Updated August 27, 2026. Quick answer: West Virginia defines the term in its own glossary — “The amount by which income exceeds the Medically Needy Income Level (MNIL) for the Period of Consideration (POC).” — and then instructs workers to pick the window in the client’s favour: “The specific months which will constitute the Period of Consideration (POC) based on the six-month POC that will most benefit the client.”
What West Virginia requires
| What the state sets out | What it says |
|---|---|
| West Virginia’s name for it | spenddown, over a Period of Consideration (POC) |
| The definition | “The amount by which income exceeds the Medically Needy Income Level (MNIL) for the Period of Consideration (POC).” |
| Choosing the period | “The specific months which will constitute the Period of Consideration (POC) based on the six-month POC that will most benefit the client.” |
| Backdating | “The beginning date of eligibility may be backdated up to three months prior to the month of application when all eligibility requirements are met, and the client has medical expenses for which he seeks payment.” |
| Who it applies to | “Spenddown provisions apply to Supplemental Security Income (SSI)-Related.” |
| If a case closes and reopens | “AGs that do not have a spenddown, but are closed due to a change in the AG’s circumstances that results in a spenddown, are not required to reapply or complete a new application for the new period of consideration (POC) that follows AG closure.” |
How it works in practice
- “That will most benefit the client” is written into the instruction, not left to discretion. The six-month POC is selected to help, which makes the choice of start month worth raising at application.
- Three months of backdating is available where all requirements are met and there are medical expenses to claim — the same window most states use, but here it is tied explicitly to expenses the client seeks payment for.
- A case that closes and reopens into a spenddown does not require a new application. That removes a common source of lost months.
The mechanism itself — why an income cap exists and what the trust must contain — is explained on the income-cap and Miller trust page. This page is the record for West Virginia.
What this page does not settle
- The MNIL is a table in the same manual. This page states the mechanism and does not reproduce the dollar figures, which are published as a chart rather than as text.
- This page reads one source: West Virginia Income Maintenance Manual (Bureau for Family Assistance). It is the state’s own publication on this rule, but no state puts its whole treatment of excess income in a single document, and a detail that decides your case may sit in one this page did not read.
- A spend-down fixes an income problem and nothing else. The resource test, the level-of-care test and the transfer-of-assets look-back are separate hurdles, each decided on your own file, and meeting this rule does not clear any of them.
- Every quotation here was read against the source on August 27, 2026. States revise these rules, and a figure or a section number can move without the page around it changing. Open the source before you rely on a detail.
Eligibility is decided by the state agency on the whole file, not by one rule on one page. Nothing here is legal advice, and no one should move, retitle or assign income on the strength of a web page.
Sources
The source above was retrieved and read against the state text on August 27, 2026. Every quotation on this page was checked against those bytes.
Income is only the first of the two Medicaid questions a family in West Virginia faces. The second is what the state can recover after death: Medicaid estate recovery in West Virginia (probate estate only).
Related: West Virginia’s Medicaid home equity limit for a single applicant with no spouse or dependent child at home.
Related: West Virginia’s Medicaid Personal Needs Allowance; the amount a nursing-facility resident keeps from their own income each month.