Self-Direction and FMS in West Virginia
Self-Direction and FMS in West Virginia
All states: self-direction map
In short: Personal Options is the self-directed model in three waivers (ADW, IDDW, TBIW); Palco is the sole fiscal/employer agent and members are the employers.
West Virginia self-direction at a glance
| Self-directed programs | Personal Options in three 1915(c) waivers: Aged and Disabled (ADW), Intellectual and Developmental Disabilities (IDDW) and Traumatic Brain Injury (TBIW) |
|---|---|
| FMS model | Fiscal/employer agent (F/EA) under contract to the Bureau for Medical Services |
| FMS vendors | One statewide vendor: Palco |
| Who is the employer | The member is the common law employer of the workers |
| Can family be paid | Yes, with limits. Not a spouse or court-appointed legal guardian. TBIW also bars parents of minor children. |
| EVV for self-directed workers | Yes for workers who do not live with the member. Live-in workers are exempt. |
| Budget authority | Yes, within limits. Members build a spending plan and set wages up to a cap. |
Last verified against state sources: 2026-10-13.
Which Medicaid programs in West Virginia offer self-direction?
West Virginia offers self-direction in three Medicaid waivers: the Aged and Disabled Waiver (ADW), the Intellectual and Developmental Disabilities Waiver (IDDW) and the Traumatic Brain Injury Waiver (TBIW). In all three the self-directed option is called Personal Options. The member hires and manages the workers and also manages a budget through a spending plan. State Plan Personal Care is agency only and has no self-directed model.
- Aged and Disabled Waiver (ADW), Personal Options: serves adults 18 and older who meet nursing facility level of care, which means older adults and adults with physical disabilities. The Bureau for Medical Services (BMS) runs it, and the ADW program site lists the Bureau of Senior Services as the self-direction contact. The member has employer authority and budget authority. Services available through Personal Options include personal attendant, case management, non-medical transportation, personal emergency response, home and vehicle adaptations, adult medical day care and pest eradication.
- Intellectual and Developmental Disabilities Waiver (IDDW), Personal Options: serves children and adults with intellectual or developmental disabilities. BMS runs it. The member has employer authority and budget authority, and can mix Traditional (agency) services with participant-directed ones. Services that can be directed include Person-Centered Support, Unlicensed Residential Person-Centered Support, in-home and out-of-home respite, transportation, participant-directed goods and services, home and vehicle adaptations, and dietary, occupational, physical and speech therapy.
- Traumatic Brain Injury Waiver (TBIW), Personal Options: serves people age 3 and older with a documented traumatic brain injury who meet nursing facility level of care. BMS runs it. The member has employer authority and budget authority. Self-directed services are personal attendant, personal emergency response, home and vehicle adaptations, pest eradication and non-medical transportation.
Employer authority means the member recruits, hires, schedules and supervises the workers. Budget authority means the member also decides how a set amount of money is spent. In West Virginia that control has limits. Members build a spending plan from their budget and choose worker wages up to a cap. In TBIW and IDDW the hourly wage cannot be more than the Medicaid rate minus mandatory deductions, and in ADW members choose from wage rates allowed by BMS within a monthly budget.
West Virginia has no single state web page for self-direction. Each waiver site describes the option briefly, and the detailed rules are in the BMS Provider Manual, Chapter 501 (ADW), Chapter 512 (TBIW) and Chapter 513 (IDDW).
Who handles financial management services (FMS) in West Virginia?
One company, Palco, handles financial management services for Personal Options in all three waivers. West Virginia uses a fiscal/employer agent (F/EA) model, which means Palco runs payroll and taxes while the member stays the legal employer of the workers. Because there is one statewide vendor under contract to the Bureau for Medical Services, members do not pick among FMS vendors.
A fiscal/employer agent is the organization that handles the paperwork side of being an employer. In West Virginia it runs payroll, withholds taxes, submits claims and provides resource consultants. A resource consultant is a person who helps the member build the spending plan and learn the employer role.
- Legal employer: the member is the common law employer of the workers in ADW, IDDW and TBIW. The ADW manual says plainly that the Personal Options F/EA is not the employer.
- Vendor by program: Palco is the F/EA for Personal Options in ADW, IDDW and TBIW.
- How long: a BMS announcement of February 2, 2024 says Palco became the Personal Options vendor effective April 1, 2024, replacing Public Partnerships LLC. The same release says the three waivers served more than 4,900 people in Personal Options at that time.
