West Virginia is one of the states that expanded Medicaid under the Affordable Care Act, which means more residents can qualify for free or low-cost health coverage than in non-expansion states. If you live in West Virginia and need health insurance, understanding the current eligibility rules can help you figure out whether you qualify and how to get enrolled. This guide covers everything you need to know about West Virginia Medicaid eligibility in 2026, including income limits, application steps, and covered services.
Not sure which benefits you may qualify for? Check your eligibility in minutes with our free screening tool.
Who Qualifies for West Virginia Medicaid in 2026?
West Virginia Medicaid covers several groups of residents. Eligibility depends on your age, income, household size, and other factors. Because West Virginia expanded Medicaid in January 2014, adults without children can also qualify, which is not the case in every state.
Here are the main eligibility categories:
- Adults ages 19 to 64 with household income up to 138% of the Federal Poverty Level (FPL)
- Infants (age 0 to 1) in households with income up to 163% FPL
- Children ages 1 to 5 in households with income up to 146% FPL
- Children ages 6 to 18 in households with income up to 138% FPL
- Pregnant women with income up to 190% FPL (Medicaid) or up to 300% FPL (CHIP)
- Postpartum women covered for 12 months after giving birth
- Aged, blind, and disabled individuals who meet income and asset requirements
Children and pregnant women with incomes above Medicaid limits but below 300% FPL may qualify for the West Virginia Children's Health Insurance Program (WVCHIP).
You must be a legal resident of West Virginia to qualify. New immigrants may face a five-year waiting period before they can enroll in Medicaid or CHIP.
2026 Income Limits for West Virginia Medicaid
Income eligibility is based on Modified Adjusted Gross Income (MAGI) as a percentage of the Federal Poverty Level. The table below shows the maximum annual income for adults (138% FPL) and children/pregnant women at various thresholds.
Adult Medicaid Income Limits (138% FPL)
| Household Size | Maximum Annual Income | Maximum Monthly Income |
|---|---|---|
| 1 | $21,597 | $1,800 |
| 2 | $29,187 | $2,432 |
| 3 | $36,777 | $3,065 |
| 4 | $44,367 | $3,697 |
| 5 | $51,957 | $4,330 |
| 6 | $59,547 | $4,962 |
| 7 | $67,137 | $5,595 |
| 8 | $74,727 | $6,227 |
Children's Medicaid and CHIP Income Limits
| Category | FPL Threshold | Max Annual Income (Family of 4) |
|---|---|---|
| Infants (0 to 1) | 163% FPL | $52,405 |
| Children (1 to 5) | 146% FPL | $46,939 |
| Children (6 to 18) | 138% FPL | $44,367 |
| CHIP (children up to 19) | 300% FPL | $96,450 |
| Pregnant Women (Medicaid) | 190% FPL | $61,085 |
| Pregnant Women (CHIP) | 300% FPL | $96,450 |
These figures are based on the current Federal Poverty Level guidelines. The income limits include a built-in 5% income disregard used in MAGI-based eligibility determinations. Actual eligibility is determined by the West Virginia Department of Human Services (DoHS).
For seniors and individuals with disabilities applying for long-term care Medicaid, income and asset limits differ. In 2026, a single nursing home applicant must generally have income under $2,982 per month and countable assets under $2,000.
How to Apply for West Virginia Medicaid
Applying for Medicaid in West Virginia is straightforward and can be done in several ways. There is no limited enrollment period for Medicaid. You can apply at any time during the year.
Step 1: Gather Your Documents
Before you start your application, collect the following:
- Social Security numbers for all household members
- Proof of income (pay stubs, tax returns, or employer letters)
- Proof of West Virginia residency (utility bill, lease, or mail with your address)
- Proof of citizenship or immigration status
- Date of birth and identification for all applicants
Step 2: Choose Your Application Method
You can apply through any of these channels:
- Online: Visit WV PATH to submit your application electronically. This is the fastest method and allows you to also apply for SNAP and other assistance programs at the same time.
- Phone: Call the DoHS Client Services line at 1-800-642-8589 to apply over the phone.
- In Person: Visit your local DoHS field office. Find your nearest office at the DoHS website.
