West Virginia Medicaid Income Limits 2026: WVCHIP Chart

Medicaid is free health coverage for people who qualify, not a cash payment. For other states, see our national Medicaid income limits guide.

West Virginia Medicaid Income Limits by Household Size (2026)

West Virginia's MAGI chart has 5 income bands, and each is about 5 points above the base percentage Medicaid.gov lists, which means the BMS figures already include the 5% disregard. According to the BMS Your Guide to Medicaid 2026, a household of four qualifies up to $45,540 a year for adults, $48,180 for children 1 to 5 and $53,796 for babies under 1. BMS publishes these as yearly income for sizes 1 to 4; the monthly amounts below are BMS's yearly figures divided by 12.

Source: West Virginia BMS, Your Guide to Medicaid 2026 (opens in a new tab), page 5, effective April 1, 2026. \The pregnancy column uses a minimum family size of two, counting the unborn baby or babies. \\BMS prints sizes 1 to 4 only. For sizes 5 to 8, Grantsights calculated the limit from the same percentage of the 2026 HHS poverty guideline, rounded up to the next dollar the way the BMS figures are; confirm these with your county DoHS office.*

Yearly limits as BMS prints them

The parent/caretaker group in West Virginia uses a small dollar standard, which the Medicaid.gov eligibility levels table (opens in a new tab) converts to 16% of poverty (as of December 1, 2023). Parents above it are covered through the adult group at 138%, so most families can ignore that line.

WVCHIP income limits (effective March 2026)

$99,000 a year is the WVCHIP ceiling for a family of four, according to the WVCHIP income guidelines and co-pays chart. Children under 19 who are over the Medicaid line are placed in one of three tiers:

Source: WVCHIP Income Guidelines and Co-Pays (opens in a new tab), "Eff. 3/2026." WVCHIP prints dollar amounts only; Grantsights divided them by the 2026 poverty guideline to show the approximate percentage. Gold and Blue have no monthly premium. The WVCHIP fact sheet (opens in a new tab) says pregnant women 19 and older can also qualify.

How West Virginia Counts Your Income

MAGI rules decide eligibility for 3 big groups: children, pregnant women and adults 19 to 64, according to the BMS guide. Income starts from what's on a federal tax return. BMS lists several types of income that don't count, including child support you receive, educational scholarships and grants, workers' compensation, veterans' benefits and certain American Indian and Alaska Native income.

Household size is built from your tax return: you, a spouse, children you claim (biological, adopted or step) and any other dependents. Someone you don't claim generally isn't in your Medicaid household even if they live with you.

Report changes within 10 days. The BMS guide tells members to notify DoHS within 10 days when someone in the household gains or loses a job, household income changes, or someone moves in or out. A raise that pushes a household over the line is better reported than discovered at renewal.

SSI-related rules apply to people who qualify through age 65+, blindness or disability without SSI, and to nursing home and waiver care. These follow SSI income and asset counting, and the asset test is checked as of the first moment of each month, according to the Income Maintenance Manual sections quoted in Board of Review decision 25-BOR-2038 (opens in a new tab).

For example, a family of three in West Virginia (a parent, a 3-year-old and an 8-year-old) earning $3,500 a month gross lands in three places. The parent is specifically $358 over the $3,142 adult limit. The 3-year-old is $176 over the age 1 to 5 limit of $3,324, and the 8-year-old is over the $3,142 limit for ages 6 to 18. Both children fit under WVCHIP Blue's $4,804 for a family of three, so they're covered with no monthly premium, and the parent would shop on HealthCare.gov, where $42,000 a year for three is about 154% of poverty.

West Virginia Medicaid Asset Limits and Long-Term Care

$2,000 is the asset limit for one person applying for long-term care Medicaid in a nursing facility, according to Income Maintenance Manual section 23.11.5.A as quoted in Board of Review decision 26-BOR-1930 (opens in a new tab) (June 23, 2026). The same $2,000 limit applies to the Aged and Disabled Waiver. Adults, children and pregnant women on MAGI coverage don't face an asset test.

West Virginia's nursing home rules use a two-step process, according to Income Maintenance Manual Chapter 24.7 as quoted in Board of Review decision 26-BOR-1491 (opens in a new tab) (April 16, 2026). First, the person has to qualify for Medicaid through a full coverage group, the special income test or an SSI-related spenddown. Second, DoHS figures how much of their income goes toward the cost of care, after deductions such as a personal needs allowance and an allowance for a spouse at home. Assets checked "as of the first moment" of the month means a balance that's over $2,000 at 12:00 a.m. on the 1st makes that whole month ineligible.

People who get SSI are automatically eligible for Medicaid and get a card around the first of the month they become eligible for SSI, according to the BMS guide. Grantsights didn't find a 2026 West Virginia chart for the couple asset limit or the Medicare Savings Program dollar limits, so those aren't listed here.

