Title 19 Waiver in WV: Eligibility, Waitlist, and Funding Changes

The Title 19 waiver in WV is the state’s Intellectual and Developmental Disabilities Waiver, or IDDW: a Medicaid program, authorized under Section 1915(c) of the Social Security Act, that pays for home and community-based services so eligible West Virginians with intellectual or developmental disabilities can live at home instead of in an institution. It has operated since 1985 and currently serves roughly 6,000 people, with more than 1,000 more waiting for a funded slot as of late 2025.¹²

Who Qualifies

To be eligible for the IDDW, an applicant must be a West Virginia resident, at least three years old, and have a diagnosis of a severe intellectual disability or a similar condition that first appeared before age 22.³

Beyond the diagnosis, the applicant must show substantial difficulty in at least three of six functional areas:

Self-care
Communication
Learning
Mobility
Self-direction (decision-making)
Capacity for independent living

These functional criteria are what distinguish the IDDW from a straight diagnostic threshold: the program is designed for people whose disability materially limits daily life.⁴

Financial eligibility is a separate hurdle. The applicant must meet Medicaid income and asset rules, and that determination is made by the local Department of Human Services office, not by the waiver program itself. Finally, the applicant has to choose home and community-based services over institutional placement; the whole point of the waiver is that it substitutes for a facility bed.⁵

How to Apply

Applications go to Acentra Health, the state’s utilization management contractor and Administrative Services Organization since 2000 (formerly known as Kepro).⁶ The IDDW application form is available through the state’s waiver programs website, and completed forms can be mailed, faxed, or emailed to Acentra’s Charleston office. If you don’t hear back within five business days, call Acentra at (866) 385-8920.³

Once Acentra receives the application, it sends the applicant a packet with a list of approved psychologists. The applicant has 14 days to select a psychologist and return that choice. Miss the deadline and the application closes. The chosen psychologist then performs a medical evaluation to confirm the diagnosis and functional limitations.

Financial eligibility runs on a parallel track through the local Department of Human Services office. Between the medical evaluation and the financial review, the full referral process usually takes 90 to 105 days, though the psychologist’s availability is the biggest variable.³

Approval isn’t permanent. Acentra conducts an annual interview to reassess medical eligibility, and the local Department of Human Services office re-verifies financial eligibility each year. Missing either review can end services.

What the Waiver Pays For

The IDDW covers a broad set of services aimed at keeping members in their homes and communities and helping them work toward the greatest possible independence. Covered services include:

Occupational, physical, speech, and dietary therapy
Skilled nursing by registered nurses and licensed practical nurses
Behavior support professional services and crisis services
Person-centered support (in-home assistance), facility-based day habilitation, and respite care
Supported employment, job development, and pre-vocational services
Environmental accessibility adaptations and electronic monitoring or surveillance systems
Service coordination (case management) and transportation to and from services

Services are not handed out from a menu. Each member has an Individual Program Plan built around an annual functional assessment conducted by Acentra, and that same assessment sets the member’s individualized annual budget.⁷⁵

The Waitlist and What Happens While You Wait

Meeting the medical and financial criteria doesn’t guarantee services. If both are approved but no funded slot is open, the applicant goes on a “managed enrollment list,” which is the waitlist. As of October 7, 2025, 1,031 people were on that list, and roughly 76 percent of them were children under 18. Earlier in 2025, the program reported only 139 available slots.²

This isn’t a new problem. In 2019, then-Governor Jim Justice directed the Department of Health and Human Resources to study ways to eliminate the waitlist, which at that point held about 1,060 people, 606 of them children. The list shrank for a period and then climbed back over 1,000.⁸

While waiting, an applicant may still be able to receive some services through regular Medicaid, including therapies and targeted case management. Children over three may be eligible to use the separate Medicaid Personal Care program in the meantime. Additional supports, including the Waitlist Support Grant and the Family and Community Support Program, may be available through the Department of Human Services’ Bureau for Behavioral Health.³

How the IDDW Differs From Other WV Waivers

The IDDW is one of four Home and Community-Based Services waivers in West Virginia, and they aren’t interchangeable. Applying to the wrong one wastes time. The others are:

The Aged and Disabled Waiver, for people 65 and older and adults 18–64 with physical disabilities who meet a nursing facility level of care.
The Children with Serious Emotional Disorder Waiver, for children ages 3–21 with serious mental, behavioral, or emotional health needs who would otherwise need hospital-level care.
The Traumatic Brain Injury Waiver, for people age three and older with brain injuries who meet a nursing facility level of care.

