West Virginia’s statute puts the burden where it belongs. Under W. Va. Code § 33-13C-8, a viatical settlement provider or broker must give the viator a set of disclosures no later than when the application is signed — and one of them is the explicit statement that there are possible alternatives to viatical settlement contracts. The company has to say it. If the paperwork a resident’s family shows you does not contain that disclosure, you have a concrete, citable reason to stop and ask questions.
That matters more here than in most states, because West Virginia combines two conditions that put pressure on families: one of the oldest populations in the country, and skilled nursing costs near the top of the national range despite a comparatively low household income base. A resident’s decades-old life insurance policy is frequently the largest asset left, and it is also the one nobody thinks to look at until a premium notice arrives at the facility.
This page is written for the practitioner running those files. It covers what Chapter 33, Article 13C requires, the 2024 reorganization that changed which agency you call, how to screen a policy quickly, the alternatives a resident is entitled to hear about, who has authority to sign, and how proceeds interact with West Virginia Medicaid’s income cap. It is education, not legal, tax, or financial advice. Pine Lake Life Solutions provides a free policy review and does not purchase policies; licensing varies by state, and eligibility questions belong with the resident’s own elder law attorney.
In This Article
The Statute Requires the Company to Say Alternatives Exist
West Virginia regulates these transactions under W. Va. Code § 33-13C-1 et seq., the Viatical Settlements Act. The regulator is the West Virginia Offices of the Insurance Commissioner — the plural is the agency’s actual name, and using it correctly signals to a company that you know who you are dealing with.
Four sections carry the weight:
- § 33-13C-2 supplies the definitions, including who is a viator and what constitutes a viatical settlement contract.
- § 33-13C-3 provides that a person may not operate as a viatical settlement provider or broker without first obtaining a license from the Commissioner. Ask for the number and verify it before allowing any outside company to meet with a resident.
- § 33-13C-8 requires that with each application, the provider or broker give the viator specified disclosures no later than when the application is signed — including the statement that there are possible alternatives to viatical settlement contracts. This is the provision a business office should know cold.
- § 33-13C-13 and § 33-13C-14 address prohibited practices and fraud prevention and control.
The practical use of § 33-13C-8 is simple. When a family brings you paperwork, look for the alternatives disclosure. Its absence is not proof of misconduct, but it is a legitimate reason to slow down, ask the company to produce its full disclosure package, and note the request in the file. See West Virginia life settlement licensing and West Virginia insurance regulator consumer help.
The 2024 Reorganization: Who You Call Now
Effective at the start of 2024, West Virginia split the former Department of Health and Human Resources into three separate departments. Medicaid now sits within the West Virginia Department of Human Services, administered through the Bureau for Medical Services, with home and community-based alternatives delivered under the Aged and Disabled Waiver program.
If a settlement company, an out-of-state relative, or a stale reference sheet still says “DHHR,” that is a signal the information is at least two years old. It is a small thing that saves your staff real time, and it is a reasonable proxy for how current the rest of a company’s knowledge is.
Cost context, and it is the number that drives urgency here: the most recent CareScout (formerly Genworth) Cost of Care Survey figures for 2024 place a semi-private nursing facility room in West Virginia in the range of roughly $12,000 to $13,000 a month — near $144,000 to $156,000 a year — well above the national median of about $9,277 monthly, and strikingly high relative to West Virginia household incomes. Verify against your own private-pay schedule.
At those rates, private-pay runway disappears fast. A $90,000 settlement funds roughly seven months. That is usually enough to complete an application without errors, to keep a spouse in the family home rather than selling it, or to secure a bed within driving distance of an adult child who may live in Ohio, Virginia, or North Carolina. It is not enough to fund an indefinite private-pay stay, and framing it honestly that way keeps expectations realistic.
Screening the File
Three buckets, ten minutes each. Triage, not underwriting.
Failing now. Grace-period or lapse notices — typically 31 days, after which reinstatement requires evidence of insurability a skilled nursing resident cannot supply. Automatic premium loan notices, meaning the carrier is funding the premium from cash value and charging interest, with the exhaustion date usually projected on the annual statement. Universal life contracts where cost-of-insurance charges have outgrown the premium the resident has paid for decades.
Worth a review. Insured generally past 65, face amount roughly $100,000 or more, health materially worse than at issue. A level term policy still inside its conversion window belongs here — only convertible term carries secondary-market value, because a buyer needs a policy that will still exist at the insured’s death.
Not a candidate. Small burial and final expense policies. Below roughly $100,000 of death benefit the market rarely produces an offer. West Virginia files carry many of these, including old fraternal, union welfare fund, and burial association policies. Those residents are better served by a reduced paid-up election, an accelerated benefit rider, or confirming the policy is an excludable burial resource.
