Mountain State Home Health Care, Inc.

How Do You Apply for Aged Disable Wavier?

Complete the Initial Medical Necessity Evaluation Request form
Have your physician complete the Physicians portion of the Evaluation Request
Fax the Initial Medical Necessity Evaluation Request to West Virginia Medical Institute
West Virginia Medical Institute will schedule an appointment for a medical evaluation to the complete the PAS 2000
West Virginia Medical Institute will inform you of your approval
The Case Management Agency will provide you with a list to select a Homemaker Agency to provide your direct care services

Applicants must meet all of the following criteria to be eligible for the A D W Program:

Be 18 years of age or older
Be approved by West Virginia Medical Institute (WVMI) as medically eligible for Nursing Home level of care
Require, in the absence of the program services, the level of care provided in a Nursing Home Facility as determined by a comprehensive medical evaluation, the Pre-Admission Screening (PAS-2000)
Meet the Medicaid Waiver financial eligibility criteria for the program as determined by the local WVDHHR staff
Be willing to participate in the ADW Program as an alternate to Nursing Home Facility care
Require services which do not exceed the currently defined cost feasibility which is based on a statewide average cost of nursing home care
CMA's and HMA's have qualified individuals who will assist applicants with the application process free of charge

Applicants are encouraged to obtain assistance with the application process.

To obtain assistance with the application process the applicant can:
Contact: