West Virginia - Housing Stabilization — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

West Virginia does not license or cover "Housing Stabilization Services" under a distinct, standalone Medicaid authority. Instead, tenancy support—including housing search, application assistance, landlord mediation, and retention planning—is delivered as an embedded component of Case Management and Person-Centered Support services within the state’s Home and Community-Based Services (HCBS) waivers, primarily the Intellectual/Developmental Disabilities Waiver (IDDW) and the Aged and Disabled Waiver (ADW).

The single biggest structural barrier to entry is that an applicant cannot enroll solely as a housing stabilization provider. To offer these services and bill Medicaid, an agency must become a fully certified IDDW or ADW waiver provider through the West Virginia Bureau for Medical Services (BMS) and its Utilization Management Contractor (UMC), Acentra Health. This requires demonstrating comprehensive HCBS operational capacity and strictly adhering to federal Conflict-Free Case Management (CFCM) mandates, which prohibit the same agency from providing both housing case management and direct care to the same member.

1. Service Definition and Scope

Because West Virginia lacks a standalone housing stabilization benefit, tenancy supports are integrated into the broader scope of HCBS waiver services. Under the IDDW and ADW programs, Case Managers and Service Coordinators take on the responsibility of assessing housing needs, while direct support professionals assist with the daily living skills required to maintain tenancy.

These services are designed to transition members from institutional settings or prevent institutionalization by securing and maintaining stable, community-based housing. All housing-related goals must be explicitly documented in the member's Individualized Support Plan (ISP).

• Applicable Authority: Intellectual/Developmental Disabilities Waiver (IDDW) and Aged and Disabled Waiver (ADW).
• Housing Search: Case managers assist members in locating accessible, affordable community housing and navigating waitlists.
• Application Assistance: Staff help members complete applications for HUD, Section 8, and local public housing authorities.
• Landlord Mediation: Case managers act as liaisons between the waiver member and landlords to resolve disputes and prevent eviction.
• Retention Planning: Developing proactive strategies within the ISP to address behaviors or financial issues that jeopardize housing.
• Direct Support: Person-Centered Support workers assist with daily living tasks (e.g., cleaning, budgeting) necessary to maintain the lease.

2. Regulatory and Oversight Agencies

The administration of Medicaid HCBS waivers in West Virginia is highly centralized. The primary oversight body is the Bureau for Medical Services (BMS) under the Department of Human Services (DoHS), which sets policy and manages the state plan and waivers.

BMS contracts with a Utilization Management Contractor (UMC) to handle day-to-day provider certification, training, and quality assurance. For the IDDW program, this entity is Acentra Health.

• West Virginia Bureau for Medical Services (BMS): The state Medicaid agency responsible for overall waiver administration (https://bms.wv.gov/).
• West Virginia Department of Human Services (DoHS): The umbrella department housing BMS (http://dohs.wv.gov/).
• Acentra Health (WV ASO): The Utilization Management Contractor (UMC) that certifies IDDW providers and approves service authorizations (https://wvaso.acentra.com/wv-aso-intellectual-developmental-disabilities).
• WV Medicaid Management Information System (WVMMIS): The fiscal agent and portal for provider enrollment and claims processing (https://www.wvmmis.com/).
• Office of Health Facility Licensure and Certification (OHFLAC): Oversees state licensure for behavioral health centers and certain residential facilities (https://ohflac.wv.gov/).

3. Gatekeeping Prerequisites: Who Can Even Apply

West Virginia imposes strict structural preconditions on agencies wishing to provide HCBS waiver services. Because there is no standalone housing stabilization enrollment, providers must pass the gatekeeping requirements for the IDDW or ADW programs before any Medicaid application is accepted.

The most significant barrier is the Conflict-Free Case Management (CFCM) mandate. Agencies must legally and operationally separate case management (which includes housing search and planning) from direct service provision (which includes in-home tenancy supports).

• No Standalone Authority: Applicants cannot enroll as "Housing Stabilization Providers"; they must apply as comprehensive IDDW or ADW Case Management or Person-Centered Support agencies.
• Conflict-Free Case Management (CFCM): Agencies cannot provide both Case Management and direct Person-Centered Support to the same individual; applicants must declare their service lines upfront.
• UMC Pre-Approval: Providers must be reviewed and approved by the Utilization Management Contractor (Acentra Health for IDDW) before BMS will process a Medicaid enrollment application.
• Managed Enrollment List (Waitlist): The IDDW program operates with a waitlist (managed enrollment list), meaning the pool of eligible clients is capped by state funding slots, limiting immediate growth for new providers.
• Business Registration: Applicants must have an active, registered business entity in good standing with the West Virginia Secretary of State before applying to the UMC.

