West Virginia Medicaid Program & Eligibility
Coverage, eligibility, and how to get Medicaid help in West Virginia.
Medicaid Expansion
State Coverage
Medicaid in West Virginia
WV Medicaid Eligibility
- Live in West Virginia
- Be a U.S. citizen, national, or a qualified immigrant
- Have a household income at or below the limit for the specific program that applies to you
West Virginia Medicaid covers several groups of people:
- Children under 19 (through Medicaid or WVCHIP)
- Pregnant women: covers prenatal care through 12 months postpartum, and your newborn is covered through their first birthday
- Parents and caretakers: if you have a dependent child living with you
- Adults ages 19–64: under Medicaid expansion, with income up to 138% of the Federal Poverty Level
- Seniors and people with disabilities: adults 65 and older, people who are blind, or those living with a qualifying disability
- Former foster youth: if you had Medicaid when you aged out of foster care, you can keep your coverage until age 26 with no income limit
- People diagnosed with breast or cervical cancer
Applying for Medicaid
West Virginia has multiple ways to apply for Medicaid, so you can choose the option that works for you.
- Online: You can apply for Medicaid at WV PATH (People's Access To Help)
- By phone: Call the WV PATH Customer Service Center at 1-877-716-1212, Monday–Friday
- By mail: You can download and complete the Application for Benefits (DFA-2) and mail it to your local DoHS office
- In person: You can also apply in person at your local DoHS office
After Applying
After you apply, the state of West Virginia will review your application and notify you of your eligibility.
While your application is under review: You may receive a notice in the mail from the state requesting proof of income and proof of identity or citizenship. Make sure to respond promptly so that your application can be processed without delays.
If you’re approved:
- Coverage may start right away or be retroactive, meaning Medicaid may help cover bills you've already received (up to 3 months prior to your application).
- You'll receive a member ID card in the mail. Keep it safe and bring it to all medical appointments.
- You will usually enroll in a Medicaid managed care plan.
Staying enrolled:
- Report any changes in income, household size, address, or family status as soon as possible.
- Your coverage must be renewed annually. Watch for renewal notices in the mail and respond promptly to avoid losing coverage.
Income Limits
Income limits for Medicaid in West Virginia depend on your household size and what program applies to you.
What’s Covered
Doctor and Hospital Visits
Preventative Care and Screenings
Mental Health and Substance Use Treatment
Prescription Drugs
Maternity and Newborn Care
Dental and Vision Services
Long-Term Care (for eligible individuals)
Transportation Services
Need help with Medicaid
in West Virginia?
Below are some of the most commonly asked questions.
Medicaid in West Virginia is a public health insurance program that provides free or low-cost health coverage to eligible low-income individuals and families. It is administered by the Bureau for Medical Services (BMS) within the West Virginia Department of Human Services (DoHS). The state's CHIP program for children is called WVCHIP.
If your income is too high for Medicaid, your children may still qualify for low-cost coverage through WVCHIP, which covers children in households with income up to 300% of the Federal Poverty Level. If you don't qualify for either program, you may still be able to enroll in an affordable paid plan through the federal Health Insurance Marketplace, with subsidies available based on income.
How you apply depends on your age and situation:
- Adults under 65 typically apply online through WV PATH (People's Access To Help)
- Seniors (65+) and people with disabilities also apply through WV PATH or directly with the Department of Human Services (DoHS)
Applications can also be completed and submitted by phone, by mail, or in person at a local DoHS office.
Filling out government forms (paper or digital) can be confusing. We know the anxiety of missing important mail from the state. We built Fortuna to take the stress out of health plan coverage.
We provide your own dedicated navigator available by phone and chat to help you out!
For most people, Medicaid in West Virginia has no monthly premium and very low or no out-of-pocket costs. Some services may require small copayments, but many groups (such as children and pregnant individuals) are exempt. WVCHIP may require a small monthly premium for higher-income households.
Medicare is health insurance that generally covers people aged 65+. Medicaid covers people of all ages if you make below a certain income or face hardship based on other circumstances like disability.
Fortuna focuses on Medicaid. If you need Medicare support, we can help you enroll onto a Medicare-Medicaid program.
Yes, if Fortuna is available through our partner health plan and providers. Please contact your insurer or provider for more information.
Yes, Fortuna is only available through providers and insurers. Please contact us at info@fortunahealth.com for more information.
Ready to renew or start your coverage?
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