Mountain Health Trust and PEIA are two entirely different programs that West Virginians often mix up because both involve state health coverage. Mountain Health Trust is the managed care arm of West Virginia Medicaid, serving low-income residents, pregnant women, children, and people with disabilities. PEIA, the Public Employees Insurance Agency, is the health plan for state and local government workers, teachers, and retirees, and it is not based on income at all. If you are trying to figure out which one you or a family member qualifies for in 2026, the short answer is that eligibility depends on whether you work for a covered public employer (PEIA) or fall under Medicaid's income and household rules (Mountain Health Trust). This guide breaks down both programs side by side, including 2026 income limits, premiums, and how to apply.
What Is Mountain Health Trust?
Mountain Health Trust is West Virginia's Medicaid managed care program, administered by the Bureau for Medical Services (BMS) within the Department of Human Services. It covers roughly 87% of the state's Medicaid population through managed care organizations, currently including Aetna Better Health, Highmark Health Options, UniCare Health Plan, and The Health Plan. Members choose an MCO and get a primary care provider, and the MCO coordinates most medical, behavioral health, and prescription drug benefits.
Mountain Health Trust is need-based. Eligibility depends on your income, household size, and category (adult, child, pregnant woman, or person with a disability), not your employer.
What Is PEIA?
PEIA is the health insurance program for West Virginia's public workforce: state employees, county and municipal government workers who opt in, teachers and school service personnel, and retirees from those groups. PEIA is not a Medicaid program and has no income limit. Eligibility is based on employment status, not household earnings. Active employees choose from PEIA's Preferred Provider Benefit (PPB) plans, currently Gold, Silver, Gold High Deductible, and WV Bronze High Deductible, or an available managed care organization option depending on county.
Because PEIA is employer-sponsored insurance, someone can be a PEIA member and also have a spouse or child who qualifies separately for Mountain Health Trust or WVCHIP if household income is low enough and the PEIA plan does not cover them, though in practice most PEIA households have income well above Medicaid limits.
PEIA vs Mountain Health Trust: Quick Comparison
| Feature | Mountain Health Trust (Medicaid) | PEIA |
|---|
| Who it's for | Low-income adults, children, pregnant women, people with disabilities | State/local government employees, teachers, retirees |
| Based on income? | Yes | No |
| Cost to member | Usually $0 to minimal copays | Monthly premium, deductible, coinsurance |
| Administered by | Bureau for Medical Services (BMS) | Public Employees Insurance Agency |
| Plan choice | Choose an MCO (Aetna, Highmark, UniCare, The Health Plan) | Choose a PPB plan tier (Gold, Silver, Gold HDHP, Bronze HDHP) |
| Application | WV PATH portal | Employer HR / PEIA open enrollment |
| 2026 changes | Adjusted FPL limits, redetermination rules | Premiums rose roughly 14% for state employees, spousal surcharge jumped from $147 to $350/month |
Mountain Health Trust Income Limits 2026
Medicaid eligibility for most adults in West Virginia (a Medicaid expansion state) is capped at 138% of the Federal Poverty Level. Children and pregnant women qualify at higher thresholds.
| Household Size | 100% FPL (Annual) | 138% FPL (Annual, Adult Limit) |
|---|
| 1 | $15,960 | $22,025 |
| 2 | $21,640 | $29,863 |
| 3 | $27,320 | $37,702 |
| 4 | $33,000 | $45,540 |
| 5 | $38,680 | $53,378 |
| 6 | $44,360 | $61,217 |
For context, 138% FPL works out to roughly $1,835 per month for a single adult and $3,795 per month for a family of four.
Higher Limits for Children and Pregnant Women
- Children under age 1: eligible up to approximately 163% FPL
- Children ages 1 to 5: eligible up to approximately 146% FPL
- Children ages 6 to 18: eligible up to approximately 138% FPL
- Pregnant women: eligible up to approximately 190% to 194% FPL
- WVCHIP (for kids in families that earn too much for Medicaid): eligible up to approximately 300% FPL, with premiums scaled to income at the higher tiers
Because children and pregnant women qualify at much higher income levels than childless adults, many working families in West Virginia have kids covered through Medicaid or WVCHIP even though the parents are not eligible themselves.
PEIA Eligibility and 2026 Premium Changes
PEIA eligibility has nothing to do with income. You qualify if you are:
- A full-time employee of a state agency, higher education institution, or county school board
- An employee of a participating local government (county, city, or public service district that has opted into PEIA)
- A retiree from a PEIA-eligible employer with sufficient years of service
- A dependent of any of the above (spouse or child)
For plan year 2026, PEIA increased premiums by approximately 14% for state employees, about 16% for local government employees, and roughly 12% for retirees. The monthly spousal surcharge, charged when a spouse has other employer coverage available but enrolls in PEIA anyway, jumped from $147 to $350 per month. Out-of-pocket maximums also rose by roughly 40%, alongside higher copays across the PPB plan tiers. Premiums are also tiered by salary bracket for active employees, so two employees on the same plan can pay different amounts depending on pay grade.
