West Virginia Medicaid 2026: Who Qualifies, How to Apply

West Virginia Medicaid pays your doctor, hospital and pharmacy bills. It isn't a cash payment or a grant, and applying is free. Our West Virginia Medicaid income limits guide lists every income line by household size.

West Virginia Medicaid at a Glance (November 2026)

West Virginia expanded Medicaid, and BMS says Mountain Health Trust covers about 87% of the state's Medicaid members. According to the BMS and DoHS pages Grantsights read on November 13, 2026:

Sources: BMS Your Guide to Medicaid 2026, BMS applying page and Income Maintenance Manual sections 1.8 and 1.9, checked November 13, 2026.

Grantsights analysis of the WVCHIP chart shows a child's line reaching more than twice as far as a parent's: a family of four is cut off from adult Medicaid at $45,540 a year, but WVCHIP's Premium plan runs to $8,250 a month ($99,000 a year) for the same family. That's according to the WVCHIP income chart data effective March 2026. A Charleston parent who earns too much for the expansion group should still list the kids on the application; WVCHIP questions go to 1-877-982-2447.

Who Qualifies for West Virginia Medicaid in 2026

According to the BMS 2026 member guide, Medicaid covers 8 groups: SSI recipients, pregnant women, children under 19, former foster care children until age 26, very low income families, people who are aged, blind or disabled, people found medically needy, and adults 19 to 64. For adults, children and pregnant women, eligibility rests on Modified Adjusted Gross Income (MAGI) and tax household size, and there's no asset test.

A few West Virginia details that change who gets in:

• SSI means automatic Medicaid. SSI recipients don't apply at DoHS; the guide says the medical card arrives on or about the first day of the month SSI starts.
• Medically frail adults choose their package. An expansion adult with a condition that limits daily activities can pick traditional Medicaid instead of the Health Bridge plan. Report it to the county office or 1-877-716-1212.
• Working people with disabilities can use Medicaid Work Incentive (M-WIN) from ages 16 to 65, with a $50 enrollment fee and a monthly premium based on income.
• Spenddown can open Medicaid for some people whose income is over the line but who have large medical bills; the county worker explains it if it applies.

Noncitizen change, October 1, 2026. The Income Maintenance Manual's revision log for Chapter 15 says that from October 1, 2026, the full-coverage Medicaid list for noncitizens is limited to lawful permanent residents, Cuban and Haitian entrants and COFA migrants. Refugees and others who lose full coverage should ask the county office about emergency Medicaid. Compare West Virginia with neighboring states in the national Medicaid income limits guide.

What West Virginia Medicaid Covers, Copays and Dental

The BMS guide compares 2 benefit packages: the Traditional Medicaid Plan and the West Virginia Health Bridge Alternative Benefit Plan for expansion adults. Both cover primary and specialty care, hospital stays, the emergency room, prescriptions, maternity care, mental health and substance use treatment, lab work, X-rays, medical equipment, family planning and non-emergency rides. The Health Bridge plan doesn't cover nursing home care or personal care services, and it allows 24 chiropractic visits a year and 100 home health visits.

Copays depend on income. BMS sorts adults into 3 tiers by poverty level:

Source: BMS copay information page (opens in a new tab) and Your Guide to Medicaid 2026, checked November 13, 2026.

Pharmacy copays are the same at every income: nothing on a drug under $5.01, then $0.50, $1, $2 and a top copay of $3 for anything over $50, still subject to the quarterly cap. Pregnant women (through 12 months postpartum), children under 21, American Indian and Alaska Native members, hospice and nursing home residents, and waiver members don't pay copays, and family planning and emergency services are copay-free for everyone. Providers can't turn away someone under 100% of poverty who can't pay the copay.

Adult dental has a $2,000 cap. Adults 21 and older get emergency dental care to treat a fracture, reduce pain or clear an infection. According to the BMS dental coverage guide, since July 1, 2024 diagnostic, preventive and restorative work needs approval first and is capped at $2,000 per member over two state fiscal years; you pay anything above that, and leftover money doesn't roll over. Children under 21 get diagnostic, preventive, restorative and surgical dental care, including orthodontics.

Rides to appointments come through the Medicaid transportation broker at 1-844-549-8353, weekdays 7 a.m. to 6 p.m. Call at least five business days before the visit.

Mountain Health Trust Plans

BMS contracts with 4 managed care organizations (MCOs) for Mountain Health Trust, which covers about 87% of members, including most adults and children, pregnant women and SSI members. WVCHIP members joined the program on January 1, 2021.

Source: BMS Mountain Health Trust page (opens in a new tab) and Your Guide to Medicaid 2026, checked November 13, 2026.

