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Learn About Requirements for Medicaid in West Virginia

If you would like to find out how to qualify for Medicaid in West Virginia, you need to know what are the requirements for Medicaid and how to use those Medicaid requirements for determining your eligibility for the health insurance program provided by the state. Medicaid eligibility requirements vary between states, although state program all share basic eligibility requirements established by the federal government. Medicaid benefits eligibility is determined by an applicant’s age, income and other factors, and certain groups can have slightly different requirements. Eligibility for Medicaid is determined by West Virginia Department of Health and Human Resources (DHHR) workers in local county offices. In WV, Medicaid is administered at the federal level by the Centers for Medicare and Medicaid Services (CMS) under the US Department of Health and Human Services. To get answers to questions like, “Who is eligible for Medicaid?” and other information about the state’s program, continue reading the information below.

Who meets requirements for Medicaid in West Virginia?

There are many ways to qualify for Medicaid in West Virginia, and many of these coverage groups are mandatory or required by the CMS to be provided by each state. With Medicaid benefits eligibility made available to a variety of mandatory and optional coverage groups, and those for which WV has received waivers from federal requirements, West Virginia offers coverage to a wide array of groups. Medicaid benefits eligibility is determined by state and federal governments since the program is jointly funded, but the state administers the WV Medicaid program. In West Virginia, eligibility for Medicaid is determined by the Bureau for Medical Services (BMS), which is the state agency that is also responsible for administering the program and providing the application process, and it is administered by the West Virginia Department of Health and Human Resources (DHHR). In West Virginia, many services are provided for those eligible for Medicaid. According to state and federal guidelines, these services depend on an applicant’s family circumstances. Those who are automatically eligible for Medicaid coverage include those applicants who receive SSI Supplemental Security Income (SSI) benefits. They do not have to apply for Medicaid benefits at their local DHHR office.

“What are the Medicaid application guidelines?” is an important question to understand before completing the Medicaid application process. In West Virginia, those eligible for Medicaid include:

  • Those applicants who are SSI beneficiaries.
  • Pregnant woman and children younger than 19 years of age.
  • Very low-income families in WV.
  • People who are aged, blind, disabled and/or medically needy.
  • Adults who are 19 to 64 years of age.

Medicaid eligibility requirements state that those who are interested in Medicaid must also be either a parent or a relative caretaker of a dependent child or children. To be eligible for Medicaid in WV, they must also have a disability or have a member of their family in their household with a disability. The requirements for Medicaid in WV depends on a Medicaid applicant’s household size. In West Virginia, household size is based on who is claimed as a dependent on their federal tax return. Those included may include yourself, your spouse and your dependent children, regardless if they are biological, adopted, or stepchildren. Under West Virginia Medicaid eligibility, relatives and some non-relatives who qualify as depends may also be included in your household size. If you meet Medicaid eligibility requirements, your costs and coverage options will vary based on your household income and composition.

What are the income requirements for Medicaid?

For an applicant to qualify for Medicaid in WV, their financial situation must be characterized as low-income or very-low income. The Medicaid eligibility requirements have changed with the passing of the Affordable Care Act (ACA) of 2010. For children eligible for WV Medicaid, the Federal Poverty Level (FPL) has expanded to at least 133 percent. For adults, their income must be below the 133 percent of the FPL. Medicaid eligibility for pregnant women, children and adults ages 19 to 64 in West Virginia is dependent on their Modified Adjusted Gross Income (MAGI) and household size. In West Virginia, income that is not counted towards determining an applicant’s MAGI includes scholarships, grants and other educational awards. Additional incomes that do not count towards eligibility for Medicaid in WV include child support income, worker’s compensation benefits, veteran benefits and certain types of income for Alaska Native and American Indians. To learn more about the income requirements for Medicaid, download our national Medicaid guide for the program’s basic requirements.

What are the requirements for Medicaid in WV?

In West Virginia, requirements for Medicaid state that those interested in Medicaid must be a US national citizen, a permanent resident or legal resident. To determine an applicant’s eligibility for Medicaid in West Virginia, he or she must show proof of their citizenship or identity. All applicants will be required to provide documents to verify their citizenship and identity if it cannot be verified through an electronic data match. Showing your proof of citizenship to qualify for Medicaid must only be provided to the state once.

To qualify for Medicaid in WV, an applicant can submit their U.S. passport, Certificate of Naturalization, a Certificate of Citizenship or documentation from a federally recognized Indian Tribe. These documents require no additional proof of their citizenship or identity. However, if an applicant uses their U.S. public birth record, a final adoption decree, an official military record of service or a US census record, then he or she must also submit a separate proof of identity. In West Virginia, applicants can prove their eligibility for Medicaid by submitting one of the below approved proof of identity: (link)

  • A driver’s license with your photograph or other identifying information.
  • A school ID card with a photograph.
  • School records, like a report card, which is verified by the issuing school.
  • US military card or draft record.
  • An ID card issued by the local, state or federal government with the same information that is listed on a driver’s license.

To prove your Medicaid eligibility in West Virginia, you can also submit a Military Dependent’s ID card, a US Coast Guard Merchant Mariner card, a Native American Tribal document or three or more specific corroborating documents to prove your identity or a clinic, doctor, or hospital records. To learn more about Medicaid application guidelines, download our national Medicaid guide today.