West Virginia Medicaid provides free or low-cost health coverage to residents across multiple eligibility categories, each with its own income threshold. For 2026, those thresholds are based on the federal poverty level (FPL), which updated in January 2026 to $15,960 per year for a single person. Whether you are a working adult, parent, pregnant, disabled, or elderly, understanding where you fall on the income chart is the first step to knowing if you qualify. This guide breaks down every major category with current dollar amounts and explains how to apply.
What Is the West Virginia Medicaid Program?
West Virginia Medicaid is administered by the West Virginia Department of Human Services (DoHS) through the Bureau for Medical Services (BMS). The state expanded Medicaid under the Affordable Care Act, which means adults aged 19 to 64 who meet income requirements can qualify even without children or a disability. Coverage includes doctor visits, hospital stays, prescription drugs, mental health services, dental, vision, and long-term care depending on the program type.
2026 Income Limits by Category
The limits below use the 2026 FPL of $15,960 annually ($1,330/month) for one person and $33,000 annually ($2,750/month) for a family of four.
Expansion Adults (Ages 19 to 64)
| Household Size | Monthly Income Limit | Annual Income Limit | % FPL |
|---|
| 1 | $1,732 | $20,783 | 138% |
| 2 | $2,343 | $28,114 | 138% |
| 3 | $2,953 | $35,441 | 138% |
| 4 | $3,564 | $42,765 | 138% |
| 5 | $4,174 | $50,092 | 138% |
No asset test applies to expansion adults. This is the broadest Medicaid category and covers most working-age adults in West Virginia who are not yet Medicare-eligible.
Children
West Virginia uses age-based thresholds for children:
| Age Group | Income Limit (% FPL) | Notes |
|---|
| Under age 1 | 163% FPL | Higher limit for infants |
| Ages 1 to 5 | 146% FPL | Standard toddler and preschool limit |
| Ages 6 to 18 | 138% FPL | Matches adult expansion limit |
For reference, 163% FPL for a family of three is approximately $3,591 per month in 2026. Children above these income limits may qualify for WV CHIP, which extends coverage up to 300% FPL.
Pregnant Women
| Category | Income Limit | Notes |
|---|
| Medicaid for Pregnant Women | 194% FPL | Approximately $2,574/month for a family of two |
| WV CHIP for Pregnant Women | 305% FPL | Approximately $4,046/month for a family of two |
Coverage for pregnant women extends 12 months postpartum regardless of income changes after delivery. No asset test applies.
Aged, Blind, and Disabled (ABD) Medicaid
ABD Medicaid covers individuals who are 65 or older, blind, or have a qualifying disability and do not yet meet full Medicare coverage.
| Household Size | Monthly Income Limit |
|---|
| Single | $994 |
| Married (both applying) | $1,491 |
| Married (one applying) | $1,491 for applicant |
Asset limits apply to ABD Medicaid: $2,000 for a single individual and $3,000 for a couple both applying.
Nursing Home and Long-Term Care Medicaid
This category covers residents in nursing facilities or those receiving home and community-based waiver services.
| Category | Monthly Income Limit | Asset Limit |
|---|
| Single applicant | $2,982 | $2,000 |
| Married (both applying) | $5,964 combined | $3,000 |
| Married (one spouse applying) | $2,982 for applicant | $2,000 applicant; up to $162,660 for community spouse |
A 60-month look-back period applies. Asset transfers made within five years of applying may result in a penalty period where Medicaid will not cover nursing home costs.
Medically Needy Spend-Down
If your income is above the standard ABD limit but you have high medical costs, you may qualify through the medically needy pathway. The spend-down income limit is $200 per month for a single person and $275 per month for a couple. You must document medical expenses that bring your income down to that threshold.
How Income Is Counted
For expansion adults, children, and pregnant women, West Virginia uses Modified Adjusted Gross Income (MAGI) methodology. This includes:
- Wages and salaries
- Self-employment net income
- Social Security benefits (some exceptions apply)
- Unemployment compensation
- Rental income
It excludes child support received, gifts, most student financial aid, and certain other non-cash benefits. For ABD and long-term care programs, gross income counting rules are different and include Social Security, SSI, pension income, and other sources.
What West Virginia Medicaid Covers
Standard WV Medicaid covers a wide range of services:
- Inpatient and outpatient hospital care
- Primary care and specialist visits
- Emergency services
- Prescription drugs
- Mental health and substance use treatment
- Lab work and imaging
- Preventive care and screenings
- Dental and vision services (some limits apply)
- Transportation to medical appointments
- Durable medical equipment
Long-term care Medicaid adds nursing facility care and home and community-based waiver services including personal care, respite, and supported living.
How to Apply for West Virginia Medicaid in 2026
West Virginia offers three ways to apply. There is no open enrollment deadline for Medicaid; you can apply at any time of year.
