West Virginia Long-Term Care Planning

The right entry point for planning in West Virginia is the spend-down structure, since the state's 2026 Medicaid guide describes people whose income exceeds the maximum as potentially becoming eligible through spend-down rather than a hard cutoff. The April 2025 long-term-care flyer sets the nursing-facility and HCB waiver income rule at 300% of the one-person SSI payment, and says people above that level may still qualify once their care costs exceed the Medically Needy Income Limit and other conditions are met.

That structure sets West Virginia apart from a simple "income-cap state, so use a Miller Trust" playbook. The state materials located for this review describe spend-down and don't point to a Qualified Income Trust as the universal published answer here. Before setting up or funding any trust for a West Virginia applicant, get a current county-office read on the applicant's coverage group and patient-liability budget first.