Two regional patterns. Coal, chemical, and steel retirees frequently hold group life certificates through union welfare funds or former employers, and value there depends entirely on whether a conversion or portability window remains open — often 31 days from the qualifying event. And residents with occupational lung disease, including black lung, may have federal benefits and a medical history that materially affects a life expectancy assessment; that is a matter for the underwriting professionals, not for your office, but it is worth knowing the file may look different than it appears. See what to do when a policy is lapsing.
| W. Va. Code section | What it requires | What the business office checks |
|---|---|---|
| 33-13C-2 | Definitions, including viator and viatical settlement contract | Confirms the vocabulary a compliant company uses |
| 33-13C-3 | License required from the Insurance Commissioner | Ask for and verify the license number |
| 33-13C-8 | Disclosures to the viator no later than when the application is signed, including that alternatives exist | Look for the alternatives disclosure in the paperwork |
| 33-13C-13 | Prohibited practices | Basis for escalating questionable conduct |
| 33-13C-14 | Fraud prevention and control | Framework behind a company’s antifraud plan |
The Options Memo
Six options, in a signed and dated memo, with the facility taking no position. Note that West Virginia’s own statute already contemplates that alternatives be disclosed, so a neutral memo is aligned with the state’s framework rather than an extra step.
Accelerated death benefit rider. Read the rider schedule first. If the contract has one and the resident meets the terminal or chronic illness definition, it pays in weeks, costs nothing in fees, and requires selling nothing. It is the most frequently missed option on the ladder.
Reduced paid-up. A nonforfeiture election that ends premiums permanently while preserving a smaller, fully paid death benefit. Usually right when the objective is a funeral rather than an inheritance.
Keep paying. Correct when a spouse still living at home needs the death benefit and the premium is affordable against household income.
Life settlement. Sale to a licensed provider for more than surrender value. The 2010 U.S. Government Accountability Office study of the market (GAO-10-775) found sellers typically received roughly 10% to 35% of face value and, on average, several times what surrender would have paid.
Surrender. Quick, certain, and the lowest-paying of the options that pay anything. Compare directly using surrender versus selling a policy.
1035 exchange. Rarely useful once a resident is institutionalized; list it so the record is complete.
Note who received the memo and file it. Where adult children live out of state and engage late, that page is what establishes the facility informed rather than steered.
Authority and Consents
Request five documents: the policy cover or declarations page showing carrier, policy number, face amount, issue date and owner; the most recent annual statement; the current premium notice; the rider schedule; and evidence of loans, collateral assignments, or an irrevocable beneficiary designation. An irrevocable beneficiary stops everything until that person consents in writing.
The viator — the owner — signs. Not the insured, not the beneficiary, not the responsible party on your admission agreement. Where a trust, an adult child, a union welfare fund, or a former employer owns the policy on the resident’s life, that owner alone controls the decision.
Where capacity is impaired, a durable power of attorney must actually grant insurance powers. West Virginia has adopted the Uniform Power of Attorney Act at W. Va. Code § 39B-1-101 and following, under which certain powers must be specifically enumerated rather than implied from general language. Absent a valid instrument, a guardianship or conservatorship through the West Virginia circuit court may be required, and in rural counties that adds weeks to a process already running 60 to 120 days.
Two consents are separate and both required in a settlement: the owner’s signature on the contract, and a HIPAA authorization satisfying 45 C.F.R. § 164.508 releasing medical records for life expectancy underwriting. Your medical records staff will receive the second. Treat it as any other authorized third-party release and reject anything without a compliant authorization attached.
The Bureau for Medical Services: Income, Assets, and Proceeds
West Virginia Medicaid is administered by the Bureau for Medical Services within the Department of Human Services. Two tests govern institutional eligibility.
Income. West Virginia applies the special income limit for institutional eligibility — 300% of the SSI federal benefit rate, adjusted every January with the cost-of-living adjustment, landing in the neighborhood of $2,980 per month for 2026. Confirm the current figure with the Bureau. Where the cap applies, a resident above it generally needs a qualified income trust, commonly called a Miller trust, to route the excess. Ask the eligibility worker on the file which pathway governs, and get it in writing if the answer will drive a financial decision.
Assets. The countable resource limit for a single applicant is $2,000. Life insurance is measured by total face value: $1,500 or less on the applicant’s life is excluded outright; above that, the cash surrender value is a countable resource. Term insurance with no cash value is generally not countable. This is the rule that surprises families, and the reason a modest whole life policy with real cash value can stall an otherwise clean application.
What a sale does. Selling for fair market value is not a gift and generally is not a penalized transfer under the 60-month look-back. Proceeds become fully countable cash on arrival and must be spent down or restructured before eligibility. Selling and then gifting the money to children is a separate transaction that squarely implicates the look-back. See West Virginia Medicaid asset and income limits and how life insurance counts as a Medicaid asset, then route the application question to counsel.