You're assigned a plan, and the guide says you can change plans at any time through mountainhealthtrust.com or 1-800-449-8466. Your plan asks you to pick a primary care provider who handles referrals. A few services stay outside the plans: prescriptions (paid by traditional Medicaid since July 1, 2017), long-term care, waiver services, personal care, transplants, school-based services and non-emergency transportation. You'll carry two cards, one from DoHS and one from your plan, and should bring both to every appointment. Children in foster, kinship or adoptive care are placed in Mountain Health Promise, which Aetna Better Health runs alone.

How to Apply for West Virginia Medicaid, Step by Step

West Virginia gives you 4 routes to apply, and BMS calls WV PATH the recommended route for most types of health coverage, and it's a better route than mail because you can see notices and requests the day DoHS posts them. WV PATH replaced the older inROADS portal; the manual's revision log shows the name changed on April 1, 2020.

Step 1: Pick a route

Source: BMS applying for health care page and Your Guide to Medicaid 2026, checked November 13, 2026.

Step 2: Gather what DoHS asks for

The guide lists Social Security numbers (or document numbers for legal immigrants), employer and income information for everyone in the family such as pay stubs or W-2s, the number of people on your tax return, policy numbers for any current health insurance, and details about job-based coverage your family could get. Noncitizens need an immigration document and ID number. DoHS checks your answers against IRS, Social Security and Homeland Security data and asks for proof only when something doesn't match.

Step 3: Watch for the approval notice

Per the Income Maintenance Manual (opens in a new tab), section 1.8.3 tells workers to approve, deny or withdraw an adult expansion application within 30 days of the application date. A pregnant woman's complete application must be approved within 13 business days, and disability-based applications can take 90 days. Your Medicaid card comes with the approval notice, and your Mountain Health Trust plan mails its own card later.

Step 4: Ask about past medical bills

Section 1.8.5 of the manual says eligibility can be backdated up to three months before the month you apply if you met every rule in those months. Tell the worker about unpaid bills when you apply. The BMS pages Grantsights read don't yet describe the shorter federal look-back periods that start in 2027, so ask DoHS how they'll apply to your case.

For example, one applicant in Huntington, a 41-year-old line cook living alone who earns $1,700 a month, is under the $1,836 monthly adult line. At that pay, he's above 100% of poverty, so he lands in copay tier 3: $4 for an office visit and no more than $143 a quarter. His earnings also clear the $580 monthly test in the 2027 work rule (an illustration built from BMS's 2026 figures, not a real case).

West Virginia's 2027 Community Engagement Rule

The new rule starts January 1, 2027 and covers adults 19 to 64 in the Medicaid Adult Expansion Group. In an August 27, 2026 release, DoHS reminded members to update contact information and report changes now. According to WVMedicaidHelp.org, which DoHS runs, the timing works like this:

• Applicants may have to meet the rule in the month before they apply, so December 2026 counts for January 2027 coverage.
• Current members are checked at renewals starting with those due in March 2027, and must show at least one qualifying month (all or part) since their last renewal.
• Six-month renewals begin in January 2027 for some members, replacing the yearly cycle.

What counts: 80 hours a month of paid, unpaid or in-kind work; an approved work training program; school, college, a GED or trade program at least half-time; community service; or any mix adding to 80 hours. Earning at least $580 a month also meets it, and seasonal workers can use a six-month average of $580, or $6,960 a year.

Who's excluded, per DoHS: people pregnant now or in the last 12 months; parents and caregivers of a child under 14 or a person with a disability; former foster youth 19 to 25; people in drug or alcohol treatment; American Indian and Alaska Native members; veterans with a 100% VA disability rating; SNAP household members subject to SNAP work rules and WV WORKS recipients meeting theirs; people in jail at renewal; and people who are medically frail, which includes people with substance use disorder in recovery for less than five years. Anyone released from jail in the three months before applying or renewing also gets an exception.

How reporting works. DoHS checks its own data first. If it needs more, it writes to you by mail or in your WV PATH account, and you have 30 days to answer or you may lose coverage. If DoHS doesn't contact you, you don't need to send anything. Send proof through WV PATH, the Customer Service Reporting Center at 1-877-716-1212, email osacsrc@wv.gov, fax 304-558-1869, or mail to P.O. Box 1668, Charleston, WV 25326-1668.

What DoHS Doesn't Tell You

Grantsights compared the BMS booklet, the BMS web pages and the Income Maintenance Manual and found 6 points that are easy to miss:

1. December 2026 activity counts for January applicants. Someone laid off in November who applies in early January needs to show December hours, earnings or an exclusion.
2. The income line on DoHS's help site is rounded. WVMedicaidHelp.org describes the adult limit as "about $22,025" for one person, while the BMS 2026 booklet prints $22,032. The booklet is the more precise figure.
3. Dental money runs on a two-year clock. The $2,000 adult cap covers two state fiscal years, so a crown in year one can leave little for fillings in year two.
4. Plan switching is easy, but pharmacy isn't part of your plan. Prescription questions go to traditional Medicaid, not your MCO.
5. Report changes within 10 days. The guide's rights section lists moves, job changes, new household members and lump sums.
6. Estate recovery applies at 55 and older. The guide says Medicaid recovers long-term care costs paid for members 55 and up; call (304) 342-1604 with questions.

