Table of Contents
The West Virginia Medicaid Program provides a medical card that may be used to receive medical care in the community or an institutional setting, such as a nursing home. This allows those who may not be able to afford medical care to have their health needs addressed.
| Program Name | West Virginia Medicaid |
| Expanded Medicaid | Yes |
| Website | dhhr.wv.gov |
| dhhrbcfchangectr@wv.gov | |
| Phone | 877-716-1212 |
| Apply Online | https://www.wvpath.org/ |
| Appeal a Denial | Fair Hearing Request Form |
| Find a Local Office | https://dhhr.wv.gov/bms/Pages/Field-Offices.aspx |
Eligibility Requirements
To be eligible for West Virginia Medicaid, you must be a resident of the state of West Virginia, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.
You must also be one of the following:*
- Pregnant
- Be responsible for a child 18 years of age or younger
- Blind
- Have a disability or a family member in your household with a disability
- Be 65 years of age or older
* ACA Medicaid expansion covers eligible low-income adults.
Annual Household Income Limits (before taxes)
| Household Size* | Maximum Income Level (Per Year) |
| 1 | $17,131 |
| 2 | $23,169 |
| 3 | $29,207 |
| 4 | $35,245 |
| 5 | $41,284 |
| 6 | $47,322 |
| 7 | $53,360 |
| 8 | $59,398 |
*For households with more than eight people, add $6,038 per additional person.
Available Services Include
| Cardiac rehabilitation | Nursing home |
| Chiropractic | Nutritional counseling |
| Diabetes education | Occupational therapy |
| Diagnostic X-ray | Orthotics and prosthetics |
| Durable medical equipment | Outpatient hospital services |
| Emergency services | Personal care services |
| Family planning services and supplies | Physical therapy |
| Home health | Podiatry |
| Hospice | Prescription drugs |
| Hospital services | Primary care office visits |
| Laboratory services and testing | Specialty care |
| Maternity services | Speech therapy |
| Non-emergency medical transport | Tobacco cessation |
Copayments
| Federal Poverty Level (FPL) | |||
| Up to 50% FPL | 50% – 100% FPL | Over 100% FPL | |
| Inpatient hospital | $0 | $35 | $75 |
| Office Visits | $0 | $2 | $4 |
| Emergency room for non-emergency | $8 | $8 | $8 |
| Outpatient services | $0 | $2 | $4 |
| Prescriptions | |
| Total Allowed Charge | Copayment |
| $0.00 – $5.00 | $0 |
| $5.01 – $10.00 | $0.50 |
| $10.01 – $25.00 | $1.00 |
| $25.01 – $50.00 | $2.00 |
| over $50.00 | $3.00 |
The following populations and services are exempt from copays:
- Pregnant Women including pregnancy-related services up to 60 days postpartum
- Children under age 21
- Native American and Alaska natives
- Intermediate Care Facility or MR services
- Preventive services for children under age 18
- Provider-preventable services
- Individuals in Nursing Homes
- Receiving Hospice services
- Medicaid Waiver services
- Family Planning services
- Emergency services
Maximum Out of Pocket (OOP)
Each calendar year quarter, West Virginia Medicaid members will have a maximum out-of-pocket (OOP) payment. The OOP is the most the member will ever be required to pay in any given quarter, regardless of the number of health care services received.
The following table shows the maximum out of pocket costs based on poverty level:
| Federal Poverty Level (FPL) | Quarterly Out of Pocket Maximum |
| Up to 50% FPL | $8 |
| 50.01 – 100% FPL | $71 |
| Over 100% FPL | $143 |