Open enrollment for the PEIA plan year runs each spring (typically April through mid-May) for coverage beginning July 1. Employees choose their plan through their HR benefits coordinator or the PEIA online enrollment portal.
Can You Have Both?
Generally no, not for the same person. If you are an active PEIA-covered employee, your income is almost always too high to qualify for Mountain Health Trust yourself. However, it's common for one household to have a mix:
- A parent works for a school system and has PEIA coverage
- A spouse who does not work outside the home, or works part-time, may not be eligible for PEIA dependent coverage in every situation and could potentially qualify for Medicaid if household income and the specific eligibility category align
- Children in a PEIA household almost always exceed Medicaid's child income limits given typical public employee salaries, but WVCHIP's higher 300% FPL threshold occasionally applies to larger families or lower pay grades
If you are unsure which category applies to your household, it is worth checking both eligibility paths rather than assuming. For a broader look at all the assistance programs available in the state, see our West Virginia benefits overview.
How to Apply for Mountain Health Trust
- Gather documents. Photo ID for each adult applicant, proof of income (pay stubs, tax return, or benefit award letters), Social Security numbers for household members, and proof of West Virginia residency.
- Apply through WV PATH. Go to wvpath.wv.gov to apply online. You can create an account or apply as a guest. The portal also handles WVCHIP, SNAP, and Medicare Premium Assistance Programs.
- Apply by phone or in person. Call the Department of Human Services at 1-877-716-1212, or visit a local DoHS county office.
- Choose an MCO. Once approved, you'll select a managed care organization, Aetna Better Health, Highmark Health Options, UniCare Health Plan, or The Health Plan, and pick a primary care provider.
- Wait for a decision. The state generally has 45 calendar days to process an application, or up to 90 days if a disability determination is required.
- Renew annually. Mountain Health Trust requires yearly redetermination. Watch for renewal notices through WV PATH and respond promptly to avoid a coverage gap.
How to Enroll in PEIA
- Confirm employer eligibility. Check with your HR office to confirm your employer participates in PEIA.
- Enroll during open enrollment. New employees can typically enroll within their first 31 days of hire. Existing employees make changes during the spring open enrollment window for the July 1 plan year start.
- Choose a plan tier. Compare Gold, Silver, Gold High Deductible, and WV Bronze High Deductible PPB plans, or a managed care organization option if available in your county.
- Review the Benefits Guide. PEIA publishes an annual Shopper's Guide with premium rate tables by salary tier, which is the best source for exact monthly costs for your pay grade and plan choice.
- Report life changes. Marriage, birth of a child, or a dependent losing other coverage triggers a special enrollment window outside the normal spring period.
Frequently Asked Questions
Is PEIA the same as West Virginia Medicaid?
No. PEIA is employer-sponsored insurance for public employees, teachers, and retirees, with no income limit. Medicaid, delivered through Mountain Health Trust, is a need-based program for people whose household income falls below set limits.
Can a PEIA member also get Medicaid?
Usually not for the same person, since PEIA-eligible employment typically pays above Medicaid's 138% FPL adult limit. However, other household members, such as a non-working spouse or a child, may qualify separately depending on their specific income and eligibility category.
What are the 2026 income limits for West Virginia Medicaid?
Most adults qualify up to 138% of the Federal Poverty Level, about $22,025 a year for a single person or $45,540 for a family of four. Children and pregnant women qualify at higher percentages, and WVCHIP covers children up to roughly 300% FPL.
How much did PEIA premiums increase for 2026?
State employee premiums rose about 14%, local government employee premiums rose about 16%, and retiree premiums rose about 12%. The spousal surcharge more than doubled, from $147 to $350 per month.
Where do I apply for Mountain Health Trust Medicaid?
Apply online at wvpath.wv.gov, by phone at 1-877-716-1212, or in person at a West Virginia Department of Human Services county office.
Does West Virginia have Medicaid expansion?
Yes. West Virginia expanded Medicaid, which is why the adult income limit is set at 138% of the Federal Poverty Level rather than a lower, pre-expansion threshold.
What managed care organizations are available through Mountain Health Trust?
As of 2026, Mountain Health Trust members can choose Aetna Better Health of West Virginia, Highmark Health Options, UniCare Health Plan of West Virginia, or The Health Plan.
