West Virginia's Children's Health Insurance Program, known as WVCHIP, provides low-cost health coverage to children in working families who earn too much for Medicaid but cannot afford private insurance. In 2026, WVCHIP accepts children from birth through their 18th birthday in households earning up to 300% of the federal poverty level, one of the more generous income ceilings among state CHIP programs. A West Virginia family of four earning up to $99,000 per year in 2026 may qualify.
WVCHIP operates as a separate program from West Virginia Medicaid and is administered by the West Virginia Children's Health Insurance Agency within the Bureau for Medical Services under the Department of Human Services. Coverage is delivered through four managed care organizations: Aetna Better Health of West Virginia, The Health Plan, Wellpoint West Virginia, and Highmark Health Options of West Virginia. Applications are open year-round with no enrollment window; most families receive a determination within two weeks of submitting a complete application.
Quick Answer: Who Qualifies for WVCHIP in West Virginia (2026)?
Yes. West Virginia children under age 19 qualify for WVCHIP if their household earns below 300% FPL in 2026, they are not Medicaid-eligible, and they have no other qualifying insurance. For a West Virginia family of four, 300% FPL equals $99,000 per year in 2026. Gold and Blue plan members pay no monthly premium; Premium plan members pay a modest premium. Applications are accepted year-round with no waiting period.
WVCHIP Income Limits by Household Size in West Virginia (2026)
West Virginia WVCHIP sets its income ceiling at 300% of the federal poverty level using MAGI (Modified Adjusted Gross Income) counting rules. Family size and household size for WVCHIP purposes follow federal tax-return definitions: include every individual you claimed or could claim as a tax dependent, plus yourself. In 2026, the WVCHIP income limits by household size are shown in the table embedded in this page. For a household of two the 2026 ceiling is $64,920; for a household of six, $133,080.
West Virginia uses three income-based plan tiers. Children in households earning up to approximately 150% FPL ($49,500/year for a family of four in 2026) are placed in the Gold plan with minimal copays and no premium. Children in households earning between roughly 150% and roughly 211% FPL ($69,630/year for a family of four) are placed in the Blue plan with standard copays and no premium. Children in households earning above that level up to 300% FPL ($99,000/year for a family of four in 2026) are placed in the Premium plan with a monthly premium and copays. All three tiers cover the same core set of WVCHIP benefits.
What Does WVCHIP Cover in West Virginia?
West Virginia WVCHIP provides comprehensive children's health coverage comparable to the benefits offered under West Virginia Medicaid. Covered services in 2026 include: primary care visits and specialist referrals, preventive care and well-child exams (annually for ages 2 through 18, more frequently for infants), all age-appropriate vaccines through age 18 per CDC Advisory Committee on Immunization Practices recommendations, prescription drugs (generic mandatory; brand names require prior authorization), dental care (no copay under Gold and Blue plans; $25 copay per procedure up to a $100 per-child or $150 per-family annual maximum under the Premium plan), vision care including up to $125 per year for corrective eyewear, and mental health and behavioral health services (medical necessity review required beyond 26 outpatient visits per year).
West Virginia WVCHIP also covers hospital inpatient and outpatient care, emergency and urgent care visits, maternity care for children covered as pregnant enrollees, durable medical equipment, physical and occupational therapy, speech therapy, and case management for children with special health care needs. Services not covered under WVCHIP include acupuncture, custodial care, routine foot care, and cosmetic procedures. American Indian and Alaska Native tribe members enrolled in WVCHIP are exempt from all copayment requirements.
How to Apply for WVCHIP in West Virginia
West Virginia WVCHIP applications are accepted year-round through the WV PATH portal at wvpath.wv.gov, which is the single online portal for WVCHIP, Medicaid, SNAP, WV WORKS (TANF), LIEAP energy assistance, and related benefit programs. When you apply through WV PATH, the system first screens for Medicaid eligibility. Children whose income falls below the age-specific Medicaid threshold are automatically enrolled in Medicaid rather than WVCHIP; children whose income is above the Medicaid limit but below 300% FPL are routed to WVCHIP. There is no separate WVCHIP-only application.
West Virginia families who prefer not to apply online may call the WVCHIP helpline at 1-877-982-2447 (Monday through Friday, 8 AM to 4 PM Eastern), visit a county DoHS field office in person, or download a paper application at chip.wv.gov. Children who are 17 or older must actively reapply at renewal; WVCHIP does not automatically send renewal notices for that age group. Once enrolled, WVCHIP provides 12-month continuous eligibility, so coverage continues for a full year without month-to-month income recertification.