Estate recovery is federally mandated under 42 U.S.C. § 1396p(b) and West Virginia pursues it against the estates of deceased members who received nursing facility services. A death benefit paid to a named beneficiary passes outside the probate estate; unspent proceeds sitting in the resident’s own account at death generally do not. Where the money will land is a planning question for counsel, decided before a check is issued.
Boundaries
Identify, disclose, document, refer. Three limits.
No recommendation. Confirming a resident heard every alternative is administration. Telling a family selling is the right answer is advice, and in West Virginia it would require a license under W. Va. Code § 33-13C-3 that the business office does not hold.
No compensation. A referral fee for steering residents to a vendor implicates the federal Anti-Kickback Statute at 42 U.S.C. § 1320a-7b(b) wherever federal health care program business is involved. In a state where a large majority of nursing facility days are federally funded, that exposure is concrete. Sponsored staff meals tied to referral volume and consulting-style marketing agreements are the same arrangement under a different label; route any such offer to your compliance officer the day it is made.
No conditioning. Federal requirements of participation at 42 C.F.R. § 483.15 prohibit requiring a third party to personally guarantee payment as a condition of admission or continued stay, and 42 C.F.R. § 483.10 protects a resident’s right to manage their own financial affairs, including funds the facility holds in trust for them. Presenting a policy review as voluntary while signaling it is expected is the fact pattern surveyors write up.
For the same transaction from the professionals you refer to, see the West Virginia elder law attorney guide and the West Virginia Medicaid planner guide. When a family needs to know whether a policy has any market value before a grace period expires, a free, no-obligation review starting from the cover page will give them an answer — often a documented no, which is still worth having in writing.
Frequently Asked Questions
What does West Virginia require a settlement company to disclose?
Under W. Va. Code section 33-13C-8, a provider or broker must give the viator specified disclosures no later than when the application is signed, including the statement that there are possible alternatives to viatical settlement contracts. If that disclosure is missing from paperwork a family shows you, ask the company for its full disclosure package and note the request in the file.
Is it still DHHR?
No. Effective at the start of 2024, West Virginia split the former Department of Health and Human Resources into three departments. Medicaid now sits within the Department of Human Services, administered through the Bureau for Medical Services. A company or reference sheet still saying DHHR in 2026 is working from information at least two years out of date.
Why is nursing facility care so expensive in West Virginia?
Recent 2024 survey data place a semi-private room in the state at roughly $12,000 to $13,000 a month, well above the national median near $9,277, which is striking relative to household incomes here. Whatever the underlying drivers, the effect on your files is direct: private-pay runway disappears quickly and a policy decision cannot wait.
A resident is a retired miner with a union welfare fund certificate. Can that be sold?
Only if a conversion or portability window is still open, often 31 days from the qualifying event, and only if the resulting individual policy meets market criteria. Group certificates through union welfare funds and former employers are common in West Virginia files. Check the certificate and plan documents quickly rather than assuming either way.
Does West Virginia require a Miller trust?
Where the special income limit applies, yes. Institutional eligibility uses 300 percent of the SSI federal benefit rate, roughly $2,980 per month for 2026 and adjusted each January, and a resident above that generally needs a qualified income trust routing the excess. Ask the eligibility worker on the file which pathway governs and get the answer in writing.
The company will not produce its license number. What should we do?
Do not permit contact with residents, and document the refusal. W. Va. Code section 33-13C-3 provides that a person may not operate as a viatical settlement provider or broker without a license from the Insurance Commissioner. A legitimate company answers that question immediately. A refusal is itself the answer you needed.
Can the facility keep a resident’s policy in force by paying the premium?
That is a decision for your administrator and legal counsel, not a routine business office action, and it raises questions about the facility’s financial relationship with residents under the federal requirements of participation. The safer path is to notify the responsible party in writing the day a notice arrives so someone with authority can act inside the grace period.
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Related Reading
- Life Settlement Licensing West Virginia
- West Virginia Insurance Department Consumer Help
- West Virginia Medicaid Asset Income Limits
- Life Insurance Counts Medicaid Asset
- Policy Lapsing What To Do
- Surrender Vs Sell Policy
- Elder Law Attorney Life Settlement Guide West Virginia
- Medicaid Planner Life Settlement Guide West Virginia
Pine Lake Life Solutions does not purchase life insurance policies and does not provide legal, tax, or investment advice. Information provided is for educational purposes only. Eligibility for any option, including life settlements, is not guaranteed and depends on individual circumstances, policy terms, underwriting, and market conditions. Consult independent legal, tax, or financial professionals before making decisions regarding a life insurance policy.