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West Virginia Medicaid Eligibility Changes

What You Need to Know About Upcoming Medicaid Eligibility Changes

Medicaid eligibility rules are changing. You may need to meet a new monthly work requirement to qualify for Medicaid and keep your coverage. Some states have already started the new requirement and others will start soon.

What’s the New Work Requirement?

If the requirement applies to you, you must spend at least 80 hours each month on one or more of these activities:

  • Working (or earning at least $580 a month).
  • Doing volunteer or community service.
  • Participating in certain job-training programs.
  • Participating in an educational program (like college, technical programs, or General Educational Development (GED) programs). If you’re enrolled in school at least half-time (as defined by your school), you likely meet the new requirement. If you’re enrolled less than half-time, your school hours can count toward your 80 hours.

You can combine different activities to reach your 80 hours.

Who This Impacts

The new work requirement may impact you if all of these apply:

  • Your state is implementing the new requirement.
  • You’re an adult between the ages of 19 - 64 years old.
  • Your household income is up to 138% of the Federal Poverty Level (about $22,025 a year for one person or $29,863 for two people).
  • You don’t qualify for any of the exclusions listed under “Who This Doesn’t Impact.” If you aren’t sure, contact your state.

Who This Doesn’t Impact

The new work requirement may not impact you if any of these apply:

  • You’re under age 19 or age 65 or older.
  • You’re currently pregnant or have given birth in the last 12 months.
  • You’re a parent, guardian, caretaker relative, or family caregiver for a child under 14 or a person with a disability.
  • You were released from a correctional facility (such as jail or prison) within the last 3 months.
  • You’re a veteran with a total disability rating from the VA.
  • You’re a member of an Indian or Urban Indian Tribe, including federally recognized Tribes and Urban Indian communities.
  • You’re a current or former foster child under age 26.
  • You already meet SNAP (food assistance) or TANF (temporary cash assistance for families) work requirements.
  • You have a functional limitation that makes it hard to do daily living activities (like dressing or moving around).
  • You’re blind or have a physical, intellectual, or developmental disability.
  • You have a substance use disorder (SUD) or serious mental health condition.
  • You’re in a SUD treatment program or recovery program.
  • You have or qualify for Medicare (Part A (Hospital Insurance) and/or Part B (Medical Insurance)).

What You Should Do

  • Update your contact information. Make sure West Virginia Medicaid has your current information (like address, phone number, and email address) so they can contact you about these eligibility changes.
  • Check your mail and email. West Virginia Medicaid will send you a letter or email in the next few months if the eligibility changes apply to you.
  • Track your activities. Keep track of any work, volunteer, job training, or school hours you complete each month. Start now so you’ll be ready to show you meet the new requirement when it’s time to renew your coverage.
  • Follow-up with your state. Contact your state Medicaid office to find out what else you can do or provide to keep your coverage.
  • Gather documents. Gather important medical or legal documents in case you need to show West Virginia Medicaid you qualify for an exclusion.

What If You Don’t Meet the New Work Requirement?

If the new requirement applies to you and you don’t meet it, your state might end your Medicaid coverage or deny your application.

If this happens:

  • You can apply again at any time. Visit Medicaid.gov/about-us/where-can-people-get-help-medicaid-chip to get started if you lose coverage.
  • You might be able to get health coverage through the Health Insurance Marketplace®, but you might not qualify for financial help to lower your monthly premium. Visit HealthCare.gov to find or enroll in a health plan or call 1-800-318-2596 (TTY: 1-855-889-4325).

More Information

Have more questions? Find organizations and other resources that can help.

By selecting links in the “West Virginia Medicaid” and “Public Resources” sections below, you will be leaving the CMS.gov website. These external links are not the responsibility of, or under the control of, the Centers for Medicare & Medicaid Services (CMS). Some of these links may be to non-federal government websites (.gov). CMS disclaims responsibility for the content and privacy policies of non-.gov websites.

West Virginia Medicaid

West Virginia Medicaid

Get more information about eligibility and coverage through West Virginia Medicaid.

Public Resources

Public Resources

Use these public resources to find organizations that can help you take steps to keep your coverage.