West Virginia Medicaid Income Limits (2026)

West Virginia Medicaid is one of the most expansive state Medicaid programs in the country by per-capita enrollment. Because West Virginia adopted the Affordable Care Act's Medicaid expansion on January 1, 2014, adults ages 19 to 64 qualify based on income alone, without needing a dependent child, a disability, or a pregnancy. For 2026, the income ceiling for expansion adults is 138% of the Federal Poverty Level (FPL): $22,025 per year for a single person and $45,540 per year for a household of four. These thresholds are computed from the 2026 HHS poverty guidelines published by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), which set the 48-state base at $15,960 for a household of one with a per-person increment of $5,680. Roughly one in three West Virginia residents, totaling more than 500,000 people, was enrolled in Medicaid or WV CHIP as of 2025 according to KFF data, a share that reflects both the expansion and the state's relatively older, lower-income population.

West Virginia Medicaid is administered by the Bureau for Medical Services (BMS), a division of the West Virginia Department of Human Services (DoHS), which replaced the former Department of Health and Human Resources (DHHR) following a January 2024 reorganization. For most enrollees, coverage is delivered through the Mountain Health Trust managed care network, which contracts with four Managed Care Organizations: Aetna Better Health of West Virginia, Highmark Health Options West Virginia, The Health Plan, and Wellpoint West Virginia. Long-term care services, pharmacy benefits, and non-emergency medical transportation are carved out of managed care and paid on a fee-for-service basis. The single intake portal for all West Virginia benefits, including Medicaid, WV CHIP, SNAP, WV WORKS (cash assistance), and LIEAP energy assistance, is WV PATH, available at wvpath.wv.gov. Applications can also be submitted by phone at 1-877-716-1212 or in person at any county DoHS field office statewide.

West Virginia Medicaid income rules follow the MAGI (Modified Adjusted Gross Income) methodology for most categories: non-elderly adults, children, pregnant women, and parents. MAGI aligns with federal tax definitions, meaning the agency reviews income you would report on a federal tax return, not your gross paycheck. Asset tests and resource counts do NOT apply to MAGI categories. For elderly (age 65+), blind, and disabled residents, eligibility follows Supplemental Security Income (SSI)-related rules with a $2,000 asset limit for individuals. West Virginia also offers a Medicaid Medically Needy Spend-Down program for people in the aged, blind, and disabled categories whose income exceeds the SSI-related threshold but who have high medical expenses. The 2026 medically-needy income limit is $200 per month for a single person and $275 per month for a couple. Long-term care Medicaid (nursing facility) carries a separate income limit of $2,982 per month for a single applicant and a strict 60-month asset-transfer look-back period consistent with federal law.

West Virginia Medicaid (Mountain Health Trust) income limits by household size (2026)

West Virginia Medicaid income limits by household size (2026). Adult column = expansion Medicaid threshold (138% FPL). Children column = standard children's Medicaid (138% FPL; WV CHIP extends to 300% FPL separately). Pregnancy column = West Virginia Medicaid for pregnant women (190% FPL). All figures based on the 2026 HHS Federal Poverty Guidelines for the 48 contiguous states.

West Virginia Medicaid (Mountain Health Trust) eligibility requirements (non-income)

West Virginia Medicaid eligibility depends on residency, income, and category. MAGI-based categories (adults, children, pregnant women, parents) do not have asset tests. SSI-related categories (aged 65+, blind, disabled) do have asset tests. The core non-income criteria are summarized below.

• West Virginia residency (required): Applicants must live in West Virginia at the time of application. There is no minimum residency duration. Homeless individuals who intend to remain in West Virginia qualify as residents.
• Citizenship and immigration status: U.S. citizens and most qualified non-citizens (lawful permanent residents, refugees, asylees, and others with qualifying immigration status) are eligible. Lawful permanent residents who have been in the country less than five years do not qualify for full Medicaid under the federal five-year bar but may receive emergency Medicaid services. Undocumented individuals are not eligible for full Medicaid through the standard federal program.
• Social Security Number: Every applicant for whom coverage is requested must provide or apply for a Social Security Number (SSN). Applicants who do not yet have an SSN may still receive coverage while the SSN application is pending.
• Household composition and income: West Virginia Medicaid uses MAGI household rules, which generally follow federal tax filing units. Children may be counted in their parent's household even if not claimed as dependents on a tax return. Stepchildren and step-parents are included if living in the same household. A pregnant woman counts her unborn child or children as household members for income purposes.
• Asset test (MAGI categories): No asset test applies to adults under 65, children, pregnant women, or parents under the MAGI expansion. Only the aged, blind, disabled, and long-term care categories are subject to resource limits ($2,000 individual / $3,000 couple for SSI-related Medicaid; $2,000 individual for nursing facility Medicaid).
• No duplicate coverage: Applicants who already have Medicare are still eligible for Medicaid as dual-eligible beneficiaries if they meet income requirements. Applicants with private health insurance may still qualify for Medicaid, though West Virginia Medicaid will coordinate as secondary payer. You may not receive benefits in two states simultaneously.
• Long-term care additional criteria: Nursing facility Medicaid applicants must also demonstrate a clinical need for nursing-level care (requiring a Level of Care assessment by the state) and must meet the 60-month look-back rule for asset transfers. The community spouse resource allowance permits the non-applicant spouse to retain up to $162,660 in countable assets in 2026.

