West Virginia Skilled Nursing Medicaid Rates and Reimbursement (2026)

Skilled nursing Medicaid rates in West Virginia are among the highest in the country. West Virginia Medicaid publishes a daily rate of $436.57 for a nursing home stay under code CBC1, effective July 1, 2026, compared with a national median of $282.59 among states with a comparable figure. West Virginia is not part of the 21-state ranking, but its rate is higher than every ranked state except New Mexico.

That high rate sits alongside nursing wages well below the national median. The combination makes West Virginia one of the more favorable rate-to-wage environments for nursing facility operators, and a methodology amendment effective July 1, 2026 is reshaping how the rate is built. Every rate here is compiled from official state Medicaid publications and linked to its source document.

The $436.57 per diem, published under code CBC1, is West Virginia Medicaid's payment for one nursing home resident day. It is the reference figure we use to compare West Virginia with other states, because a daily rate is the only unit that lines up across state nursing facility systems.

West Virginia Medicaid is administered by the Bureau for Medical Services on a fee-for-service basis for nursing facilities. The current Nursing Facility Fee Schedule runs from July 1, 2026 to December 31, 2026. Facility per diems are set facility by facility, so the statewide figure is a reference point; each facility should confirm its own rate. The West Virginia state page lists the published rates and links each to its source document.

A nursing facility per diem is all-inclusive. One daily payment funds nursing at three licensure levels, room and board, dietary, housekeeping and laundry, activities, social services, administration and capital. Medicaid does not pay separately for most of these; the facility allocates the daily payment across them.

Two practical points follow. Occupancy drives revenue, because payment is earned per resident day while fixed costs continue whether a bed is filled or not. And the rate period matters: with a fee schedule covering a half-year, costs that rise mid-period are carried until the next schedule takes effect.

West Virginia's May 2025 wages are below the national median at every nursing level:

This is the defining feature of West Virginia's nursing facility economics. In most high-rate states, such as Washington or Rhode Island, high per diems are matched by high wages. In West Virginia, the per diem is far above the national median while every nursing role earns well under it. Nursing assistants, who provide most direct-care hours, earn $17.66 against a national $20.32.

Where the room in the budget goes

For an operator, that gives room in the budget to raise pay, add staff hours or invest in the building. The constraint tends to be supply rather than cost: where wages are well below national levels, facilities compete with hospitals, with employers in neighbouring states and with each other for a limited pool of nurses. A strong per diem is what makes competitive pay possible, and facilities that use it to pay above the local median are better placed to keep staff and reduce reliance on agency nurses.

West Virginia issued a public notice on June 29, 2026 for State Plan Amendment (SPA) 26-0003, regarding nursing facility reimbursement methodology, with an effective date of July 1, 2026.

A methodology amendment changes how rates are calculated, not just their level, so it can shift rates differently across facilities depending on their costs and residents. Two facilities that received similar per diems under the old method can end up further apart under the new one, even if the statewide average barely moves. Each facility should model its own rate under the amended method as soon as the details are final, rather than assuming the statewide trend applies to it.

Reading a methodology change from the inside

The most useful preparation is to understand which inputs the new method weighs most. If it leans more on a facility's reported costs, cost report accuracy becomes the priority; if it leans more on resident acuity, assessment practice does; if it adds or changes quality or occupancy factors, those operational measures start to carry dollars. Mapping the facility's position on each input, before the first rates under the new method are published, turns a policy notice into a concrete forecast and shows where effort will pay off.

Earlier West Virginia actions frame the current system:

1. SPA 24-0004, regarding nursing facilities: public notice July 9, 2024, effective October 1, 2024, approved by CMS on August 28, 2025.
2. Nursing facility per diem rates, July 1 to September 30, 2024: published in an OAMR memo dated June 18, 2024, effective July 1, 2024.
3. SPA 22-0016: a 2022 amendment rescinding the state's disaster relief policies for the COVID-19 national emergency as they applied to the nursing home rate increase.

Two patterns stand out. First, West Virginia publishes per diems for set periods, quarterly in 2024 and now a half-year fee schedule, so facility rates can change more than once a year. Second, CMS approval can trail the effective date by many months: SPA 24-0004 took effect in October 2024 and was approved in August 2025. Facilities should expect the same for SPA 26-0003 and watch for retroactive adjustments once CMS acts.

Planning for retroactive adjustments

When an amendment is effective before it is approved, any change CMS requires can reach back to the effective date. A cautious finance team books revenue at the published rate but keeps track of the exposure, so a retroactive change does not arrive as a surprise in a later year's results.

West Virginia runs Medicaid managed care through plans including Aetna Better Health of West Virginia, Highmark Health Options West Virginia, The Health Plan of West Virginia, UniCare Health Plan of West Virginia and Wellpoint West Virginia. Nursing facilities sit outside it: in West Virginia, nursing facilities are paid directly by the state, outside managed care.

The published per diem is therefore the payment for a Medicaid resident day, regardless of a resident's plan for other services. There is no plan-level negotiation over the nursing facility rate, and rate changes come through state plan amendments and Bureau for Medical Services publications. We record 5 plans in West Virginia. The West Virginia managed care page explains how each service line is paid.

For an operator, this concentrates attention on the state. Comment periods on state plan amendments, such as the notice for SPA 26-0003, are the formal point where facilities can weigh in on a methodology before it takes effect.

Of the 44 states with a published nursing home rate, 21 are ranked on a single daily figure. New Mexico leads at $826.00, followed by Colorado ($419.22), Rhode Island ($381.06), Washington ($373.84) and Kentucky ($365.78). At the low end are Connecticut ($107.21), Michigan ($99.90) and Arkansas ($70.00).

At $436.57, West Virginia would sit second only to New Mexico, just ahead of Colorado. Its neighbour Kentucky also appears in the top five, and Maryland and Ohio are the other regional comparisons for operators with buildings across state lines.

Cross-state comparisons need care. States differ in what a per diem includes and how much they pay through supplemental programs, so the headline gap is a starting point for analysis, not a final answer about relative revenue.

• SPA 26-0003 at CMS. Approval, or requested changes, will confirm the methodology behind the July 2026 rates.
• The January 2027 fee schedule. The current schedule ends December 31, 2026; the next one will show the first full rate reset under the new method.
• Wage pressure. With wages below national levels and a strong per diem, the question is whether facilities can recruit enough staff, not whether they can afford the pay.

Build the Medicaid budget from the facility's own rate for each fee schedule period, not the statewide reference, and update it when each new schedule is published. Keep a separate note of any amount that depends on a pending amendment, so the exposure to a retroactive adjustment is visible.

For benchmarking, compare the facility's rate across schedule periods and against similar West Virginia facilities, and use the national comparison for board and lender context. West Virginia's nursing facility line carries 3,111 current rates, part of all 88,707 current West Virginia Medicaid rates available through MedicaidRate plans.

Rates on this page are compiled from official state Medicaid publications, and each rate links to its source document. The West Virginia nursing facility source is the Bureau for Medical Services Nursing Facility Fee Schedule effective July 1, 2026 to December 31, 2026. Policy changes come from state plan amendment public notices, OAMR memos and CMS approvals.

Cross-state ranks compare one daily nursing home rate per state; West Virginia is shown against the national median but not ranked. See the skilled nursing industry hub for every state and the methodology page for how rates are compared.