Option 1: Apply Online Through WV PATH
WV PATH (wvpath.wv.gov) is the state's preferred online portal for applying for Medicaid, SNAP, and other assistance programs simultaneously.
Steps:
- Go to wvpath.wv.gov and create an account or log in
- Start a new application and select "Healthcare" or "All Programs" if you want to check multiple benefits
- Enter household information including names, dates of birth, and Social Security numbers for all members applying
- Enter income details including pay stubs, self-employment income, or other income sources
- Review and submit your application
- Watch for a notice in the mail or through your WV PATH account confirming your eligibility decision
Most online applications are processed within 45 days. If you are pregnant or need emergency coverage, note that on your application to request expedited processing.
Option 2: Apply Through the Federal Marketplace
If you are also considering a Marketplace plan or are unsure whether you qualify for Medicaid, you can apply at healthcare.gov. The Marketplace will automatically screen for Medicaid eligibility and refer you to WV DHHR if you qualify.
Federal Marketplace helpline: 1-800-318-2596 (24 hours, 7 days a week)
Option 3: Apply In Person or By Phone
Visit your local Department of Human Services office or call:
- Office of Client Services: 1-800-642-8589
- General Medicaid information: 1-877-716-1212
Bring the following documents:
- Photo ID (driver's license, state ID, or passport)
- Social Security cards for all household members applying
- Proof of residency (utility bill, lease, or similar)
- Proof of income (recent pay stubs, W-2 forms, or award letters for Social Security or other benefits)
- Proof of immigration status if applicable
What Happens After You Apply
After submitting your application, DoHS will review your documents and verify information through electronic data sources. You may receive a request for additional documentation. Once approved, coverage is typically effective the first day of the month following approval, though some categories allow retroactive coverage back up to three months.
West Virginia CHIP: Coverage for Children Above the Medicaid Limit
WV CHIP covers children in families whose income is too high for Medicaid but below 300% FPL. Premiums are low or zero depending on income, and the benefit package is similar to Medicaid. Children enrolled in CHIP get the same doctor network access as Medicaid members in most cases. Apply through WV PATH or healthcare.gov.
Renewing Your Coverage
WV Medicaid renewals happen every 12 months. The state mails a renewal packet to your address on file. You can also renew online through WV PATH. Missing a renewal deadline can result in a gap in coverage, so update your mailing address whenever you move. If you receive a renewal notice, respond even if nothing has changed.
Use the Free Screener to Check Your Eligibility
Not sure which category applies to you? The Benefits Navigator screener lets you enter your household size, income, and state to get an estimate of which programs you may qualify for, including Medicaid, SNAP, WIC, LIHEAP, and others. It takes about three minutes and is completely free with no obligation.
For more information on all assistance programs available to West Virginia residents, visit the West Virginia benefits guide.
Frequently Asked Questions
What is the income limit for Medicaid in West Virginia in 2026?
For expansion adults aged 19 to 64, the limit is 138% of the federal poverty level, which equals approximately $1,732 per month for a single person or $3,564 per month for a family of four in 2026. Other categories like pregnant women (194% FPL) and children (up to 163% FPL for infants) have higher limits.
Does West Virginia have Medicaid expansion?
Yes. West Virginia expanded Medicaid under the Affordable Care Act. Adults aged 19 to 64 can qualify based on income alone without needing children, a disability, or other qualifying factors.
Is there an asset test for WV Medicaid?
For expansion adults, children, and pregnant women, there is no asset test. For aged, blind, and disabled (ABD) Medicaid, the asset limit is $2,000 for a single person. For nursing home Medicaid, the limit is also $2,000 for the applicant, though the non-applicant spouse can retain up to $162,660.
How long does WV Medicaid take to approve?
Most standard applications are processed within 45 days. Pregnant women and emergency cases may receive a faster decision. You will be notified by mail or through your WV PATH account.
Can I apply for WV Medicaid at any time?
Yes. There is no open enrollment period for Medicaid. You can apply at any time during the year online at wvpath.wv.gov, by calling 1-800-642-8589, or at your local DoHS county office.
What does WV Medicaid cover?
West Virginia Medicaid covers doctor visits, hospital care, prescriptions, mental health and substance use services, dental, vision, lab work, preventive care, and transportation to medical appointments. Long-term care Medicaid adds nursing home coverage and home-based waiver services.
What if my income is above the Medicaid limit in West Virginia?
If you are above 138% FPL, you may qualify for an ACA subsidy through the health insurance Marketplace, which can significantly reduce your monthly premium. Children up to 300% FPL may qualify for WV CHIP. You can also run a free eligibility check using the Benefits Navigator screener to see all programs you may qualify for.
What is the spend-down program in West Virginia Medicaid?
The medically needy spend-down program allows individuals with income above the ABD Medicaid limit to qualify if they have high out-of-pocket medical costs. The spend-down threshold is $200 per month for a single person. Documented medical expenses can be used to reduce your countable income to that level.