What income counts for West Virginia Medicaid (Mountain Health Trust)

West Virginia Medicaid uses Modified Adjusted Gross Income (MAGI) to determine eligibility for adults, children, pregnant women, and parents. MAGI tracks what you would report as income on a federal tax return, with a few additions. West Virginia applies the standard federal 5% income disregard on top of MAGI thresholds, which means the effective eligibility ceiling is approximately 143% FPL before the disregard is subtracted. The following lists show what income counts toward and what is excluded from MAGI for West Virginia Medicaid eligibility purposes, consistent with guidance from the West Virginia Bureau for Medical Services and the federal Medicaid MAGI rules at medicaid.gov.

Income sources included

• Wages, salaries, tips, and other W-2 employee compensation, including overtime pay.
• Net self-employment income (business revenue minus allowable business expenses as reported on Schedule C or Schedule F).
• Taxable interest, dividends, and capital gains from investments.
• Unemployment compensation benefits.
• Social Security retirement and Social Security Disability Insurance (SSDI) benefits (counted even if not taxed on the return).
• Pension and retirement distributions (taxable portion), including 401(k) and IRA withdrawals.
• Alimony received under divorce agreements finalized on or before December 31, 2018 (pre-TCJA decrees only).
• Rental income (net of allowable expenses), royalties, and other passive income reported on Schedule E.

Income sources excluded

• Supplemental Security Income (SSI) payments: SSI is a needs-based federal program and does not count as MAGI income, unlike SSDI.
• Child support payments received (excluded from MAGI income by federal Medicaid rule).
• Veterans Administration (VA) benefits, including disability compensation, GI Bill payments, and VA pension.
• Workers' compensation benefits.
• Gifts, inheritances, and most one-time non-recurring payments.
• TANF (Temporary Assistance for Needy Families) cash assistance and most other means-tested cash programs.
• Foster care and adoption assistance payments made for the care of a foster or adopted child.

How to apply for West Virginia Medicaid (Mountain Health Trust) in West Virginia

West Virginia Medicaid applications are submitted through WV PATH (People's Access To Help), the statewide online portal at wvpath.wv.gov, operated by the West Virginia Department of Human Services (DoHS). The same WV PATH application covers Medicaid, WV CHIP, SNAP food benefits, WV WORKS (TANF cash assistance), LIEAP energy assistance, and the School Clothing Allowance. You can also apply by phone at 1-877-716-1212, Monday through Friday, or in person at any county DoHS field office. Medicaid enrollment in West Virginia is year-round with no open-enrollment windows.

1. 1. Gather your documents before starting: government-issued photo ID, Social Security Numbers for every household member applying, proof of West Virginia residency (utility bill, lease, bank statement with WV address), proof of U.S. citizenship or qualifying immigration status, and the past 30 days of pay stubs or other income documentation for each earning household member.
2. 2. Create an account at wvpath.wv.gov and start a new application. The portal allows you to save progress and return later. If you prefer not to apply online, call 1-877-716-1212 or visit a county DoHS field office to complete a paper application.
3. 3. Complete the full household application: list every person in your household, report all income sources, and indicate which programs you want to apply for. Listing all programs in one application is faster than filing separately.
4. 4. Upload or attach supporting documents through the WV PATH portal. You can scan or photograph documents with a smartphone. Missing documents are the single most common reason processing is delayed.
5. 5. Sign and submit the application electronically through WV PATH. Print or save the confirmation number. DoHS will send an acknowledgment letter with your case number; keep this for your records.
6. 6. Respond promptly to any DoHS requests for additional information. You typically have 10 days to provide requested documents. Failing to respond to a request is one of the most common reasons Medicaid applications are denied.
7. 7. Wait for your eligibility determination notice. Standard applications are decided within 30 to 45 days. Pregnancy applications are processed in 15 days under federal expedited rules. Disability-based applications may take up to 90 days due to required medical determinations. If approved, you will receive information about choosing a Mountain Health Trust managed care plan.