Documents Needed to Apply for WVCHIP in West Virginia
West Virginia families applying for WVCHIP in 2026 should gather the following before starting their application. Having all documents ready typically speeds processing time from the two-week standard to as little as a few days.
- Proof of West Virginia residency: utility bill, lease, bank statement, or any postmarked government mail addressed to your WV address
- Income proof for all earning household members: most recent federal tax return, last 30 days of pay stubs, W-2 or 1099 forms for the prior tax year, or a signed employer letter stating current wage and hours
- Child's birth certificate or other proof of age and identity (hospital birth record, U.S. passport, or school enrollment record)
- Social Security numbers for the child and all household members counted in the income calculation; if a Social Security number has been applied for but not yet received, bring the application receipt
- Immigration or citizenship documentation for any household member who is not a U.S. citizen (permanent resident card, employment authorization document, or other USCIS-issued documentation)
- Proof that the child lacks qualifying health insurance, or if the child has employer-sponsored insurance available, documentation showing that coverage would cost more than 9.5% of gross household income
Is West Virginia a Medicaid Expansion State? How WVCHIP Fits In
West Virginia is a Medicaid expansion state. Under the ACA, West Virginia expanded Medicaid coverage to adults earning up to 138% of the federal poverty level (up to $22,025 per year for an individual in 2026). This means most West Virginia adults below that threshold are already covered by Medicaid before they need WVCHIP. For children, Medicaid in West Virginia covers those under age 1 up to 163% FPL, children ages 1 through 5 up to 146% FPL, and children ages 6 through 18 up to 138% FPL. WVCHIP picks up coverage for children whose household income is above the applicable Medicaid age-based threshold but below 300% FPL.
Because West Virginia has expanded Medicaid, there is no ACA coverage gap in West Virginia. Adults in West Virginia earning between 100% and 138% FPL qualify for Medicaid and do not fall into the gap. In the 10 states that have not expanded Medicaid (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming), adults in that income range cannot get Medicaid and may be too poor to qualify for ACA marketplace subsidies, creating a coverage gap. West Virginia residents in that income range get Medicaid; only adults above 138% FPL look to the ACA marketplace.
Common Reasons WVCHIP Applications Are Denied in West Virginia
West Virginia WVCHIP denial notices explain the specific reason for denial. The five most common denial reasons are listed below. Each has a path to resolution, including a right to appeal through a state Fair Hearing at the local DoHS office.
- Income exceeds 300% FPL for the household size: verify your 2026 income limits against the household-size table on this page; if your income recently dropped, report the change to DoHS within 10 days to trigger a re-evaluation.
- Child has qualifying health insurance: if the existing insurance is unaffordable (the employee-only or family premium exceeds 9.5% of gross household income), request an insurance exception review at chip.wv.gov/insurance-exceptions.
- Child is Medicaid-eligible: this is not truly a denial; the child receives Medicaid, which provides equivalent or greater benefits. If you believe the Medicaid determination is wrong, you may request a Fair Hearing.
- Child is 19 or older: WVCHIP covers children through their 18th birthday only. Adults under 65 in West Virginia may qualify for adult Medicaid (up to 138% FPL) or an ACA marketplace plan with premium tax credits.
- Missing or incomplete documentation: the application goes on hold for up to 10 days. Contact your local DoHS office or call 1-877-982-2447 to identify and submit the missing items before the hold period expires.
How to Appeal a WVCHIP Denial in West Virginia
West Virginia WVCHIP applicants who receive a denial have the right to appeal through a state Fair Hearing. To request a Fair Hearing, contact your local Department of Human Services field office within 90 days of the denial notice date. You may submit the request in person, by phone, or in writing. During the Fair Hearing, a neutral hearing officer reviews the denial reason, hears your evidence, and issues a written decision. If the hearing officer finds in your favor, WVCHIP enrollment is backdated to the original application date.
West Virginia also permits children already enrolled in WVCHIP to appeal a termination or reduction of benefits. In that case, requesting a Fair Hearing before coverage ends allows continuation of benefits during the appeal period. The West Virginia WVCHIP helpline at 1-877-982-2447 can help families understand the appeal process and locate their county DoHS office.
About WVCHIP: West Virginia's Children's Health Insurance Program
WVCHIP was established under Title XXI of the Social Security Act, the federal legislation that created the State Children's Health Insurance Program in 1997. West Virginia operates a combination CHIP program that integrates both Medicaid expansion CHIP (for children in households just above the previous Medicaid threshold) and a separate CHIP component (for children between the Medicaid limit and 300% FPL). The program is jointly funded by the federal government and West Virginia, with a federal match rate of approximately 93% under the enhanced CHIP match established by the Affordable Care Act. Federal CHIP funding is authorized through federal fiscal year 2027.
