How West Virginia pays for disability services
West Virginia ranks 33 of 51 on Medicaid waiver funding for people with intellectual and developmental disabilities, with a score of 60.1 out of 100.
Medicaid waivers in West Virginia
Waiver inventory
| Program name | Authority | Population served | Enrollment (with year) | Residential covered? | Official URL |
|---|---|---|---|---|---|
| Intellectual/Developmental Disabilities Waiver (IDDW) | 1915(c), CMS control no. WV.0133.R08 | People of all ages with intellectual disability or a related developmental condition meeting ICF/IID level of care | 6,158 active members, June 2026 (6,165 CMS-approved slots) | Yes: Person-Centered Support in Licensed Group Home; Unlicensed Residential Person-Centered Support; Home-Based Person-Centered Support; Family Person-Centered Support; Crisis Site Person-Centered Support | iddwprogram.wv.gov ; approval letter bms.wv.gov |
| Applied Behavior Analysis benefit (autism) | Medicaid state plan / EPSDT, delivered through Mountain Health Trust and Mountain Health Promise | Children with autism spectrum disorder | Not found | No | bms.wv.gov |
| Traumatic Brain Injury Waiver (TBIW) | 1915(c) | People with traumatic brain injury | 94 active, June 2026 (102 slots) | Not confirmed in retrieved documents | bms.wv.gov |
Excluded per scope: Aged and Disabled Waiver (1915(c), 8,707 active June 2026), Children with Serious Emotional Disorders Waiver (1915(c)), Mountain Health Trust and Mountain Health Promise (1915(b)), and the SUD 1115 demonstration. West Virginia has no 1915(i), 1915(k)/Community First Choice, or 1915(b)(3) authority serving people with IDD that I could locate on the state waiver-approvals page.
State-only funded programs
Administered by the West Virginia Department of Human Services, Bureau for Behavioral Health (BBH), listed at bbh.wv.gov :
- Family Support Program. State-funded flexible grants for families supporting a member with a developmental disability at home. Pays for clothing and adaptive equipment, occupational and physical therapy, home and environmental modifications, respite, medical transportation, training, and utility/rent/mortgage assistance. Policy effective March 1, 2024 states, "This grant is based upon the availability of State funds, which are designated on a state fiscal basis (July 1 to June 30)." Administered through six regional Family Support Councils hosted by Brooke Hancock FRN, East Ridge Health Systems, Westbrook Health Services, LiveAbility, Prestera Center, and Southern Highlands/Seneca Health Systems/FMRS Health Systems. Annual appropriation: not found. Policy: bbh.wv.gov ; application: bbh.wv.gov
- Waitlist Support Grant Program. State grant providing interim support to people approved for the IDDW who are on the managed enrollment list. Appropriation: not found. iddwprogram.wv.gov ; bbh.wv.gov
- Unmet Needs Program, Customized Employment, and Traumatic Brain Injury Funds, all BBH-administered day and community support programs. Appropriations: not found. bbh.wv.gov
Checked and could not retrieve dollar figures: WV Governor's Recommended FY2027 budget volumes (https://budget.wv.gov/governors-recommended-budget-fy-2027 ; Volume II exceeded fetch size limits), BBH program pages, and BMS legislative interim reports (Medicaid only, no BBH general revenue detail).
County / regional / local funding
None identified. West Virginia delivers IDD and behavioral health services through 13 regional comprehensive behavioral health centers and six BBH regions rather than county boards or county levies. Nothing on bms.wv.gov, bbh.wv.gov, or iddwprogram.wv.gov describes a county tax, county board, or local mill levy dedicated to IDD services.
Funding scale
- IDD Waiver expenditures, SFY2026 year to date through 6/30/2026: $466,989,757 all funds, against a budget of $414,966,408, a variance of +$52,023,349. bms.wv.gov
- ICF/IID expenditures, SFY2026 YTD: $77,735,197 (private providers); $0 public providers. Same source.
- Aged and Disabled Waiver, SFY2026 YTD: $254,483,573. TBI Waiver: $3,567,398. Same source.
- Total West Virginia Medicaid expenditures, SFY2026 YTD: $6,934,432,332. Same source.
- FMAP: 74.22% applicable October 2025 through June 2026 per the BMS report above. KFF lists West Virginia's FY2027 regular FMAP at 74.25%. kff.org
- State vs federal share (computed): at 74.22% FMAP, the SFY2026 IDD Waiver spend splits to roughly $346.6M federal and $120.4M state. Computed, not published.
