UPDATE: In 2020, Medicaid requirements and application steps are expected to remain the same.
Learn how to qualify for Medicaid in West Virginia in order to gain access to Medicaid benefits successfully in the state. West Virginia Medicaid eligibility requirements are conditional to both personal and financial circumstances.
Deciding who is eligible for Medicaid in WV is the responsibility of the state’s Department of Health and Human Resources. Officials consider an applicant’s WV Medicaid benefits eligibility through a combination of medical need, current assets and income requirements. These factors make up the Medicaid application guidelines. What are the requirements for Medicaid in WV?
Who meets the requirements for Medicaid in West Virginia?
The state limits West Virginia Medicaid benefits eligibility to individuals and households who have a dire need for health insurance coverage. Medicaid eligibility requirements allow state officials to select applicants with a true financial and/or medical need for health care services based on regulated guidelines.
What are the Medicaid application guidelines in West Virginia? Medicaid eligibility actually varies by government health care program. For example, an applicant who is eligible for Medicaid Work Incentive (M-WIN) may not be eligible for Specified Low-Income Medicare Beneficiaries (SLIMB) program.
What are the requirements for Medicaid in West Virginia, exactly? General WV Medicaid eligibility requirements make it mandatory for applicants to be residents of the state and U.S. nationals, citizens, permanent residents or legal aliens who are also in need of health care coverage or health insurance assistance due to a low income.
Medicaid requirements ask that candidates provide proof of identity and citizenship status with valid photo identification or a combination of acceptable documents. Requirements for Medicaid are specific to certain patients, including:
- The elderly at 65 years of age.
- Pregnant women.
- Caretakers of relatives and the disabled.
Medicaid benefits eligibility greatly depends on the applicant’s patient category or the health program for which he or she is requesting Medicaid benefits.
Learn more about Medicaid requirements by downloading our comprehensive guide.
Most Medicaid candidates younger than 65 years of age, including pregnant women and minors, are subject to income limits in West Virginia. Applicants must also have a household income less than the financial threshold, which ranges between 100 to 250 percent of the Federal Poverty Level, depending on the Medicaid program. However, the state may waive income requirements for Medicaid when applicants are medically needy or are part of a special eligibility group. For example, female patients qualify for Medicaid regardless of income if diagnosed with breast or cervical cancer, so long as they do not have health care insurance already.
Those automatically eligible for Medicaid in West Virginia do not need to apply for Medicaid benefits. Supplemental Security Income (SSI) beneficiaries qualify for Medicaid automatically in West Virginia. SSI beneficiaries will receive a Medicaid health insurance card during the month in which the state approves them for SSI. Beneficiaries of other government programs may be able to meet Medicaid qualifications through their current government-funded programs. However, the state accepts only those beneficiaries of SSI without prompting.
Download our helpful guide to learn about the different requirements for Medicaid.
What are the income requirements for Medicaid in West Virginia?
Applicants curious about how to qualify for Medicaid financially will discover that income requirements are not fixed. WV Medicaid eligibility requirements for assets and earnings are not exclusive to the individual applicant. Medicaid benefits eligibility pertaining to financial need is dependent on the size and collective income of the household.
Note: An applicant who is eligible for Medicaid based on his or her single income and group size of one may not qualify for Medicaid when including his or her spouse’s earnings. Likewise, an applicant may not qualify for Medicaid benefits without including dependents.
What are the Medicaid application guidelines when calculating household income? Candidates can exclude earnings from child support, worker’s compensation, veterans’ benefits, educational awards and certain American Indian and Alaska Native (AIAN) income. Household size must include all dependents claimed on the applicant’s federal tax return. Dependents may include the applicant’s spouse and biological, adopted and step children as well as other relatives, such as dependent parents and non-blood-relatives, like foster children
Medicaid income requirements vary based on the applicant’s household factors. By means of example, a family of four with children 6 years of age and older cannot have an income greater than $33,465 annually, while a similar size family with children between 1 and 6 years of age cannot have an income greater than $34,272 annually.
Furthermore, if a family of four has children younger than 1 year of age or a pregnant woman included, the maximum annual household income cannot be greater than $36,456. Most Medicaid requirements make it mandatory for candidates to have household incomes totaling less than 138 percent of the federal poverty line.
In addition to income requirements for Medicaid, some West Virginia Medicaid programs also have asset levels. What are the requirements for Medicaid household assets? First, consider the intended Medicaid benefits program and the household size when reviewing these details. Assets can include finances in a bank account, owned property (other than residences) and the cash value of life insurance policies. Medicaid benefits eligibility in West Virginia implements a five-year financial history of potential Medicaid beneficiaries to verify that the individual has not purposefully hid, transferred or given away assets.