Official portal: wvpath.wv.gov (WV PATH)

Documents needed

• Government-issued photo ID for the head of household (West Virginia driver's license, state ID, or U.S. passport).
• Social Security Numbers (or proof of application for an SSN) for every household member applying for coverage.
• Proof of West Virginia residency: utility bill, lease or rental agreement, mortgage statement, or official mail with a West Virginia address dated within the last 90 days.
• Proof of U.S. citizenship or qualifying immigration status: birth certificate, U.S. passport, permanent resident card, Employment Authorization Document, or other USCIS document.
• Income documentation for the past 30 days: pay stubs for employed household members, most recent federal tax return or self-employment records (profit/loss statement) for self-employed members, award letters for Social Security or SSI, unemployment benefit letters, or other income statements.
• For pregnancy applications: a statement from a licensed healthcare provider confirming the pregnancy and the expected due date.

Processing timeline: Standard West Virginia Medicaid applications are decided within 30 to 45 days of a complete submission. Pregnancy-related applications are processed within 15 days under federal expedited rules. Disability-based applications can take 60 to 90 days because they require a clinical Level of Care determination. Retroactive Medicaid coverage (covering bills from up to three months before the application date) is available for eligible individuals in some categories.

Common reasons applications get denied

• Income above the population-specific threshold: the most common reason for denial. Make sure to report monthly income accurately, including irregular earnings averaged over 12 months.
• Failure to respond to a DoHS request for additional information within the required timeframe (typically 10 days). If you miss the window, reapply immediately.
• Residency cannot be verified: no utility bill, lease, or official document with a West Virginia address. Homeless applicants can provide a statement from a shelter or social worker.
• Immigration status bar: lawful permanent residents who entered the U.S. less than five years ago do not qualify for full Medicaid under the federal five-year bar. Emergency Medicaid may still be available.
• Duplicate coverage or enrollment in another state: you cannot be enrolled in Medicaid in two states at the same time. If you recently moved to West Virginia, formally disenroll from your previous state's Medicaid before applying.

If your child's income is above the West Virginia Medicaid limit

WV CHIP (West Virginia Children's Health Insurance Program) covers children and teenagers under age 19 in households that earn too much for standard Medicaid. For 2026, WV CHIP covers children in families with income between 138% FPL (the standard Medicaid ceiling) and 300% FPL, which equals approximately $99,000 per year for a family of four based on 2026 FPL math. WV CHIP is delivered through the same Mountain Health Trust managed care network as West Virginia Medicaid. Apply through WV PATH at wvpath.wv.gov or call 1-877-982-2447 for WV CHIP-specific questions. West Virginia is also one of a small number of states that extends CHIP coverage to pregnant women with income above 190% FPL and up to approximately 305% FPL, filling a gap not covered by standard pregnancy Medicaid.

Compare CHIP and Medicaid income limits across all 50 states

If you are 65 or older with limited income: West Virginia Medicare Savings Programs

West Virginia administers three Medicare Savings Programs (MSPs) for low-income Medicare beneficiaries. These programs help pay Medicare Part A and Part B premiums, deductibles, and copays. The three tiers are: QMB (Qualified Medicare Beneficiary), which pays Medicare Part A and Part B premiums plus cost-sharing for income up to approximately 100% FPL ($1,330 per month in 2026 for one person); SLMB (Specified Low-Income Medicare Beneficiary), which pays the Part B premium ($202.90 per month in 2026) for income between 100% and 120% FPL; and QI (Qualifying Individual), which also pays the Part B premium for income between 120% and 135% FPL. West Virginia uses the federal asset limits for MSPs: $9,660 for a single person and $14,470 for a married couple in 2026. Dual-eligible individuals who qualify for both Medicare and West Virginia Medicaid can receive comprehensive coverage through a Dual Special Needs Plan (D-SNP) or through separate coordination of the two programs. Apply for West Virginia MSPs through WV PATH at wvpath.wv.gov.

Read the Medicare eligibility guide

Frequently Asked Questions