Aged and Disabled Waiver is a Medicaid benefits package for Medicaid recipients that offers specific services designed to provide in-home services to individuals who are aged or have a disability. The mission of the program is to provide person-centered care to help individuals have more choices and independence while maintaining their dignity.

A person who meets the requirements for ADW and wants to stay in their own homes will receive the same type of care provided in a nursing home.

You may get the form from one of the following places:

• WV Aging and Disability Resource Network –  1-866-987-2372
• WV Bureau of Senior Services –  1-866-767-1575
• WV Department of Health and Human Resources, Bureau for Medical Services –  304-558-1700

The physician will send the form to Keystone Peer Review Organization, Inc., (KEPRO). KEPRO will notify you and send you a form to select a provider or Case Management Agency. Return the form to KEPRO and they will notify the agency you selected. Within five days, the Case Manager should contact you.

Yes, a Case Management Agency listed on the form may help you.

You will need to submit the form and a copy of the letter from KEPRO to your local Department of Health and Human Resources (DHHR) office.

DHHR will decide if you qualify financially. If so, they will send the form to KEPRO who will contact you to make an appointment for a registered nurse to come to house to discuss your medical needs.

There are two ways you can get services. One is a Traditional Agency Model, where you receive services from employees of a certified provider agency who sends people to your home. There is also a Personal Options Model, which means  you choose who provides the services and the employees work directly for you.

Here are examples of the type of help that can be provided to you:

• Personal Attendants are people trained to help you with bathing, dressing, preparing your meals, eating, and other personal care needs.
• Case Management Services are licensed professionals who help identify your needs and plans for your care. They also advocate for you and help you connect with services in the community.
• Non-medical Transportation is provided to get you to and from services on your individual service plan.
• Nursing Assessment and Supervision occurs when a registered nurse assesses your needs and writes the plan which the personal attendant will follow.

Yes.

• ADW (Aged and Disabled Waiver)
• CMS (Centers for Medicare and Medicaid Services)
• WVDHHR (West Virginia Department of Health and Human Resources)
• WVBMS (West Virginia Bureau for Medical Services)
• MNER (Medical Necessity Evaluation Request)
• LBHC (Licensed Behavioral Health Centers)
• HIPAA (Health Insurance Portability and Accountability Act)
• KEPRO (Keystone Peer Review Organization)
• MAT (Medication Assisted Treatment)
• IOS (Intensive Outpatient Services)
• PHP (Partial Hospitalization Program)
• RAS (Residential Adult Services)

If you are denied ADW Services, you have the right to appeal and ask for a “Fair Hearing“. Look carefully at the denial notice to see your appeal deadline. Make sure you file your appeal on time. Also, review the notice to find out why you were denied so that you can start preparing for your hearing. You may need to get more medical records or witnesses, and that will take time.

Legal Aid can help people with these appeals.  To see if we can help you, apply for help. Also, federal Medicaid rules also allow you to use a relative, friend, or any other spokesperson that you choose to help you with your appeal, or you can represent yourself.