A person can only be enrolled in one waiver at a time. However, someone on the IDDW may also receive services through the separate Medicaid Personal Care program if they qualify for both. Personal Care is a state plan benefit narrowly focused on hands-on help with bathing, dressing, and similar daily activities; the IDDW is the broader program that adds habilitation, therapies, employment support, and behavioral services.⁹¹⁰

Recent Funding and Rate Changes

Provider availability directly affects how quickly a slot turns into actual services, and provider pay has been the main lever the state has pulled in recent years.

In the 2024 legislative session, lawmakers reduced the IDDW’s state appropriation by roughly $10.85 million, from $108.5 million to $97.7 million. Because the waiver draws federal matching funds, advocates estimated the total reduction closer to $33 million once the lost federal match was counted. Disability Rights West Virginia legal director Mike Folio said the cut threatened services for the roughly 6,000 people then enrolled. Advocates also pointed out that community-based waiver care runs about $390 per day, compared with about $990 per day for institutional placement in state hospitals.¹¹

Following a rate review mandated by Senate Bill 617 (2023), the Bureau for Medical Services raised provider reimbursement rates by 15 percent effective October 1, 2024, and removed 50 members from the waitlist at an annual cost of $3.9 million, on top of 99 members taken off the list on July 1, 2024.¹²

In October 2025, Governor Patrick Morrisey announced a further 9 percent rate increase for IDDW providers, along with 6 percent increases for the Aged and Disabled and Traumatic Brain Injury Waivers, effective October 1, 2025. Morrisey said the raises were meant to lift pay for direct care workers, who were earning roughly $13 to $15 per hour at the time.¹³¹⁴

House Bill 5022, introduced by Delegate Evan Worrell in February 2026 and effective June 10, 2026, now requires the Bureau for Medical Services to conduct an annual study of reimbursement rates across the IDDW, Aged and Disabled Waiver, Personal Care, and Traumatic Brain Injury Waiver programs and report findings to the Joint Committee on Finance, with comparisons to other states and analysis of inflation, recruitment, and retention.¹⁵

For an applicant, none of these numbers change eligibility. What they change is the practical picture of whether providers will be available to deliver approved services once a slot opens, which is why families and advocacy organizations track the rates as closely as they track the waitlist itself.

1
Medicaid.gov. West Virginia Intellectual and Developmental Disability Waiver
2
West Virginia Watch. Waitlist for Disability Services in WV Climbs to More Than 1,000
3
WV IDDW Program. Intellectual and Developmental Disabilities Waiver Program
4
WVU Center for Excellence in Disabilities. Personal Care vs. Waiver Comparison
5
WVU Center for Excellence in Disabilities. Personal Care vs. Waiver Comparison
6
Acentra Health. West Virginia Administrative Services Organization
7
Acentra Health. WV ASO Intellectual Developmental Disabilities
8
NASDDDS. WV Governor Directs to Eliminate Waitlist for Intellectual and Developmental Disabilities
9
WV Bureau for Medical Services. Home and Community-Based Services (HCBS) Waivers
10
WV IDDW Program. Intellectual and Developmental Disabilities Waiver Program – Section: Differences Between Personal Care and IDDW
11
West Virginia Public Broadcasting. W. Va. Grapples With IDD Waiver Program
12
WV Bureau for Social Services. Gov. Justice, DoHS Announce Increase Provider Waiver Rates and IDD Waiver Expansion
13
West Virginia Public Broadcasting. Care Providers for Waiver Recipients Get Pay Raise
14
West Virginia Watch. Morrisey Tries to Increase Number of In-Home Caregivers Through Medicaid Rate Increase
15
WV Legislature. House Bill 5022 Enrolled