4. Licensure and Certification Requirements

Providers delivering housing-related supports under WV Medicaid waivers must meet the certification standards specific to the waiver they are operating under. While traditional real estate or housing agencies cannot simply bill Medicaid, human service agencies must obtain the proper credentials.

Depending on the exact services offered, agencies may also need a Behavioral Health Center license from OHFLAC, though purely administrative Case Management agencies may only require UMC certification and BMS enrollment.

• UMC Certification: Agencies must pass a readiness review and annual reviews conducted by Acentra Health (for IDDW) to maintain certified provider status.
• OHFLAC Licensure: Agencies providing direct behavioral health or specialized residential services must obtain a Behavioral Health Center license from the WV Office of Health Facility Licensure and Certification.
• Liability Insurance: Providers must maintain comprehensive general liability insurance and professional liability insurance, submitting certificates during enrollment.
• NPI Requirement: Agencies must obtain a National Provider Identifier (NPI) tied to the specific taxonomy of the waiver service (e.g., Case Management).
• Policy Manual Approval: Applicants must submit comprehensive operational manuals, including CFCM policies, for UMC review prior to certification.

5. Medicaid Provider Enrollment

Once certified by the UMC, agencies must formally enroll as West Virginia Medicaid providers through the WVMMIS portal, managed by Gainwell Technologies. This process links the agency's NPI to the state's billing system.

Enrollment requires submitting proof of UMC certification, ownership disclosures, and passing federal screening requirements. Providers must revalidate their enrollment at least every five years.

• Enrollment Portal: Applications must be submitted electronically through the WVMMIS Provider Enrollment portal (https://www.wvmmis.com/sitepages/provider-enrollment.aspx).
• Application Fee: Institutional providers must pay the federal Medicaid application fee (approximately $709 for 2024/2025) unless they provide proof of payment to Medicare or another state's Medicaid program.
• Provider Agreement: Applicants must sign the WV Medicaid Provider Agreement, legally binding them to Title XIX regulations and the WV State Medicaid Plan.
• Ownership Disclosures: Agencies must complete detailed disclosures of ownership and control interest (individuals owning 5% or more) to comply with federal screening rules.
• Revalidation: Providers must verify their enrollment information and update disclosures at predetermined intervals (typically every 5 years) to avoid termination.

6. Staffing, Training and Background Checks

Staff providing tenancy supports under the guise of Case Management or Person-Centered Support must meet strict educational and background requirements. West Virginia uses a centralized background check system for all HCBS workers.

Training is heavily regulated by the UMC, requiring staff to complete specific modules on waiver policies, incident reporting, and person-centered planning before billing for services.

• WV CARES: All staff must pass a fingerprint-based state and federal criminal background check through the WV Clearance for Access: Registry & Employment Screening (WV CARES) system prior to employment.
• Case Manager Qualifications: Staff performing housing search and planning (Case Managers) typically must hold a Bachelor’s degree in a human services field and have at least one year of relevant experience.
• Direct Support Qualifications: Staff providing in-home tenancy sustaining supports must have a high school diploma or GED and pass competency evaluations.
• CPR and First Aid: All direct-contact staff must maintain current CPR and First Aid certifications.
• UMC Training: Staff must complete mandatory training modules through the Acentra Health CareConnection© web portal, including abuse/neglect reporting and waiver-specific protocols.

7. Documentation, Policies and Records

Because housing stabilization is not a distinct billing code, all housing-related activities must be meticulously documented as part of the member's broader waiver services. Auditors look for a direct link between the billed time and the goals in the member's plan.

Agencies must maintain robust internal policies, particularly regarding conflict of interest, member rights, and incident reporting, which are reviewed annually by the UMC.

• Individualized Support Plan (ISP): All housing search, mediation, and retention activities must be explicitly tied to goals and objectives written into the member's annual ISP.
• Progress Notes: Staff must write detailed progress notes for every encounter, documenting the date, start/stop times, specific housing activities performed, and the member's response.
• Electronic Visit Verification (EVV): Agencies providing direct in-home supports (Person-Centered Support) must use the state-mandated EVV system to log the location and duration of visits.
• CFCM Policy: Agencies must maintain and enforce a written Conflict-Free Case Management policy, demonstrating how they separate assessment/planning from direct service delivery.
• Record Retention: Providers must retain all clinical and financial records for a minimum of five years, making them available for BMS or UMC audits upon request.

