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How to Apply to Medicaid

How to Apply to Medicaid

If You Receive Supplemental Security Income (SSI)

If you are receiving a check from Supplemental Security Income Program, you are automatically eligible for Medicaid and should receive a medical card from the West Virginia Department of Health and Human Resources (DHHR).

If You DO NOT Receive Supplemental Security Income (SSI)

If you are not receiving an SSI check, you must apply for Medicaid benefits. Applications are taken weekdays at your local office of the West Virginia Department of Health and Human Resources (DHHR). For your convenience, you may wish to call for an appointment. Most local hospitals and primary care clinics have staff available to assist you in making application.

If, because of a physical handicap or disability, you are unable to go to the local office, you may request a staff person to visit your home and take the application. To request a home visit, call your local office of the WV DHHR or call the Office of Client Services toll free at 1-800-642-8589.

Providing Citizenship and Identity Documentation for Medicaid

Prior to the enactment of the Deficit Reduction Act (DRA) of 2005 on February 8, 2006, if you had Medicaid or applied for Medicaid, you could declare your citizenship and identity status through self-attestation. Congress passed a new law. Beginning on July 1, 2006, all people who are recipients of Medicaid or people who are applying for Medicaid must be able to document that they are U.S. citizens or nationals.

If you are enrolled in Medicare or receive SSI you will not be affected by these provisions or requirements. Also, this provision does not affect individuals who have declared they are aliens in a satisfactory immigration status. The DRA requires evidence of both citizenship and identity and specifies forms of acceptable evidence of citizenship or nationality and identity.

To establish U.S. citizenship the document must show:

  • A U.S. place of birth, or
  • That the person is a U.S. citizen.

To establish identity a document must show:

  • Evidence that provides identifying information that relates to the person named on the document.

The best way to document that you are a citizen is with one of these:

  • A U.S. Passport
  • A Certificate of Naturalization (DHS Forms N-550 or N-570)
  • A Certificate of U.S. Citizenship (DHS Forms N-560 or N-561)

If you do not have any of these documents, you will need two documents, one to show you are a citizen and one to show who you are.

Document you are a citizen with:

  • Your birth certificate, or
  • Report of Certification of Birth Abroad of US Citizen (Form FS-240 or FS-545), or
  • Adoption Papers, or
  • Military record.

Document your identity with:

  • Your picture on your current State driver's license or State identity card, or
  • School identification card, or
  • Federal, State or Local government identification card, or
  • U.S. Military identification card.

All applicants and recipients must be given a reasonable opportunity to provide documents to establish U.S. citizenship or nationality and identity. Current recipients continue to receive benefits until determined ineligible. Medicaid is closed only after the recipient is given a reasonable opportunity to present evidence or fails to make a good faith effort to provide it. Applicants are not approved until the required verification is supplied. For assistance, contact your local DHHR office or call 1-800-642-8589.

Eligibility for Medicaid

Except in the case of pregnant women and children up to age 19 years, eligibility for Medicaid is based on categorical relatedness, income and assets. Categorical relatedness means that an applicant must be a member of a family with a child who is deprived of support due to the absence, incapacity or unemployment of a parent(s). If the applicant has no children under age 18, the individual must be age 65 or over, blind or disabled.

The second factor considered is an applicant’s income and assets. Income is any money a family or individual receives such as wages, pensions, retirement benefits or support payments. Assets include money in the bank, property other than the homestead, and the cash or loan value of certain life insurance. When applying for Medicaid, you will be asked about your income and assets you own. DHHR staff will inform you of any documentation needed at the time of your application.

The eligibility of pregnant women and children up to age 19 for Medicaid is determined solely on income. There is no asset test. Pregnant women must provide a medical statement confirming pregnancy.

What is "Spenddown"?

Individuals and families who are INELIGIBLE for medical assistance (Medicaid) at the time of application because of income higher than the "protected level" may become eligible under the "spenddown" process. The process of subtracting your medical bills from your family income in order to become eligible for Medicaid is called "spenddown". The month of application, plus five months, equals a period of spenddown consideration.

You may use current payments OR the unpaid balance on "old" medical bills in order to meet spenddown and achieve eligibility at the earliest possible time. However, if you choose to use old bills to meet your spenddown, you may not use them again for the same purpose.