- Program representatives: a member who cannot manage the employer role can be required to appoint a program representative or move to the Traditional model. In ADW and TBIW the representative, who may be a family member or friend, is not paid for that role.
One naming point helps when reading state documents. West Virginia uses "Personal Options" for both the self-directed model and the FMS itself. The provider manuals do not name Palco. They say "Personal Options F/EA" or "Personal Options vendor".
Who can be a paid caregiver under self-direction in West Virginia?
Members can hire relatives and friends, but each waiver sets limits. In all three waivers a spouse cannot be paid, and a person acting as the member's program representative cannot also be the paid worker. ADW and TBIW also bar court-appointed legal guardians, and TBIW bars parents of minor children.
Important: The family rules are not the same in each waiver. Check the manual chapter for the member's own waiver before hiring a relative, and do not assume a rule from one waiver carries over to another.
- ADW: legally responsible persons cannot be paid, and the manual defines that as the spouse. Court-appointed legal guardians cannot be paid caregivers either. A person who holds a medical power of attorney or power of attorney, or who is a health care surrogate or other legal representative, may be the paid attendant, but a self-directing member must then have a program representative who is a different person.
- TBIW: the spouse, a parent of a minor child (under 18) and court-appointed legal guardians cannot be paid to provide waiver services. This applies in both the Traditional and Personal Options models.
- IDDW: spouses cannot provide Person-Centered Support under Personal Options, and a representative cannot be a paid employee providing Personal Options services to the member. Staff providing Unlicensed Residential Person-Centered Support cannot be the spouse or a family member (parents, adult siblings, grandparents, aunts and uncles, including step relations).
For parents of minor children in IDDW, the manual says Person-Centered Support cannot replace the routine care and supervision a parent is expected to give. We did not find a flat rule in the chapter on whether a parent of a minor can be paid. Ask the member's case manager or BMS before planning around it.
IDDW also caps the amount of Person-Centered Support under Personal Options at the value of 1,830 hours per plan year for members under 18 and 2,920 hours for adults, combined with other person-centered support. We did not find a published overtime rule or weekly hour cap for Personal Options workers. Ask Palco or the resource consultant.
Does EVV apply to self-directed workers in West Virginia?
Yes, for most workers. Electronic visit verification (EVV) applies to Personal Options workers who do not live with the member. They record visits in Palco's Connect EVV, by mobile app or by phone. Workers who live in the member's home are exempt in all three waivers.
- Whose system: Personal Options workers use the EVV system that Palco provides. Palco's notice gives go-live dates of November 4, 2024 for TBIW, December 2, 2024 for ADW and January 13, 2025 for IDDW. In ADW it replaced the earlier AuthentiCare system.
- Live-in exemption: Palco's worker living setting form says West Virginia Medicaid policy requires workers who do not live with the member to use EVV, and that workers who live in the home are not required to use it in ADW, IDDW or TBIW. Palco's forms page lists a paper timesheet marked for EVV-exempt workers only.
- Proof of living arrangement: Palco says it is working with BMS to audit worker live-in data. Each worker is asked to attest to the living arrangement for each member, with an effective date.
- NPI: the ADW and TBIW manuals require every personal attendant who does not live with the member to hold an individual National Provider Identifier (NPI) that links the worker to the member. Live-in attendants are exempt for the member they live with. In IDDW, Personal Options respite workers are subject to EVV and NPI rules.
One point could not be confirmed. We did not find a statement on whether pay is held, or a claim denied, when a shift by a non-live-in worker has no EVV record. Neither the state manuals nor the Palco documents we read address it. Ask Palco West Virginia customer support at 866-710-0456, or BMS.
What is changing next for self-direction in West Virginia?
We did not find an upcoming change to self-direction in West Virginia as of the last check on October 13, 2026. The vendor change to Palco and the move to Connect EVV are both complete. No future-dated rule change, procurement or vendor change was found in the sources we read.
Two recent manual updates are already in effect and worth knowing:
- ADW manual (Chapter 501), effective June 1, 2026: the manual removed the parent of a minor child from its definition of legally responsible persons, in both the personal attendant qualifications and the glossary. The definition now covers the spouse only. ADW serves adults 18 and older, so we did not find how this plays out in practice. The Bureau of Senior Services self-direction contact, (304) 558-3317 ext. 56111, can confirm.
- IDDW manual (Chapter 513), effective August 1, 2026: this is the current chapter for IDDW Personal Options and the source for the IDDW rules on this page.
