Health Insurance for Low-Income
The West Virginia Medical Assistance Program, also known as "Medicaid", is a federal and state funded program providing medical and health-related services for eligible West Virginia residents.
The Executive Office of Health and Human Services (EOHHS) administers the Medicaid program to provide health insurance for low-income families with children, pregnant women, senior citizens, people with disabilities or special needs, and other residents struggling to access affordable healthcare.
West Virginia Medicaid is financed as a joint partnership between the state and the federal government but is administered by the state through Bureau for Medical Services (BMS). Through the Medicaid program, health insurance is provided to children, low-income families and adults, pregnant women, and others based on a variety of eligibility factors.
West Virginia Medicaid Programs
Mountain Health Trust (Managed Care)
West Virginia Medicaid is operated through Managed Care Organizations (MGO). The MGO is contracted with the state and receives funding to provide services to the enrolled participant. This program is called the Mountain Health Trust. The following MCOs are currently under contract in West Virginia:
- Coventry Healthcare of West Virginia
- Health Plan of the Upper Ohio
- West Virginia Family Health
Children’s Health Insurance Program (CHIP)
The Children’s Health Insurance Program (CHIP) provides health coverage to eligible children that do not qualify for Medicaid because their household income is too high.
Aged and Disabled Waiver (ADW) Program
This program is in reference to providing coverage for individuals that over age 65, blind or disabled that also meet the income and resource requirements. There are a variety of coverage options available, depending on the extent of assistance needed
Traumatic Brain Injury Waiver Services
The Traumatic Brain Injury Waiver program (TBI) provides home and community-based services to help avoid institutionalization by providing services that may provide enough independence or support to function outside of a facility.
Medicare Costing Savings programs
The purpose of Medicare Costing Savings programs is to assist individuals in paying their Medicare premiums and by making payments to medical providers for coinsurance and deductibles for Medicare services.
The Qualified Medicare Beneficiary (QMB) program pays for Medicare Part B premiums, coinsurance, and deductibles for those eligible and enrolled in Medicare Part A.
The Specified Low Medicare Beneficiary (SLMB) program provides payment of Medicare Part B premiums only for individuals who would be eligible for the QMB program except for excess income.
The Qualified Individual (QI-1) program provides payment of Medicare Part B premiums only for individuals who would be eligible for the SLMB program except for excess income.
The Qualified Disabled Working Individual (QDWI) program provides payment of Medicare Part A premiums only for individuals meeting income limits.
West Virginia Medicaid FAQs
- What is Medicaid?
Medicaid is a state funded insurance that that provides coverage to low income families, pregnant women, newborns, and children that may not be able to afford to purchase their own care.
- Who is eligible for Medicaid?
The following individuals are eligible for West Virginia Medicaid:
- Children 0 - 18 years with a household income less than 300% of the Federal Poverty Limit FPL
- Pregnant women with a household income less than 158% of the FPL
- Adults with a household income less than 138% of the FPL
- How do I find out if I am eligible for Medicaid?
To find out if you are eligible for Medicaid, you must fill out an application for Medicaid or CHIP. You may fill out an application at any time of the year. See more on Medicaid.
- Will Medicaid cover my children?
Your household income level will determine if your child or children can be covered by Medicaid.
- What is CHIP?
CHIP is a program that supports children in families that cannot afford private health insurance, but whose household income is too high to qualify for Medicaid.
- Does Medicaid satisfy the health insurance requirement?
Yes, Medicaid will satisfy the Affordable Care Act (Obamacare) health insurance requirement for the covered individuals.
- What information and documents should I have when I'm signing up for Medicaid?
Depending on the Medicaid program being applied for, you will need the following: Identity, Social Security, proof you live in West Virginia, proof of income, proof of medical costs, and bank account information.
- How does Obamacare work with Medicaid?
Because of West Virginia's Medicaid eligibility requirements, Obamacare does not impact people who qualify for Medicaid and vice versa. As such, tax credits are only available for people who are not eligible for other plans.