Applying for Medicaid in West Virginia does not have to be complicated. Whether you are a parent trying to cover your children, a single adult with limited income, or a pregnant woman seeking prenatal care, West Virginia Medicaid provides free or low-cost health coverage to residents who qualify. The state expanded Medicaid under the Affordable Care Act in 2014, opening the door for hundreds of thousands of West Virginians to get covered.
This guide walks you through everything you need to know about how to apply for Medicaid in West Virginia, including who qualifies, the income limits for 2025 and 2026, required documents, and step-by-step application instructions.
Not sure if you qualify? Check your eligibility in minutes with our free screener to see all the benefits you may be entitled to.
Who Qualifies for Medicaid in West Virginia?
West Virginia is a Medicaid expansion state, which means adults aged 19 to 64 can qualify for coverage even if they do not have children. As of late 2024, more than 497,000 West Virginians were enrolled in Medicaid and CHIP.
You may be eligible for West Virginia Medicaid if you are:
- An adult aged 19 to 64 with household income at or below 138% of the Federal Poverty Level (FPL)
- A parent or caretaker relative living with a dependent child
- A pregnant woman with income up to 190% FPL (or up to 300% FPL for CHIP coverage)
- An infant under age 1 in a household with income up to 163% FPL
- A child aged 1 to 5 with household income up to 146% FPL
- A child aged 6 to 18 with household income up to 138% FPL
- An individual who is aged 65 or older, blind, or has a disability
- A recipient of Supplemental Security Income (SSI), who automatically qualifies
You must be a legal resident of West Virginia to apply. New lawful immigrants may face a five-year waiting period before they can enroll in Medicaid or CHIP.
West Virginia Medicaid Income Limits
Your eligibility depends primarily on your household size and monthly income. The table below shows the approximate income limits for the most common Medicaid categories in West Virginia, based on 2025 Federal Poverty Level guidelines. These figures include the standard 5% income disregard used for MAGI-based eligibility.
Adults (19 to 64) at 138% FPL
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 | $1,800 | $21,597 |
| 2 | $2,437 | $29,244 |
| 3 | $3,074 | $36,891 |
| 4 | $3,711 | $44,538 |
| 5 | $4,349 | $52,185 |
| 6 | $4,986 | $59,832 |
Pregnant Women at 190% FPL
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 | $2,480 | $29,754 |
| 2 | $3,357 | $40,290 |
| 3 | $4,234 | $50,814 |
| 4 | $5,111 | $61,338 |
Children (CHIP) up to 300% FPL
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 2 | $5,300 | $63,600 |
| 3 | $6,680 | $80,160 |
| 4 | $8,063 | $96,750 |
| 5 | $9,443 | $113,310 |
Note: These are approximate figures based on 2025 FPL guidelines. Exact amounts may vary slightly. Your actual eligibility is determined by the state agency.
For a complete look at all programs you might qualify for, visit our West Virginia Benefits Overview.
How to Apply for Medicaid in West Virginia: Step by Step
West Virginia offers several ways to apply for Medicaid. You can apply at any time of year since there is no open enrollment period for Medicaid.
Step 1: Gather Your Documents
Before you start your application, collect the following:
- Proof of identity: Driver's license, state ID, passport, or school ID with photo
- Proof of U.S. citizenship: U.S. birth certificate, passport, Certificate of Naturalization (N-550 or N-570), or Certificate of Citizenship (N-560 or N-561)
- Social Security numbers for all household members applying
- Proof of income: Recent pay stubs, W-2 forms, tax returns, or self-employment records
- Proof of West Virginia residency: Utility bill, lease agreement, or bank statement with your address
- Information about current health insurance (if any)
- Other benefits verification: Documentation of any other government benefits you receive
Note that proof of citizenship only needs to be provided once. If your information can be verified through electronic data matching, you may not need to submit physical documents.
Step 2: Choose Your Application Method
You have four ways to apply:
Option A: Apply Online Through WV PATH
The fastest and most convenient method is through the WV PATH (People's Access To Help) online portal.
- Visit wvpath.wv.gov
- Create an account or log in
- Select "Apply for Benefits"
- Complete the application, which also covers SNAP and other assistance programs
- Upload or submit required documents
- Submit your application
Option B: Apply Through HealthCare.gov
- Visit HealthCare.gov or call 1-800-318-2596 (available 24 hours)
- Create an account and fill out an application
- If you appear eligible for Medicaid, your information will be forwarded to West Virginia Medicaid
- The state agency will contact you about enrollment
Option C: Apply by Phone
Call the West Virginia Department of Human Services Client Services line at 1-800-642-8589 to request an application or get help completing one over the phone.
Option D: Apply in Person
Visit your local Department of Human Services field office. You can find office locations by calling 1-800-642-8589 or checking the WV Department of Human Services website.
