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Medicaid Eligibility

Medicaid Eligibility

Medicaid at a Glance

Medicaid is health insurance that helps many people who can't afford medical care pay for some or all of their medical bills. The Medicaid Program provides medical benefits to groups of low-income people, such as pregnant women, children, and some older adults.

Managed Medicaid Programs

WV Medicaid will assign members into one of the two Medicaid Managed Care plans upon enrollment in the Medicaid program:

  • Mountain Health Trust (MHT) – the name of WV's Medicaid mandatory managed care program for TANF and TANF-related children and adults who are eligible to participate in managed care.
  • WV Health Bridge (WVHB) – the name of WV's mandatory managed care program for adults eligible for the Medicaid Alternative Benefit Plan.

WVFH services members in all counties in WV for either the MHT or WVHB Managed Medicaid Program assigned to the member.

Eligibility for Medicaid

To determine your individual eligibility and the benefits offered under the Medicaid program, visit the Department of Health and Human Resources (DHHR) and Bureau of Medical Services (BMS) homepage for more detail.

There are some things you need to consider as you begin to determine your potential Medicaid eligibility. When DHHR reviews your application, they consider several factors about the individual applying for coverage:

  • What is your income from wages, benefits or support payments you receive?
  • How many assets do you own such as money in the bank, property other than your home, or cash value of life insurance policies?
  • Are you a family member with a child who is without support due to absence, incapacity or unemployment of parents?
  • Are you an individual age 65 or over, or are you blind or disabled?
  • Are you a pregnant women (subject to income requirements)?
  • Are you a child up to the age of 19 years old (subject to income requirements)?

Apply for Medicaid

When applying for Medicaid, DHHR staff will request documentation they need to allow them to process your application for coverage. Once an application is approved, the BMS/DHHR representative refers an individual to select a managed care organization (insurance) and allows enrollment with West Virginia Family Health (WVFH). Until approval is received from BMS/DHHR, individuals must address eligibility questions or concerns to your DHHR case worker.

Read more about how to apply to Medicaid.

What happens when I am approved for Medicaid?

When an individual receives notice they have been approved for Medicaid, they have the option of selecting WVFH from among the 4 WV Medicaid MCOs in the state.

Once an individual has selected the WVFHP, BMS gives the member's name, address, age, and sex of each member to WVFH along with the effective date of enrollment in the plan. This effective date will appear on the member's ID card that will be sent by WVFH.

To be sure you still meet all the guidelines set out by BMS, your continued Medicaid coverage and eligibility will be periodically reviewed by DHHR. They will look for major changes in your financial condition, family relationship changes and other health coverage.

Some of the things they will monitor that impact continued eligibility include:

  • Family size changes
  • Moves to a new county or state
  • Pregnancy
  • Changes in income or assets
  • Availability of other health insurance other than Medicaid.

To report any changes in status and initiate a recalculation of your benefit eligibility call the WVFH Member Services department at 855-412-8001; the TTY number is 711 or 1-800-982-8771. And you will also need to call your DHHR case worker.