Medicaid Expansion in West Virginia: The 2027 Changes and the Trigger Question

West Virginia expanded Medicaid, and the Medicaid.gov table lists 133% of poverty for expansion adults (138% with the disregard), 158% for infants, 141% for children 1 to 5, 133% for ages 6 to 18, 185% for pregnant women and 300% for separate CHIP. Neighboring expansion states Ohio, Pennsylvania and Virginia use the same 138% adult line, and Kentucky does too. For a state that never expanded, compare Texas.

No trigger law is in effect. At a March 28, 2025, advisory council meeting, BMS Commissioner Cindy Beane said House Bill 3518 had been introduced and that, as written, any change to the federal match would end coverage for the expansion population of about 165,000 West Virginians, according to the Medical Services Fund Advisory Council minutes (opens in a new tab). The Legislature's bill history shows HB 3518's last action as "On 1st reading, House Calendar" on April 1, 2025. It didn't pass.

What changes on January 1, 2027. BMS and DoHS have published these dates:

• Community engagement requirement. Starting January 1, 2027, some members ages 19 to 64 must complete at least 80 hours a month of work or approved activities (work, training, school at least half time, volunteering, or a mix), unless exempt, according to BMS. DoHS's WVMedicaidHelp.org adds that income of at least $580 a month also meets the requirement.
• Applicants may need to meet the requirement in the month before they apply; someone applying for January 2027 coverage may need to show December 2026 activity.
• Current members aren't affected until their regular renewal in 2027, starting with renewals due in March 2027.
• Six-month renewals. WVMedicaidHelp.org says some members will renew every six months instead of every 12, beginning January 2027.
• Noncitizen eligibility. A June 24, 2026, BMS announcement (opens in a new tab) says DoHS was on schedule for the October 1, 2026, federal deadline for eligibility changes affecting certain noncitizen categories. It didn't list which categories.

Exclusions DoHS lists include people who are pregnant or were in the last 12 months; parents, guardians or caretakers of a child under 14 or a disabled person; former foster youth 19 to 25; people in certain drug or alcohol treatment; American Indians and Alaska Natives; veterans with a 100% VA disability rating; people meeting SNAP or WV WORKS work rules; and people who are medically frail. People with Medicare and anyone under 19 are outside the requirement entirely.

What West Virginia DoHS Doesn't Tell You About the Income Chart

The BMS chart fits on one page, which is part of the problem. Grantsights found 5 gaps:

1. It stops at four people. The official chart prints only household sizes 1 to 4, so larger families have to work out their own limits or call. The table above extends it to eight.
2. Your kids may qualify at very different incomes. Grantsights analysis of the 2026 BMS chart shows a baby in a family of four qualifies up to $4,483 a month, $688 more than an older sibling at $3,795. Above those lines, WVCHIP's $8,250 Premium Plan ceiling for four sits $4,455 above the adult limit.
3. The parent line is a decoy. Medicaid.gov's 16% parent figure looks like parents are shut out, but the adult group covers parents to 138%.
4. Copays depend on income. According to the BMS guide, a household of two with quarterly income up to $1,966 has an $8 out-of-pocket maximum per quarter, while one above $3,933 can owe up to $143. Children under 21, pregnant women and people in long-term care don't pay copays, and providers can't turn away someone under 100% of poverty for not paying one.
5. The appeal window is long, but continued coverage isn't. You get 90 days to ask for a hearing, but your coverage only stays in place if you ask before the effective date on the notice, which DoHS mails at least 13 days ahead.

Common Mistakes and Red Flags

These are the errors that most often lead to a wrong answer in West Virginia:

• Multiplying weekly pay by 4. A month has more than four weeks, so that shortcut can underestimate income by several hundred dollars and give a false yes. Add up a full month of pay stubs instead.
• Reading the yearly column as monthly. The BMS chart is in yearly income; $22,032 is the limit for a full year, not a month.
• Assuming the work rule already applies. It doesn't start until January 1, 2027, and current members are checked at renewal from March 2027.
• Missing renewal mail. A common mistake is letting a renewal packet sit. DoHS asks members to keep their address current in WV PATH and to watch for mail about the new rules.
• Paying for help. Applying for Medicaid or WVCHIP costs nothing. A red flag is anyone who charges a fee, demands gift cards or asks for your bank password to "guarantee" approval. DoHS offices and the WVCHIP helpline don't charge.
• Giving away savings before a nursing home application. The 60-month look-back can delay coverage. Talk to legal aid or an elder law attorney first.

How to Apply for West Virginia Medicaid and How Long It Takes

Federal rules allow up to 45 days to decide most Medicaid applications and 90 days for disability-based ones, under 42 CFR 435.912 (opens in a new tab). The BMS guide lists four ways to apply if you don't get SSI:

1. Online at WV PATH (opens in a new tab), which also handles change reports.
2. Through the federal Marketplace at HealthCare.gov or by calling 1-800-318-2596.
3. In person or by mail at your county DoHS office, open Monday through Friday from 8:30 a.m. to 5:00 p.m. Call 1-877-716-1212 to find an office or make an appointment.
4. Home visit: if a disability keeps you from getting to the office, call DoHS Client Services at 1-800-642-8589 to ask for one.