WVCHIP is administered by the West Virginia Children's Health Insurance Agency, a unit within the Bureau for Medical Services under the West Virginia Department of Human Services. Coverage is delivered exclusively through managed care organizations, not fee-for-service. As of the most recent federal reporting, WVCHIP covered approximately 39,000 West Virginia children with a participation rate of over 96% among eligible children. The program's main office is located at 350 Capitol Street, Room 251, Charleston, WV 25301.
Frequently Asked Questions
What is the income limit for a family of 4 for WVCHIP in 2026?
A West Virginia family of four can earn up to $99,000 per year in 2026 and still qualify for WVCHIP. That figure equals 300% of the 2026 federal poverty level for a 4-person household. At that income level the child would be placed in the Premium plan, which requires a monthly premium but covers the same core WVCHIP benefits as the no-premium Gold and Blue plans. Families at lower incomes (roughly below $49,500/year for a family of four, approximately 150% FPL) qualify for the Gold plan with minimal copays and no monthly premium.
What counts as income for WVCHIP?
WVCHIP uses MAGI (Modified Adjusted Gross Income) counting rules, the same standard used for Medicaid and ACA marketplace plans. MAGI income includes wages and salaries, tips, net self-employment income, Social Security benefits (except SSI), unemployment compensation, rental income, alimony received, and most other forms of taxable income. It does not count child support received, SSI, veterans' non-service-connected disability, or certain other non-taxable income sources. Household size follows federal tax return rules: count yourself, your spouse if filing jointly, and all individuals you could claim as tax dependents.
Can my child get WVCHIP if we already have insurance?
Generally no. WVCHIP is designed for children without other qualifying health insurance. However, West Virginia provides an insurance exception if the available employer-sponsored coverage would cost your household more than 9.5% of your gross household income. If that exception applies, your child may still qualify for WVCHIP even with employer insurance available. Visit chip.wv.gov/insurance-exceptions or call 1-877-982-2447 to request an exception review.
What documents do I need to apply for WVCHIP?
To apply for WVCHIP in West Virginia in 2026 you need proof of West Virginia residency (utility bill or lease), income documentation for all earning household members (pay stubs, tax return, or W-2/1099), the child's birth certificate or other proof of age, Social Security numbers for all household members, and immigration status documents if any household member is not a U.S. citizen. Having all documents ready before you start the online application at wvpath.wv.gov can reduce processing time.
What happens if my WVCHIP application is denied?
West Virginia WVCHIP sends a written denial notice stating the specific reason. You have 90 days from the notice date to request a Fair Hearing through your county Department of Human Services office. You can request the hearing in person, by phone, or in writing. If the hearing is decided in your favor, coverage is backdated to your original application date. The WVCHIP helpline at 1-877-982-2447 can explain the appeal process and connect you with your local DoHS office.
Is West Virginia a Medicaid expansion state?
Yes. West Virginia expanded Medicaid under the ACA, covering adults earning up to 138% of the federal poverty level (up to $22,025 per year for an individual in 2026). Because West Virginia has expanded, there is no ACA coverage gap in the state; adults between 100% and 138% FPL qualify for Medicaid rather than falling into a coverage gap. Children in West Virginia are covered by Medicaid up to age-specific thresholds (138% to 163% FPL by age group) and by WVCHIP from that Medicaid ceiling up to 300% FPL.
How long does the WVCHIP application process take in West Virginia?
West Virginia WVCHIP applications are typically processed within two weeks of the local Department of Human Services receiving a complete application. Applications submitted online through wvpath.wv.gov that include all required documentation often move faster. Once approved, WVCHIP grants 12-month continuous eligibility, so coverage lasts for a full year without monthly income rechecks. Children aged 17 and older must actively reapply at the end of the 12-month period; WVCHIP does not automatically send renewal notices to that age group.
What is the difference between WVCHIP and West Virginia Medicaid?
West Virginia Medicaid and WVCHIP both provide comprehensive children's health coverage, but they serve different income ranges and have different cost-sharing rules. West Virginia Medicaid covers children whose household income falls below age-specific FPL thresholds (138% to 163% FPL by age group) with no monthly premiums and very limited copays. WVCHIP serves children above those Medicaid thresholds up to 300% FPL and may require modest copays or, under the Premium plan, a monthly premium. WVCHIP is a separate program from Medicaid with its own managed care network; not all providers who accept West Virginia Medicaid also accept WVCHIP. When you apply through wvpath.wv.gov, the portal screens for Medicaid eligibility first and routes to WVCHIP only if the child does not qualify for Medicaid.
