Time for West Virginia to Look at Improving Long-term Care Options

February 19, 2021

By Kathleen Stoll & Nancy Tyler

West Virginia has a large and growing population of older people who will likely need some type of long-term care and services to live safely in their later years. Among the states, West Virginia has the third highest percentage—20%—of its total population who are 65 or older. According to the West Virginia University Bureau of Business and Economic Research, the total population of West Virginians over 65 will grow 41% between 2010-2030.

This increase of the state’s elderly population is expected to put significant stress on public services. It will require increased spending on Medicaid, disability benefits, retiree benefits and more. This will likely put a strain on the state budget. Planning for how to meet the growing demand is critical for West Virginia. Changes to Medicaid coverage of long-term care and services must be part of how the state successfully responds.

West Virginia should recognize that while the state’s population is aging, the needs of its older individuals are changing. Today, earlier medical interventions help many elders judge themselves to be healthy and wanting to be active in their later years, and research shows activity can keep older folks healthier longer. There is a growing demand for long-term care and services that provide a lower level of assistance and more activities and utilize appropriate technological supports. Not all elders who cannot live safely at home are ready for full-blown nursing home care.

Almost a third—more than 550,000—of West Virginians are eligible for Medicaid, the public health insurance program that covers low-income individuals. It is Medicaid, not Medicare, that pays for long-term care in West Virginia and in the rest of the country. However, West Virginia Medicaid does not currently provide coverage for a full range of long-term care options. The Mountain State’s Medicaid program has done a good job of expanding home- and community-based long-term care, but once a person cannot live safely in the home, the next step options are few.

West Virginia, through its Medicaid Personal Care option, does pay for personal care for West Virginians in their place of residence, be that in their own homes or the homes of other family members. If a person cannot safely stay in the home, the personal care health services can be provided in an assisted living community facility or adult family care home.

Assisted living is a housing alternative for older people or people with disabilities who need assistance in their activities of daily living such as dressing, bathing, eating and toileting but do not need the more intensive medical interventions provided in nursing homes. West Virginia statutorily recognizes and defines assisted living and regulates assisted living community facilities. In assisted living, residents can live in more home-like units with more autonomy and independence. Often these facilities offer a broader range of social activities and opportunities for outings.

Here’s the catch. Medicaid does not pay the cost of room and board for assisted living housing—the highest part of the total bill. If a person can’t afford to pay the room and board at an assisted living community facility out of their own pocket, they are out of luck. This reality creates a huge financial barrier to lower income West Virginians who are otherwise a good fit for an assisted living community facility. They have no real option but to enter a nursing home so Medicaid will pay. This makes the decision purely financial rather than based on need for services and level of care.

Expanding Medicaid coverage of room and board at an assisted living community facility—for Medicaid enrollees who do not need the higher level of care provided in a nursing home—could save West Virginia money and provide a new residential option for people with disabilities and for seniors. For these enrollees, the option can provide a more independent and active quality of life.

Families looking for assisted living in West Virginia have a wide array of communities from which to choose. There are more than 100 assisted living communities in West Virginia. A resident in an assisted living community in this state will pay on average $3,700 a month while nursing home care can be more than $9,500.  

The bottom line is there is an important role for both nursing home care and assisted living care. Nursing homes are appropriate and sought when a resident needs skilled nursing care and ongoing support for many health services. Assisted living is appropriate for those who need less help. It makes no sense that Medicaid pushes people into the wrong level of care.

West Virginia legislators have expressed a strong commitment to funding effective care for West Virginians who cannot live completely without help with their care. A good example of this commitment is the recent action by the Department of Health and Human Resources (DHHR) and the state legislature that closed a waiting list for people with intellectual and development disabilities so that all qualified West Virginians could receive appropriate home- and community-based care.

With that commitment in mind, it is time for West Virginia to look comprehensively at how Medicaid funds the entire long-term care system, including nursing homes and assisted living residences. With appropriate changes and rebalancing, West Virginia can cover more lives in the most efficient manner possible. Medicaid coverage of assisted living is a win-win proposition that could help destress the state budget and provide improved long-term care options to West Virginians.

The state legislature should act in 2021 and create a task force with consumer and provider stakeholder representation and staffed by DHHR and Bureau of Medical Services—the state Medicaid agency—to look at this issue. The task force could explore all the avenues for re-balancing Medicaid funding for long-term care and services under federal Medicaid rules and guidelines and report its recommendations to the legislature, DHHR and the public in six months.

Moving forward, West Virginia should seize the opportunity to create a more equitable and cost-effective long-term care system. An equal and full range of options that provide the right level of care should be available to all West Virginians regardless of personal finances. We all deserve to live with dignity and with the greatest independence possible.

About the Authors

Kathleen Stoll is the policy director for West Virginians for Affordable Health Care. A resident of Berkeley Springs, she served on the board of West Virginians for Affordable Care for more than eight years. She is also the principal of Kat Consulting, which provides health policy and economic analysis with a focus on the lives of low-income people to diverse state and national clients. She constructs original data analysis and has written more than 50 earned media reports on health care issues over the past 20 years. Stoll serves as a key spokesperson to the media on health policy issues, including the Affordable Care Act, Medicaid and health system improvement. In the past, Stoll has held roles with Families USA, the Center for Women Policy Studies and the National Health Law Program. She is an attorney and holds a master’s degree in economics.

Nancy Tyler, MSW, JD, is a private health care consultant in the Charleston area. She is chair of the board of the Fair Shake Network and vice chair of the board of West Virginians for Affordable Healthcare. Tyler received her bachelor’s degree in family services from Auburn University, master’s in social work from West Virginia University and juris doctor from the University of Denver. In the past, she has held various roles with the Counsel for the House Health Committee and Counsel for the House Finance Committee for the West Virginia Legislature, Office of Health Facilities Licensure and Certification in the West Virginia Department of Health and Human Resources, United Health Care, Boulder Valley Women’s Health Center, United Cerebral Palsy, and Shawnee Hills Community Behavioral Health Center. More recently she has provided consulting services to organizations including the West Virginia Partnership for Elder Living, Perinatal Partnership, Cabin Creek Health Systems and Center for Rural Health Development.