8. Billing, Rates and Claims

Billing for housing-related supports is processed through the WVMMIS Health PAS-Online system. Providers bill using the specific HCPCS codes assigned to their waiver service (e.g., Case Management or Person-Centered Support).

Services are typically billed in 15-minute increments. Providers must ensure that they do not exceed the annual budget or unit limits authorized in the member's ISP.

• Claims Portal: All claims are submitted electronically via the WVMMIS Health PAS-Online portal (https://www.wvmmis.com/).
• Billing Codes: Housing activities are billed under waiver-specific HCPCS codes, such as T1016 for Case Management, rather than a dedicated housing stabilization code.
• Unit Increments: Services are generally billed in 15-minute units; providers must have documentation supporting the exact time spent on housing-related tasks.
• Prior Authorization: All services must be prior-authorized by the UMC (Acentra Health) based on the approved ISP before any claims will be paid by WVMMIS.
• Managed Care Organizations (MCOs): While IDDW is largely managed by the UMC, providers serving other Medicaid populations may need to contract with MCOs like The Health Plan or Aetna Better Health of WV for reimbursement.

9. Approval Sequence and Timeline

Becoming an approved waiver provider in West Virginia is a multi-step process that requires coordination between the Secretary of State, the UMC, and BMS. The process cannot be expedited and must be completed in a specific order.

From initial business registration to receiving an active Medicaid provider number, agencies should expect the process to take between 90 and 120 days, assuming all applications are complete and accurate.

• Step 1: Business Entity Registration: Register the agency with the West Virginia Secretary of State and obtain an EIN.
• Step 2: NPI Acquisition: Apply for a National Provider Identifier (NPI) matching the intended waiver service taxonomy.
• Step 3: UMC Certification: Submit the provider application, policies, and procedures to Acentra Health for review and approval.
• Step 4: WV CARES Enrollment: Register the agency with WV CARES to begin processing staff background checks.
• Step 5: WVMMIS Enrollment: Submit the formal Medicaid provider enrollment application through the WVMMIS portal, including the UMC approval letter.
• Step 6: Credentialing Timeline: Expect 60 to 120 days for full processing, depending on UMC review times and WVMMIS volume.

10. Common Denials and Survey Findings

Provider applications and annual surveys are frequently delayed or denied due to administrative errors or failure to adhere to strict waiver guidelines. BMS and the UMC conduct rigorous oversight.

The most common issues revolve around background check compliance, conflict of interest violations, and inadequate documentation linking services to the ISP.

• CFCM Violations: Applications denied because the agency's organizational structure fails to demonstrate a clear separation between case management and direct care.
• Incomplete Background Checks: Survey citations for allowing staff to provide services before receiving a cleared WV CARES background check.
• Missing Primary Source Verification: Enrollment delays caused by failing to provide primary source verification for staff degrees or licenses.
• Unsubstantiated Claims: Recoupment of funds during audits because progress notes did not clearly describe the housing-related activity or match the billed time.
• Expired Documentation: Enrollment rejections due to uploading expired liability insurance certificates or blank policy templates into the WVMMIS portal.

11. Key Contacts and Resources

Navigating the West Virginia Medicaid system requires utilizing the specific helpdesks and portals provided by the state and its contractors. Providers should rely on these official channels for the most current manuals and forms.

The UMC and WVMMIS offer dedicated provider relations representatives to assist with certification, enrollment, and billing inquiries.

• WV Bureau for Medical Services (BMS): 304-558-1700, the central authority for WV Medicaid policy (https://bms.wv.gov/contact-us).
• Acentra Health (WV ASO): The UMC for IDDW provider certification and authorizations (https://wvaso.acentra.com/wv-aso-intellectual-developmental-disabilities).
• WVMMIS Provider Enrollment Unit: Manages the Health PAS-Online portal and enrollment applications (https://www.wvmmis.com/sitepages/provider-enrollment.aspx).
• WV CARES: The centralized background check system for all HCBS providers in West Virginia (https://wvcares.wv.gov/).
• Office of Health Facility Licensure and Certification (OHFLAC): For agencies requiring Behavioral Health Center licensure (https://ohflac.wv.gov/).

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