- Through HealthCare.gov: You can also start the process at HealthCare.gov or by calling 1-800-318-2596 (available 24 hours a day). If you appear eligible for Medicaid, your information will be forwarded to West Virginia Medicaid.
Step 3: Complete and Submit Your Application
Fill out all required sections. Be accurate with your income and household information. Incomplete applications may delay processing.
Step 4: Wait for a Decision
Standard Medicaid applications are typically processed within 45 days. Applications involving disability determinations may take up to 90 days. You will receive a notice by mail with the decision on your eligibility.
Step 5: Enroll and Start Using Your Coverage
Once approved, you will receive information about your Medicaid managed care plan and how to select a primary care provider. Your coverage may be effective retroactively up to three months before your application date if you were eligible during that time.
What Does West Virginia Medicaid Cover?
West Virginia Medicaid provides comprehensive health coverage, including:
- Doctor visits and specialist care
- Hospital stays (inpatient and outpatient)
- Prescription medications
- Mental health services and counseling
- Substance abuse treatment
- Preventive care and screenings
- Lab tests and X-rays
- Dental care (limited for adults, more comprehensive for children)
- Vision care (limited for adults, includes eyeglasses for children)
- Home health services
- Transportation to medical appointments
Children enrolled in Medicaid or CHIP receive a broader set of benefits under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program.
West Virginia Medicaid Enrollment Numbers
West Virginia has seen significant growth in Medicaid enrollment since expanding the program in 2014. As of late 2025, approximately 497,700 people were enrolled in Medicaid and CHIP in the state. About 170,200 of those enrollees gained coverage specifically through the ACA Medicaid expansion.
Total enrollment increased by roughly 40% between 2013 and 2025. Enrollment peaked during the COVID-19 pandemic in mid-2023 due to the continuous coverage requirement, then declined as the state completed its redetermination process in 2024.
Medicaid vs. CHIP in West Virginia
If your household income is too high for Medicaid but still below 300% of the Federal Poverty Level, your children may qualify for the West Virginia Children's Health Insurance Program (WVCHIP). Pregnant women in this income range may also qualify for CHIP coverage.
WVCHIP provides similar benefits to Medicaid, including doctor visits, prescriptions, dental care, vision care, hospital stays, and mental health services. You can apply for CHIP through the same WV PATH portal or by calling the CHIP Helpline at 1-877-982-2447.
Frequently Asked Questions
Can I apply for West Virginia Medicaid at any time?
Yes. Unlike marketplace health insurance, Medicaid does not have an open enrollment period. You can apply any time of the year, and if you qualify, your coverage can begin immediately.
What if my income changes after I enroll?
You are required to report changes in income, household size, or other circumstances to the DoHS. Changes may affect your eligibility. If your income increases above Medicaid limits, you may qualify for subsidized marketplace insurance through HealthCare.gov.
How long does it take to get approved?
Most applications are processed within 45 days. If your application involves a disability determination, it may take up to 90 days.
Can I get Medicaid if I am undocumented?
Undocumented immigrants are generally not eligible for full Medicaid benefits. However, emergency Medicaid may cover emergency medical conditions regardless of immigration status.
Does West Virginia Medicaid cover dental and vision?
Yes, but coverage for adults is limited. Children receive more comprehensive dental and vision benefits, including eyeglasses. Adult dental coverage typically includes emergency extractions and limited restorative services.
What is the difference between Medicaid and marketplace insurance?
Medicaid is a government program that provides free or very low-cost coverage to people with limited income. Marketplace insurance (through HealthCare.gov) offers private plans with premium subsidies for people with higher incomes who do not qualify for Medicaid.
Can I have both Medicare and Medicaid?
Yes. People who qualify for both programs are called "dual eligible" beneficiaries. Medicaid can help pay Medicare premiums, deductibles, and copays, and may cover services Medicare does not, such as long-term care.
Next Steps
If you think you or your family members may qualify for West Virginia Medicaid or other assistance programs, the best first step is to check your eligibility. Use our free benefits screening tool to see all the programs you may qualify for in just a few minutes.
You can also visit our West Virginia Benefits Overview page for information on other programs available in the state, including SNAP, LIHEAP, WIC, and more.
For direct assistance, contact the West Virginia DoHS at 1-800-642-8589 or visit WV PATH to start your application today.
