West Virginia Medicaid

Medicaid is a government health insurance program that helps certain people get health care services at a lower cost. There are different Medicaid programs in West Virginia for different groups of people.

What does West Virginia Medicaid cover?

West Virginia Medicaid pays for routine and acute health care services. This includes:

• Visits to health care providers (including physicians and nurse practitioners)
• Inpatient and outpatient hospital services
• Early and periodic screening, diagnostic, and treatment services
• Preventive care (e.g., vaccinations)
• Lab tests and X-rays
• Dialysis services
• Mental health services
• Substance use treatment
• Rural health clinic services
• Medical transportation
• Long-term care (e.g., nursing facility care, home health services)

Most states also cover optional services such as:

• Physical, respiratory, and occupational therapy
• Home- and community-based care
• Case management
• Prescription drugs
• Dental and vision care
• Hearing services
• Podiatry services
• Hospice care

Since the program serves those with limited income and resources, people with West Virginia Medicaid pay few to no out-of-pocket costs for their benefits. To get coverage once you are enrolled, you must go to health care providers that take part in the West Virginia Medicaid program.

In West Virginia, Medicaid is administered by the West Virginia Department of Human Services (DoHS). Call DoHS at 1-877-716-1212 to learn more about the coverages provided.

How do I know if I qualify for Medicaid in West Virginia?

In general, to be eligible for Medicaid, you must:

• Be a West Virginia resident
• Be a U.S. citizen or a qualified non-citizen
• Meet the income and/or asset limit for your coverage group

What are the different Medicaid programs in West Virginia?

You may be able to get health coverage if you fall into one of the following categories.

Nursing Home Medicaid

Nursing Home Medicaid in West Virginia covers health care and support services in a nursing home or other medical facility. It may cover room and board as well as nursing care, rehabilitation services, and social services. You may be able to get this coverage if you have limited income and resources. You must also have a medical condition that requires the skills of a licensed nurse on a regular basis.

Medicaid Aged and Disabled Waiver (ADW)

This West Virginia Medicaid program provides health care and support services so that you can stay in your own home to avoid having to move into a nursing home. It can help you take care of your daily needs by providing services such as case management, homemaking, personal care, meals, and adult day programs. You may be placed on a waiting list before you can get help from this program.

Medicaid Personal Care Services

This Medicaid program helps you with personal care services in your home if you need help caring for yourself in West Virginia. These services may help you continue to live in your own home. Specific types of help provided may include assistance with bathing, dressing, meals, shopping, and light housework.

Medically Needy Program (Medicaid Spend-Down)

This program lets you get West Virginia Medicaid even if your income is higher than Medicaid program guidelines. It works by letting you spend down your income so that you meet Medicaid income limits. The spend-down amount is the amount of income that is over the Medicaid limit. This amount is different for each person.

To get Medicaid benefits, you must submit current paid or unpaid medical bills equal to or greater than your monthly spend-down amount. Once your medical bills reach this amount, you will get Medicaid coverage for the rest of the calendar month. While using Medicaid to pay for your medical expenses, be sure to use a health care provider who takes part in the Medicaid program.

Some examples of medical expenses you can use to meet your share of cost include:

• Unpaid medical bills that have not been used to meet the share of cost before
• Health insurance premiums
• Medical bills you paid within the last three months
• Medical bills that will not be paid by health insurance (or any other source)
• Co-pays for medical bills
• Medical services prescribed by your doctor
• Transportation by ambulance, bus, or taxi to get health care services

Some examples of medical expenses you cannot use to meet your share of cost include:

• Premiums for insurance policies that pay you for hospitalization
• Over-the-counter medical supplies (e.g., cold medicine, bandages)

Note: Certain health care providers do not accept West Virginia Medicaid or the Medically Needy Program. Be sure to tell your provider that you take part in the Medically Needy Program before making an appointment.

How do Medicare and Medicaid work together?

If you get Medicare, you may also be able to get help from West Virginia Medicaid. This is called being “dual eligible.” Medicaid pays for some services not covered by Medicare such as eyeglasses, hearing aids, and dental care.

If you have Medicare and qualify for full Medicaid coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums.

Depending on the level of West Virginia Medicaid you qualify for, the state might also pay for:

• Your share of Medicare costs, like deductibles, coinsurance, and copayments
• Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage

In addition, if you are dual-eligible for Medicare and Medicaid:

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.
• You may be able to get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, visit the Medicare website or call 1-800-633-4227 or 1-877-486-2048 (TTY).

How do I prepare to apply for Medicaid in West Virginia?

When you apply for Medicaid in West Virginia, you’ll be asked for important information to help determine if you qualify for benefits.

Before you start, gather some basic information to make your application process easier: 

• A document that shows your age, such as your birth certificate or driver’s license
• Your Social Security card
• Pay stubs for anyone in your household who has earned income
• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)

Information about your financial assets, such as bank account or investment account statements

How do I apply for Medicaid in West Virginia?

There are a few different ways you can apply for Medicaid in West Virginia. Read below to learn more about which option might be right for you.

Apply Online

The quickest and easiest way to apply for Medicaid in West Virginia is online through the WV Path website. All your personal information is kept 100% confidential and protected by special security technology. 

Apply Online

Apply by Phone or in Person

Call the West Virginia DoHS Customer Service Center at 1-877-716-1212.

Apply by Mail

You can download and print a benefits application, complete it, and mail it to your nearest DoHS field office.

How can I get help with my West Virginia Medicaid application?

There are a few ways to get help filling out your Medicaid application:

• Contact your DoHS field office.
• Call the DoHS hotline at 1-877-716-1212.
• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.
• NCOA also has a HelpLine you can call to get free support. To get started today, call  1-800-794-6559.