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

Last reviewed: 2026-09-10

The West Virginia Bureau for Medical Services (BMS) does not currently cover standalone Housing Stabilization or Tenancy Support as a distinct service within its 1915(c) Medicaid waivers. Providers seeking to offer housing search, landlord mediation, and retention planning must instead enroll to provide Case Management or Community Transition Services under the Aged and Disabled Waiver (ADW) or the Intellectual/Developmental Disabilities (IDD) Waiver.

Approval to bill for these housing-adjacent supports requires passing a provider enrollment screening through the WVMMIS portal and, for IDD waiver services, obtaining a Behavioral Health Center license from the Office of Health Facility Licensure and Certification (OHFLAC). Applicants must first establish themselves as a comprehensive waiver agency rather than a specialized housing-only entity.

1. Service Definition and Scope

Because West Virginia lacks a dedicated Housing Stabilization service, tenancy support activities are absorbed into broader waiver service definitions. Under the ADW and IDD waivers, Case Management covers the coordination of community resources, including assisting members in locating and securing affordable housing.

Community Transition Services provide one-time funding and logistical support for members moving from an institution into a community setting. This includes paying for security deposits, utility setup fees, and essential furnishings, but it does not cover ongoing monthly rent or standalone landlord mediation outside of the transition window.

2. Regulatory and Oversight Agencies

The Bureau for Medical Services (BMS) serves as the single state Medicaid agency, defining waiver policies and managing the overarching provider network. BMS delegates specific operational and licensing duties to other state divisions.

The Office of Health Facility Licensure and Certification (OHFLAC) regulates facility and behavioral health standards, while the state's Medicaid Management Information System (WVMMIS) handles the actual provider enrollment and claims processing.

3. Gatekeeping Prerequisites: Who Can Even Apply

West Virginia strictly prohibits the enrollment of standalone housing stabilization agencies. To bill for housing-related supports, an entity must be approved as a comprehensive Case Management Agency (CMA) or a designated Transition Services provider under the ADW or IDD waivers.

For the IDD waiver, an applicant cannot even submit a Medicaid enrollment application without first holding an active Behavioral Health Center license from OHFLAC. There is no separate enrollment track for housing-only vendors.

4. Licensure and Certification Requirements

Agencies providing housing supports through the IDD waiver must obtain a Behavioral Health Center license from OHFLAC. This process involves submitting a detailed policy manual, passing a life safety code inspection if operating a facility, and undergoing an initial site survey.

ADW Case Management Agencies do not require a Behavioral Health Center license but must be certified by the Bureau for Medical Services and its operating agency, the Bureau of Senior Services, demonstrating compliance with Chapter 501 of the BMS Provider Manual.

5. Medicaid Provider Enrollment

All providers must enroll through the WVMMIS portal (Health PAS-Online). The state utilizes a phased enrollment and revalidation approach, requiring providers to submit their applications digitally along with proof of licensure and corporate standing.

Institutional providers, including waiver agencies, are subject to the federal Medicaid application fee unless they have already paid it to Medicare or another state's Medicaid program. The enrollment effective date is the date the application is fully reviewed and approved by BMS.

6. Staffing, Training and Background Checks

All staff providing direct waiver services, including housing-related case management, must clear a fingerprint-based background check through the WV CARES system. This system checks state and national criminal databases as well as abuse registries.

Case managers must meet specific educational requirements, typically holding a bachelor's degree in a human services field and completing state-mandated waiver orientation training before billing for services.

7. Documentation, Policies and Records

Providers must maintain comprehensive records in accordance with Chapter 100 and Chapter 300 of the BMS Provider Manual. This includes detailed individualized service plans (ISPs) that document the member's housing goals and the specific steps taken to achieve them.

Agencies must also maintain customized policy manuals covering member rights, incident reporting, confidentiality (HIPAA), and emergency housing protocols.

8. Billing, Rates and Claims

Because housing support is billed under Case Management or Transition Services, providers use standard waiver procedure codes. Claims are submitted electronically via the WVMMIS portal or through a clearinghouse using the 837P format.

Providers must ensure that all billed units are supported by corresponding case notes detailing the housing-related activity, the duration of the service, and the member's progress toward their ISP goals.

9. Approval Sequence and Timeline

The approval sequence begins with corporate formation and obtaining an NPI, followed by OHFLAC licensure (if applicable to the IDD waiver). Only after licensure is granted can the agency submit its WVMMIS enrollment application.

Once WVMMIS approves the enrollment (typically a 30-to-45 business day review window), the provider must then execute network contracts with the Mountain Health Trust managed care organizations to receive referrals and authorizations.

10. Common Denials and Survey Findings

Enrollment applications are frequently denied or delayed due to taxonomy mismatches between the NPPES registry and the WVMMIS application, or failure to upload the correct IRS CP-575 form.

During OHFLAC surveys or BMS audits, providers are commonly cited for failing to link housing support activities directly to the goals outlined in the member's approved ISP, or for missing WV CARES background check clearances in personnel files.

11. Key Contacts and Resources

Providers should rely on the official BMS and WVMMIS websites for the most current provider manuals, enrollment checklists, and fee schedules. The WVMMIS Provider Relations team is the primary contact for portal navigation issues.

For licensure questions regarding the IDD waiver, providers must contact OHFLAC directly. Managed care contracting questions should be directed to the individual Mountain Health Trust plans.

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