer.

How many hours can a paid family caregiver work in West Virginia?

It depends on the member's service level. Traditional ADW ranges run from up to 62 hours a month at Level A to 125-155 hours at Level D; Personal Options members work within an individual monthly budget. State Plan Personal Care allows up to 210 hours a month.

Does Medicaid pay family caregivers in West Virginia if the person has dementia?

Dementia counts toward the ADW assessment score, so a person with Alzheimer's may qualify for the waiver and hire a relative through Personal Options. The separate FAIR program gives family caregivers respite hours, not pay.

Sources

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