Option E: Apply by Mail or Fax
Download and print the application form from the WV DHHR website:
- Family Application: Form DFA-SLA-1
- Individual Application: Form DFA-SLA-2
Complete the form and mail or fax it to your local office.
Step 3: Complete and Submit Your Application
Fill out all sections of the application completely. Incomplete applications can delay processing. Make sure to:
- List all household members
- Report all sources of income accurately
- Include information about any current insurance coverage
- Sign and date the application
Step 4: Follow Up on Your Application
After submitting your application:
- You should receive a response within 45 days (or 90 days for disability-based Medicaid)
- The state may contact you for additional information or documents
- You can check your application status through the WV PATH portal
- If approved, your coverage may be backdated up to three months before your application date
What Does West Virginia Medicaid Cover?
West Virginia Medicaid provides comprehensive health coverage including:
- Doctor visits and specialist appointments
- Hospital care (inpatient and outpatient)
- Prescription drugs
- Mental health services and counseling
- Substance abuse treatment
- Preventive care and screenings
- Lab tests and X-rays
- Dental care (comprehensive for children, limited for adults)
- Vision care (comprehensive for children, limited for adults)
- Maternity and newborn care
- Emergency services
- Transportation to medical appointments (non-emergency medical transportation)
WV CHIP: Coverage for Children and Pregnant Women
If your household income is too high for Medicaid but still within 300% FPL, your children may qualify for the West Virginia Children's Health Insurance Program (WVCHIP). CHIP covers:
- Children up to age 19
- Pregnant women
CHIP provides similar benefits to Medicaid including doctor visits, prescriptions, dental care, vision care, hospital stays, and mental health services.
To apply for CHIP, use the same WV PATH portal or call the CHIP Helpline at 1-877-982-2447.
What to Do If Your Application Is Denied
If your Medicaid application is denied, you have the right to appeal the decision. Here is what you should do:
- Review the denial letter carefully to understand the reason for denial
- Request a fair hearing within 90 days of the denial notice
- Gather supporting documents that address the reason for denial
- Contact legal aid if you need help with your appeal. West Virginia Legal Aid (wvlegalservices.org) can provide free assistance
Common reasons for denial include missing documents, income reported above the limit, or failure to respond to requests for additional information. Many denials can be resolved by providing the missing documentation.
Tips for a Successful Application
- Apply as soon as possible: Medicaid coverage can be backdated up to three months, so applying quickly ensures you do not miss out on coverage you may have already been eligible for
- Report income accurately: Include all sources of income, but also know that some types of income (like child support received) may not count toward your Medicaid income limit
- Keep copies of everything: Save copies of your application and all documents you submit
- Update your information: If your income, address, or household size changes after applying, report it right away
- Use the online portal: Applying through WV PATH is typically the fastest method and lets you track your application status
- Ask for help: If you are unsure about any part of the application, call 1-800-642-8589 for assistance
Frequently Asked Questions
How long does it take to get approved for Medicaid in West Virginia?
Most applications are processed within 45 days. Disability-related applications may take up to 90 days. Applying online through WV PATH and submitting all required documents upfront can help speed up the process.
Can I apply for Medicaid at any time?
Yes. Unlike marketplace health insurance plans, Medicaid has no open enrollment period. You can apply at any time of year and coverage can start as early as the date of your application.
Does West Virginia Medicaid cover dental and vision for adults?
West Virginia Medicaid provides limited dental and vision coverage for adults. Children enrolled in Medicaid or CHIP receive comprehensive dental and vision benefits, including eyeglasses.
Can I have Medicaid and employer insurance at the same time?
In some cases, yes. Medicaid can serve as secondary insurance alongside employer coverage. This can help cover copays, deductibles, and services not covered by your employer plan.
What happens if my income changes after I am approved?
You are required to report changes in income, household size, or other circumstances to the Department of Human Services. If your income increases above the Medicaid limit, you may qualify for subsidized marketplace coverage through HealthCare.gov instead.
Is there an asset limit for West Virginia Medicaid?
For most Medicaid categories (including expansion adults, children, and pregnant women), there is no asset test. For certain categories like the medically needy spend-down program, asset limits of $2,000 for an individual or $3,000 for a couple may apply.
Can I get Medicaid if I am pregnant?
Yes. Pregnant women in West Virginia can qualify for Medicaid with income up to 190% FPL. If your income is between 190% and 300% FPL, you may qualify for CHIP coverage instead. Postpartum coverage continues for 12 months after your baby is born.
What if I am denied but think I should qualify?
You have the right to request a fair hearing to appeal the decision. Contact your local Department of Human Services office or call 1-800-642-8589 to learn how to file an appeal.
Take the Next Step
If you think you or your family might qualify for Medicaid in West Virginia, do not wait to apply. The application process is free and coverage can be backdated.
Use our free benefits screener to check your eligibility for Medicaid and dozens of other assistance programs in just a few minutes. You could be leaving valuable benefits on the table.
For more information about all available programs in your state, visit our West Virginia Benefits Overview.
