We scoured the internet to bring you everything you need to know about West Virginia Medicaid Benefits.
Medicaid is a joint federal-state program that provides health insurance to low-income people who satisfy specific criteria, such as children, pregnant women, the elderly, and people with disabilities. It is simple to apply for Medicaid in person, by phone, or online.
This article will tell you all you need to know about Medicaid in West Virginia.
What is the West Virginia Medical Program?
West Virginia Medicaid is a service for adults and families that meet specific income and resource requirements. Within the confines of stated laws, resources broadly apply to the elderly, blind, or crippled population.
Who is eligible for the West Virginia Medical Program?
Through the Medicare Savings Plan, West Virginia Medicaid provides some financial assistance to select limited Medicare beneficiaries who are not eligible for the complete Medicaid benefit package.
- Expectant mothers
- People who are blind or disabled or who have a spouse who is blind or disabled;
- People whom someone adopts;
- People whom someone adopted;
- People who are blind or disabled or have a spouse who is disabled.
The Annual Household Income Limits (before taxes)
|Household Size*||The Maximum Income Level (Per Year)|
*Add $6,136 per additional person for households with more than eight people.
How do I contact Medicaid in West Virginia?
West Virginia Department of Health & Human Resources
1110 Main Street. Wheeling, WV
What are the Medicaid plans in West Virginia?
Mountain Health Trust (MHT)
The Mountain Health Trust (MHT) program was nearly expanded to all counties in the state. As of 2011, MHT was optional for low-income adults and children but required for pregnant people living in poverty and kids with special needs.
Physician Assured Access System
Physician Assured Access System (PAAS), a PCCM program available in areas where other managed care delivery systems are not offered, provides coverage for Medicaid beneficiaries.
PAAS is optional for low-income adults and kids but requires it for people with disabilities, kids in foster care, and low-income people.
Mountain Health Choices
Mountain Health Choices, an MCO program launched in 2007, allows low-income adults and kids without disabilities to participate.
This program covers enhanced benefits not typically covered by Medicaid, like cardiac rehabilitation and nutritional education, for beneficiaries who agree to adhere to specific care requirements.
For more details regarding Medicaid plans in West Virginia, visit here.
How do I apply for West Virginia Medicaid?
Call 1-877-716-1212 to enroll.
Apply in person at the West Virginia Department of Health & Human Resources
Online: Download and print the application.
Mail: To 1110 Main Street. Wheeling, WV
What is covered by West Virginia Medicaid?
West West Virginia Medicaid covers the following services:
|Ambulatory surgery||Hospital stays|
|Audiology services||Laboratory tests|
|Behavioral health services||Vision care|
|Women’s health care||Non-emergency transportation|
|Dialysis||Orthotic and prosthetic devices|
|Doctor visits||Occupational therapy|
|Smoking cessation services||Pharmacy (medications)|
|Emergency care||Physical rehabilitation|
|Family planning services||Preventive care|
|Hearing aids||Hospital outpatient care|
|Home health care||X-rays and other radiology services|
Can I have both West Virginia Medicaid and Medicare?
You may be “dual eligible” if you are qualified for West Virginia Medicaid and are over 65, have ALS or ESRD, or have received SSDI for at least 25 months. You can receive Medicaid and West Virginia coverage if you have dual eligibility.
West Virginia Waiver
- Aged and Disabled Waiver
- Intellectual/Developmental Disabilities Waiver
- Children with Serious Emotional Disturbance Waiver
- Substance Use Disorder (SUD) Waiver
- Traumatic Brain Injury Waiver
They do not have to pay a copayment. When a member is
- under 21 years old;
- Held by TBIstate
- Placed under government supervision
- Native American participants who qualify for Contract Health funding
- Services or Tribal Union of Indian Health Services
- The hospital (inpatient)
- A facility for skilled nursing
- A nursing home
What is not covered by West Virginia Medicaid?
In West Virginia, Medicaid is not required to provide in-home care or private nursing coverage. Bandages, adult diapers, and other disposable products, as well as cosmetic surgery and other elective operations, are routinely excluded from insurance coverage.
What is the highest income limit for West Virginia Medicaid?
A household income of up to 138% of the federal poverty level makes adults aged 19 to 64 eligible for Medicaid under the expanded eligibility criteria. In 2022, that equates to $18,754 yearly income for a single adult.
What if a person’s income is too high to qualify for regular Medicaid benefits?
Even if your income is too high, thanks to the asset spend-down option; you may still be qualified for West Virginia Medicaid.
What documents do I need to apply for Medicaid?
The following documents are required with the application:
- The Social Security Number;
- Evidence of citizenship or authorized residency in the United States, such as a passport, driver’s license, birth certificate, green card, or job authorization card
- Evidence of all income sources, both legal and illegal
- Proof of origin
- Proof of residency
- Including the Medicare card, any insurance cards
- When non-parents apply for Medicaid on their behalf, they must provide evidence of their financial position.
What is the best Medicaid in West Virginia?
In the recently released National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings 2018-2019, UniCare Health Plan of West Virginia shared first place in the state.
Where do I find the letter showing the reason(s) for denial or discontinuance from West Virginia Medicaid?
By signing into your account at Portal, you can see the progress of your West Virginia Medicaid application.