- Spending per participant (computed): $466,989,757 divided by 6,158 active members is approximately $75,800 per person per year. Computed. The approved waiver's own Year 1 per-capita waiver-services estimate is $91,332.17, with $6,886.93 for other Medicaid state plan services and $124,533.30 for the institutional comparison. bms.wv.gov
- People served in the DD waiver: 6,158 active at end of June 2026; 6,165 CMS-approved slots for all five renewal years. bms.wv.gov
- Waiting list (Managed Enrollment List): 1,317 applicants as of June 2026; longest wait 1,828 days (about 5.0 years). In June 2026 alone, 46 applicants were added, 2 were enrolled, and 8 were removed due to death. Same source. For comparison, the MEL stood at 1,031 on October 7, 2025, with 789 of those being children. westvirginiawatch.com
Residential funding detail
The IDDW pays for residential support through the Person-Centered Support (PCS) service family, billed in 15-minute units with modifiers that step the rate down as staffing is shared across more people. There is no per diem and no acuity tier per se; intensity is expressed through the staffing-ratio modifier and the number of authorized units in the member's individualized budget, which is set annually from a functional assessment by the utilization management contractor, Acentra Health.
Settings funded (Chapter 513, effective August 1, 2026, bms.wv.gov ):
- Licensed group home, provider-controlled, four or more members, 24/7 staffing. Billed S5125 with U1 through U4.
- Unlicensed residential, provider-controlled, 24/7 supported settings serving fewer people. Billed S5125 with HI, UN, UP.
- Family/member-owned or leased home (integrated setting), funded through Home-Based Person-Centered Support (S5125 U6-U8) and Family Person-Centered Support (S5125 U5). West Virginia is unusual in historically paying parents as caregivers under this service.
- Crisis site person-centered support (T1005 U7-U9), short-term stabilization residential.
- ICF/IID, a Medicaid state plan institutional benefit, entirely private-provider in West Virginia; $77.7M in SFY2026. No state-operated ICF/IID remains.
Both provider-controlled setting types receive annual HCBS settings-rule compliance evaluations covering choice of setting, lockable doors, privacy, and control of daily schedule.
Room and board: not a covered waiver service. Chapter 513 frames the residential choice as reflecting "members' needs, preferences, and available resources for room and board," which falls to the member's own income, principally SSI. I could not verify any West Virginia optional state supplementary payment for congregate residential settings.
Rate structure: bms.wv.gov
Comparable service rates
All rates below are per 15-minute unit, effective October 1, 2025, from the IDDW rate memo at bms.wv.gov . Modifier tiers step down with shared staffing; the top tier is shown.
| Service (national label) | State's service name | Unit | Current rate | Effective date | Source URL |
|---|---|---|---|---|---|
| Residential group home 24-hour | Licensed Group Home (Person-Centered Support), S5125 | 15 min | $7.47 (U1); $3.74 (U2); $2.49 (U3); $1.87 (U4) | 10/01/2025 | bms.wv.gov |
| Supported living / host home / shared living | Unlicensed Residential (Person-Centered Support), S5125 | 15 min | $7.47 (HI); $3.74 (UN); $2.49 (UP) | 10/01/2025 | bms.wv.gov |
| Day habilitation | Facility Based Day Habilitation, T2021 | 15 min | $7.90 (U5); $3.39 (U6); $2.15 (U7) | 10/01/2025 | bms.wv.gov |
| Community supports / personal assistance (hourly) | Home-Based Person-Centered Support, S5125 | 15 min | $6.75 (U7); $3.38 (U8); $2.51 (U6). Family PCS S5125 U5 is $5.02 | 10/01/2025 | bms.wv.gov |
| Respite | In-Home Respite, T1005 UA/UB; Out of Home Respite, T1005 U1/U5/U6 | 15 min | In-home $6.75 (UA), $3.38 (UB). Out of home $6.75 (U1), $3.38 (U5), $2.25 (U6) | 10/01/2025 | bms.wv.gov |
| Supported employment | Supported Employment, T2019; Job Development, T1019 HB | 15 min | $7.96 individual (T2019); $3.20 group (T2019 HQ); $7.96 job development | 10/01/2025 | bms.wv.gov |
| Case management / service coordination | Service Coordination (Traditional Option) | Not published in the 10/01/2025 IDDW rate memo, see fee schedule | Not published, see fee schedule | n/a | bms.wv.gov |
Official rate schedule links
- IDDW rates page (index): bms.wv.gov
- IDDW rates effective 10/01/2025 (PDF): bms.wv.gov
- IDDW prior rate file: bms.wv.gov
- Aged and Disabled Waiver rates: bms.wv.gov
- TBI Waiver rates: bms.wv.gov
- Applied Behavior Analysis fee schedule: bms.wv.gov