Common Mistakes and Red Flags

A common mistake is letting the renewal packet sit. BMS says DoHS contacts members by mail, phone and email before a renewal is due, and that most Medicaid and WVCHIP coverage must be renewed every 12 months, with some expansion adults moving to six months in 2027.

Other ways West Virginians lose or miss coverage:

• Underestimating the 30-day response window on a community engagement request. Coverage can end even if you'd have qualified.
• Applying for the wrong program. A parent turned down for adult Medicaid may have kids who qualify for WVCHIP; ask the worker to check every household member.
• Skipping the medically frail question. It can exempt you from the work rule and open the traditional benefit package.
• Missing the copay cap. Keep receipts; once you hit $8, $71 or $143 in a quarter, you shouldn't pay more until the next quarter starts.

Red flags: avoid anyone who charges a fee to apply or promises faster approval. Nobody legitimate charges a fee to apply for West Virginia Medicaid or asks for your WV PATH password. If you're denied, BMS points people to HealthCare.gov or the free navigator line at 1-844-WV-CARES, not to paid helpers.

Appeals: 90 Days to Ask for a Hearing

You have 90 days from the effective date of an action to ask for a fair hearing, under section 710.16 of the Common Chapters Manual (revised August 22, 2024). If you already have Medicaid and ask before the effective date, the change is put on hold until the hearing decision, though the BMS guide warns DoHS may try to recover the cost if the decision goes against you.

The Board of Review takes requests in writing or by phone:

• Mail: Board of Review, State Capitol Complex, Building 6, Room 817, Charleston, WV 25305
• Email: OIGBOR@wv.gov
• Phone: 304-352-0805
• Online: the hearing request form linked from the Board of Review page (opens in a new tab)

You can speak for yourself or bring a lawyer, relative or friend. Check the notice for the exact reason first; a missing pay stub is often the whole problem.

Other Help in West Virginia

Many Medicaid households also qualify for food and heating help. SNAP pays up to $306 a month for one person from October 1, 2026, according to the USDA FNS cost-of-living data, and the same WV PATH account handles that application:

• Food: our West Virginia SNAP benefits guide walks through applying, and the West Virginia food stamps guide has the SNAP income limits.
• Heating bills: see the West Virginia LIHEAP guide for the Low Income Energy Assistance Program.
• Rent: a Wheeling or Beckley renter who's behind can start with the rental assistance programs guide.

West Virginians checking for other benefits can use Grantsights' free eligibility checker, which points to official programs. Only DoHS can approve Medicaid.

FAQ: West Virginia Medicaid

How do I apply for Medicaid in West Virginia?

Through WV PATH, HealthCare.gov or 1-800-318-2596, or at a county DoHS office in person or by mail.

What is the income limit for West Virginia Medicaid in 2026?

$22,032 a year for one adult and $45,540 for four; pregnant women and children qualify higher.

When does the West Virginia Medicaid work requirement start?

January 1, 2027, with renewals checked starting March 2027.

Which Mountain Health Trust plans can I choose?

Aetna Better Health, The Health Plan, Highmark Health Options or Wellpoint, and you can switch any time.

Does West Virginia Medicaid cover dental for adults?

Yes: emergency care, plus preventive and restorative care up to $2,000 over two fiscal years with prior approval.

How long does West Virginia take to decide a Medicaid application?

30 days for adult expansion cases, 13 business days for complete pregnancy cases and up to 90 days for disability.

How long do I have to appeal a West Virginia Medicaid decision?

90 days from the effective date; ask before that date to keep coverage during the appeal.

---

Sources

1. BMS booklet: Your Guide to Medicaid 2026 (coverage, copays, dental and plans) (opens in a new tab), effective April 1, 2026, read November 13, 2026
2. West Virginia BMS: Applying for Healthcare (opens in a new tab), checked November 13, 2026
3. West Virginia BMS: Mountain Health Trust (Managed Care) (opens in a new tab), checked November 13, 2026
4. West Virginia BMS: Copay Information (opens in a new tab), checked November 13, 2026
5. West Virginia BMS: New Medicaid Rules Are Coming (opens in a new tab), checked November 13, 2026
6. West Virginia BMS: DoHS outlines steps ahead of 2027 eligibility changes (opens in a new tab), August 27, 2026
7. West Virginia DoHS: WVMedicaidHelp.org (opens in a new tab), current as of October 2026
8. West Virginia DoHS: Income Maintenance Manual (opens in a new tab), revisions through November 1, 2026
9. WVCHIP: Income Guidelines and Co-Pays (opens in a new tab), effective March 2026
10. West Virginia OIG: Common Chapters Manual, Chapter 700 (opens in a new tab), revised August 22, 2024
11. West Virginia OIG: Board of Review (opens in a new tab), checked November 13, 2026