For WVCHIP, call 1-877-982-2447 or apply through WV PATH. Bring pay stubs or W-2s, Social Security numbers, the number of people on your tax return, and any immigration documents. If you also need food help, our West Virginia food stamps guide explains SNAP's separate limits.

What to Do If You're Denied

You have 90 days from the effective date of the action to request a hearing, under section 710.16 of the Common Chapters Manual (opens in a new tab) (revised August 22, 2024). If you're a current member and ask for a hearing before the effective date, the action is put on hold until the hearing decision. A mailed request counts as on time if it's postmarked within the deadline.

You can ask your local DoHS office, or contact the Board of Review directly at 304-352-0805 or OIGBOR@wv.gov; the Board of Review page (opens in a new tab) also has an online request form. You can represent yourself or bring a lawyer, relative or friend. Legal Aid of West Virginia helps with Medicaid hearings at no cost.

If You're Over the West Virginia Medicaid Limit

At least 6 options are left when income is over 138%:

• WVCHIP for the kids: free (Gold and Blue) up to $69,630 a year for four, and Premium Plan coverage up to $99,000. For most families with children, this is the best bet to start with.
• WVCHIP for pregnancy: pregnant women 19 and older over the Medicaid line can apply.
• Marketplace coverage: adults over 138% can buy a plan with premium tax credits; see HealthCare.gov's savings page (opens in a new tab).
• Spenddown: the BMS guide says people over the income limit may still qualify through a spenddown once medical bills are counted.
• M-WIN: working adults 16 to 65 with a disability can buy into Medicaid with a $50 enrollment fee and a monthly premium.
• Medicare help: some Medicare enrollees qualify for help with Part A or B premiums and cost sharing; ask DoHS about the Medicare Buy-in Program.

For other household needs, the WIC income limits guide covers food for pregnant women and young children, the SSI income limits guide and help for seniors programs guide cover older and disabled West Virginians, and the federal poverty guidelines guide shows how each percentage translates to dollars. West Virginians facing a winter heating bill can check the LIHEAP income limits guide. Grantsights' free eligibility checker points to official programs for rent, utilities and other costs; it doesn't make Medicaid decisions or submit applications.

FAQ: West Virginia Medicaid Income Limits

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

$1,836 a month ($22,032 a year) for one adult; $3,795 a month for four.

What is the WVCHIP income limit?

Up to $99,000 a year for a family of four in the Premium Plan; Gold and Blue are free.

What is the West Virginia Medicaid income limit for pregnant women?

$41,124 a year for a household of two and $51,912 for three.

What is the income limit for nursing home Medicaid in West Virginia?

$2,982 a month in 2026, with a $2,000 asset limit for one person.

Does West Virginia have Medicaid work requirements?

Starting January 1, 2027, for some adults 19 to 64 who aren't exempt.

Will West Virginia end Medicaid expansion if federal funding drops?

No trigger law is in effect; HB 3518 stalled in 2025.

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.

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Sources

1. West Virginia BMS: Your Guide to Medicaid 2026 (opens in a new tab), effective April 1, 2026 - MAGI chart, copays, application routes, appeal rights
2. WVCHIP: Income Guidelines and Co-Pays (opens in a new tab), effective March 2026
3. WVCHIP: Program fact sheet (opens in a new tab), effective March 2026
4. West Virginia BMS: New Medicaid Rules Are Coming (opens in a new tab) - community engagement start dates
5. West Virginia BMS: DoHS encourages Medicaid members to stay informed about upcoming federal changes (opens in a new tab), June 24, 2026
6. West Virginia DoHS: WVMedicaidHelp.org (opens in a new tab) - $580 income option, exclusions, six-month renewals
7. West Virginia OIG: Common Chapters Manual, Chapter 700 (opens in a new tab), revised August 22, 2024 - hearing time limits
8. West Virginia OIG: Board of Review (opens in a new tab)
9. West Virginia OIG: Board of Review decision 26-BOR-1930 (opens in a new tab), June 23, 2026 - $2,000 LTC asset limit
10. West Virginia OIG: Board of Review decision 25-BOR-2038 (opens in a new tab), July 17, 2025 - 300% SSI income test
11. West Virginia OIG: Board of Review decision 26-BOR-1491 (opens in a new tab), April 16, 2026 - two-step nursing facility process
12. West Virginia BMS: Medical Services Fund Advisory Council minutes (opens in a new tab), March 28, 2025
13. West Virginia Legislature: HB 3518 (2025) bill history (opens in a new tab)
14. CMS state-by-state MAGI eligibility table, West Virginia row (opens in a new tab) on Medicaid.gov, based on state decisions as of December 1, 2023
15. HHS ASPE: 2026 Poverty Guidelines (opens in a new tab)
16. Federal Register: Cost-of-Living Increase and Other Determinations for 2027 (opens in a new tab), October 26, 2026 - 2026 and 2027 SSI rates
17. 42 CFR 435.912, Timely determination of eligibility (opens in a new tab) (Cornell LII copy of the federal regulation)
18. HealthCare.gov: Lower costs on Marketplace coverage (opens in a new tab)