We did not find a published end date for the Palco contract or a statement on whether a new FMS procurement is planned. FMS organizations and agencies that want to track this should ask BMS or watch West Virginia Purchasing Division award records.
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Who to ask about self-direction in West Virginia
Questions about self-direction in West Virginia are best put to the state. Start with WV Aged and Disabled Waiver program page (describes Personal Options and lists a Self-Direction contact). Published contact: ADW self-direction at the Bureau of Senior Services: (304) 558-3317 ext. 56111. Palco West Virginia customer support: 866-710-0456, customersupport@palcofirst.com.
West Virginia self-direction sources
- WV Bureau for Medical Services: BMS selects new financial management services vendor (February 2, 2024)
- BMS Provider Manual Chapter 501: Aged and Disabled Waiver (effective June 1, 2026)
- BMS Provider Manual Chapter 513: Intellectual and Developmental Disabilities Waiver (effective August 1, 2026)
- BMS Provider Manual Chapter 512: Traumatic Brain Injury Waiver (effective February 1, 2025)
- WV Bureau for Medical Services: Policy manuals
- West Virginia Aged and Disabled Waiver program site
- Palco: West Virginia programs
- Palco: Connect EVV notice for West Virginia
- Palco: WV Worker Living Setting Verification Questionnaire
Related reading
- Self-Directed Medicaid Home Care Services in 2026
- Understanding Self-Direction and FMS
- Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
- 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
- Self-direction in every state (map)
- West Virginia EVV requirements
Other states with one statewide FMS vendor
Arkansas, Connecticut, District of Columbia, Indiana, Iowa, New Mexico, North Dakota, Oklahoma, South Carolina, Tennessee, Vermont, Washington, Wyoming. See every state on the self-direction map.
Page history
- October 13, 2026: Page rewritten and checked against state sources.
This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.
Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.
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Questions about EVV?
EVV is still to be implemented in most of the states with different guidelines and regulations. We’re keeping up with the updates related to EVV implementation and if there is something we haven’t included, please share with us. To learn how ankota can help in ensuring compliance, please get in touch with us.
West Virginia self-direction questions
Who is the FMS vendor for self-direction in West Virginia?
Palco is the fiscal/employer agent for Personal Options in all three waivers: Aged and Disabled, Intellectual and Developmental Disabilities, and Traumatic Brain Injury. The Bureau for Medical Services selected Palco effective April 1, 2024, replacing Public Partnerships LLC. Palco also provides resource consultants, who help members with spending plans and the employer role.
Can a spouse be paid as a caregiver under Personal Options?
No. In ADW and TBIW a spouse cannot be paid to provide waiver services. In IDDW a spouse cannot provide Person-Centered Support or Unlicensed Residential Person-Centered Support under Personal Options.
Can a parent be paid to care for a child under West Virginia participant direction?
It depends on the waiver. TBIW bars a parent of a minor child (under 18) from being paid. In IDDW the manual says Person-Centered Support cannot replace the routine care a parent is expected to give, and we did not find a flat rule on paying parents of minors. Ask the member's case manager or the Bureau for Medical Services.
Can a legal guardian or power of attorney be the paid worker?
In ADW and TBIW a court-appointed legal guardian cannot be paid. In ADW a person holding a power of attorney or medical power of attorney may be the paid attendant, but the member must then have a program representative who is a different person. A program representative cannot be the paid worker.
Who is the employer in West Virginia self-direction?
The member is the common law employer of the workers in all three waivers. The fiscal intermediary, Palco, handles payroll, tax withholding and claims as the employer's agent but does not employ the workers. A member who needs help with the employer role can have a program representative.
Does EVV apply to Personal Options workers in West Virginia?
Yes, for workers who do not live with the member. They record visits in Palco's Connect EVV by mobile app or by phone. Workers who live in the member's home are exempt in ADW, IDDW and TBIW, and Palco asks workers to attest to their living arrangement.
Do members control a budget in Personal Options?
Yes, within limits. Members build a spending plan from their budget with help from a Palco resource consultant and choose worker wages. In TBIW and IDDW the hourly wage cannot be more than the Medicaid rate minus mandatory deductions, and in ADW members choose from wage rates allowed by the Bureau for Medical Services.
Can members choose their own FMS provider in West Virginia?
No. West Virginia has one statewide FMS vendor, Palco, under contract to the Bureau for Medical Services for all three Personal Options waivers. Members who do not want to self-direct can use the Traditional model, where a provider agency employs the workers.