- All Medicaid fee schedules: bms.wv.gov
Notable features and flags
- October 1, 2025: across-the-board IDDW rate increase. Most services rose roughly 6% (for example Facility Based Day Habilitation U5 from $7.47 to $7.90). Residential rates rose more, about 13.7%: Licensed Group Home U1 and Unlicensed Residential HI both moved from $6.57 to $7.47 per 15 minutes. bms.wv.gov
- July 1, 2025: five-year IDDW renewal approved (WV.0133.R08) holding capacity flat at 6,165 unduplicated participants in every one of the five years, meaning no programmed slot growth through 2030. bms.wv.gov
- Waiting list is growing, not shrinking. The managed enrollment list went from 1,031 on October 7, 2025 to 1,317 in June 2026, with a longest wait of 1,828 days. Monthly flow in June 2026 was 46 added against 2 enrolled. bms.wv.gov
- SFY2026 IDD Waiver spending ran $52.0 million over budget ($466.99M actual against $414.97M budgeted), the largest variance in the state's HCBS line items. bms.wv.gov
- August 1, 2026: Chapter 513 policy manual reissued, with a public comments and responses document published alongside it, tightening conflict-free case management and HCBS settings-rule compliance evaluation for provider-controlled residential settings. bms.wv.gov
- Direct support workforce: as of October 2025 the West Virginia Behavioral Healthcare Providers Association reported direct care pay of $13 to $15 per hour against a $17 competitive benchmark, with families reporting multi-year gaps in respite staffing. westvirginiawatch.com
Confidence
Solid: IDDW enrollment, waitlist size and longest wait, approved slot counts, SFY2026 expenditures by waiver, ICF/IID spending, FMAP, and the full October 2025 rate table, all from BMS primary documents dated within the last three months. Residential service architecture is solid from Chapter 513 and the rate file. Estimated or computed by me, not published: the per-participant figure (~$75,800), and the state/federal dollar split. Could not find: appropriation amounts for any of the BBH state-funded programs (Family Support, Waitlist Support Grant, Unmet Needs, Customized Employment, TBI Funds), because the FY2027 executive budget Volume II exceeded fetch limits; the meaning of the U1-U4 and HI/UN/UP staffing modifiers, which the rate memo does not define; a published service coordination rate; and whether West Virginia pays any state supplement toward room and board in group homes.
Named programs in West Virginia and how to apply
Every Medicaid waiver and related program the state runs, with its waiting list status and the providers in the Atlas tied to it. Open a program for the steps to apply.
| Program | Authority | Waiting list | Providers in the Atlas |
|---|---|---|---|
| Aged and Disabled Waiver | 1915(c) waiver | Has a waiting list | 1 |
| Children with Serious Emotional Disorder Waiver | 1915(c) waiver | No waiting list | 0 |
| Intellectual/Developmental Disabilities Waiver (IDDW) | 1915(c) waiver | Has a waiting list | 0 |
| Traumatic Brain Injury (TBI) Waiver | 1915(c) waiver | Waiting list varies | 1 |
Vocational rehabilitation in West Virginia
The state agency that pays for job training, job coaching, and help finding work, including Pre-Employment Transition Services for students.
West Virginia Division of Rehabilitation Services (WVDRS)
Combined agency · rank 6 of 73 · score 80.0
Agency profile
Sits inside
West Virginia Department of Education and the Arts (per WVDRS's stated statutory/administrative housing; WVDRS also independently administers Disability Determination Services)
Authority
Rehabilitation Act of 1973, Title I (34 CFR Part 361); WV Code Chapter 18 (governing statutes referenced at wvdrs.org)
Who it serves
West Virginians with disabilities, including specialized services (per site nav: "Specialized Services" under Adults)
Order of selection
Not on OOS, serving all eligible AS OF the WV WIOA Combined State Plan VR Portion (PYs 2024 to 2027) · "The VR agency is not implementing an order of selection and all eligible individuals will be served." · wvdrs.org (Order of Selection section, checkbox response)
Waiting list
none (per OOS status above; the plan lists priority-category order, waiting-list-management method, and category-opening-timeline fields as "N/A" because no OOS is in effect) · same source
People served
12,172 West Virginians served through the VR program in the FY2023 reporting year, of whom 7,502 (62%) were students ages 14 to 21 · wvdrs.org This is the most recent WVDRS annual report locatable (no FY2024/FY2025 edition found linked from the publications page as of this fetch).
Outcomes
PY2022 (July 1, 2022, June 30, 2023) WIOA performance: Employment Rate, 2nd quarter after exit = 72.8% (negotiated target 64%); Median Earnings, 2nd quarter after exit = $7,063 (negotiated target $5,371); Employment Rate, 4th quarter after exit = 70.1% (negotiated target 61.6%) · wvdrs.org Also: 1,276 consumers obtained/retained employment in FY2023; consumers' aggregate estimated annual earnings rose from $32,436,898 at application to $48,381,736 post-services (a 49% increase) · same source.
State match and federal drawdown
FY2023 financial report shows $14,992,439 in State Appropriations against $53,281,393 in Federal Grants (total funds $69,328,302 · note this total combines VR with Disability Determination Services, which is 100% federally funded, so the ratio is not a clean VR-only match rate) · wvdrs.org WV's FY2026 federal VR Basic State Grant award alone is $32,414,987 (RSA award H126A260096) · rsa.ed.gov WV requested $20,000,000 in FY2025 reallotment and received $5,862,956 · 29.3% of its request · rsa.ed.gov (FY2025 Table 2, WV listed as "Combined"), exactly matching the lead given in the task brief. WV did not appear in any relinquishment table (FY2024, FY2026), meaning it was a net *seeker* of extra federal funds, not a state giving money back · the mirror image of TN/UT's pattern.
Pre-employment transition services
FY2023 expenditure on Pre-Employment Transition Services: $6,543,036 (listed as its own line under "Expenditures by Program Category") · wvdrs.org
Supported employment
FY2023 expenditure on "Supported Employment Extended Care": $41,163 (a distinct, much smaller line item from general VR case services) · same source. No further Title VI-specific narrative found.
State-funded programs outside the federal grant
- Randolph-Sheppard Program · $928,477 (FY2023 expenditure) · wvdrs.org - Ron Yost Personal Assistance Services Fund · $282,871 (FY2023 expenditure) · same source - Older Blind (VISIONS) · $297,895 (FY2023 expenditure) · same source - Employment Attendant Care Program · $109,292 (FY2023 expenditure) · same source
Notable
- WV requested $20M in FY2025 reallotment and received only $5.86M (29.3%) · confirms the lead exactly · rsa.ed.gov - WV is affirmatively off order of selection per its current (PY2024 to 2027) WIOA state plan · wvdrs.org - Consumers' aggregate estimated earnings rose 49% (from $32.4M to $48.4M) after receiving VR services in FY2023 · wvdrs.org - WVDRS's public Client Services Manual (wvdrs.org) is structured as numbered policy sections (2000s, 4000s) but does not expose a purchased-service fee schedule in the static page content that could be fetched
Confidence
Solid on served/outcomes/expenditure-by-category figures · all from one dated, primary-source FY2023 annual report PDF, and on the reallotment figure (RSA primary source, exact match to the lead). Dated · the annual report is FY2023 (the most current one found; no FY2024/FY2025 edition was linked from the publications page), so served/outcome numbers are roughly two years old relative to the 2026-08-31 research date. Could not find · a public purchased-service fee schedule (the Client Services Manual's numbered sections did not yield fee tables via direct fetch, and it may require session-based or JS-rendered navigation not reachable by static curl/WebFetch).
VR service rates: West Virginia Division of Rehabilitation Services (WVDRS)
rank 6 of 78 · 0 of 7 priced
Not determinable from pages crawled. WV's FY2023 annual report shows $19,502,385 in "Case Services" and $10,797,374 in "Counseling, Guidance and Placement" as aggregate FY2023 spending categories, but no per-unit rate table.
| Comparable service | Agency’s own service name | Unit | Current rate | Effective | Source |
|---|---|---|---|---|---|
| Vocational assessment and discovery | Not published | Not published | Not published | Not published | none found |
| Job development and placement | Not published | Not published | Not published | Not published | none found |
| Job coaching | Not published | Not published | Not published | Not published | none found |
| Supported employment | Not published | Not published | Not published | Not published | none found |
| Pre-employment transition services | Not published | Not published | Not published | Not published | none found |
| Benefits counseling | Not published | Not published | Not published | Not published | none found |
| Retention and extended services | Not published | Not published | Not published | Not published | none found |
Find services in West Virginia
Providers that take Medicaid waivers How to apply in West Virginia
From ConnectIDD's State Disability Funding Atlas research (August and September 2026). Waiting list status and program steps updated October 2026. Every figure carries its fiscal year.