Medicaid Eligibility in West Virginia: Income Limits & How to Apply

Medicaid Eligibility in West Virginia

Thanks to ACA Medicaid expansion, West Virginia offers coverage through WV Medicaid for adults earning up to 138% FPL — approximately $21,597/year for an individual and $44,367/year for a household of four in 2026.

WV Medicaid provides coverage to the following groups:

• Adults aged 19-64 with income up to 138% FPL
• Children in families with income up to 200-300% FPL (varies by age)
• Pregnant women with income up to 185-200% FPL
• Seniors and people with disabilities who meet income and asset requirements

About WV Medicaid

If you're a West Virginia resident trying to understand your health coverage options, you've come to the right place. West Virginia Medicaid, known as WV Medicaid, is an expanded program that provides health insurance to many residents. Adults aged 19-64 can qualify with a household income up to 138% of the Federal Poverty Level (FPL). For a single adult in 2025, this means an annual income up to $21,597. For a household of two, the monthly income limit is $2,432, and for a household of three, it's $3,064. Children, pregnant women, seniors, and individuals with disabilities also have specific income pathways to qualify. As of 2024, over 534,800 people, or about 30.2% of West Virginia's population, were enrolled in Medicaid, demonstrating it's a vital and active program in the state.

If your income is just above the WV Medicaid limit, you'll likely transition to the federal marketplace, HealthCare.gov, where you can apply for subsidies to help pay for your health insurance. Because West Virginia's benchmark Silver plan is around $752 per month, which is higher than the national average, these subsidies can significantly reduce what you pay. It's important to remember that your eligibility for either program can change with your income. If your income fluctuates, you might shift between Medicaid and marketplace subsidies. West Virginia saw a decline in Medicaid enrollment during the "unwinding" of pandemic-era continuous coverage rules, with about 118,000 residents removed from Medicaid and CHIP since the eligibility review began. If you were among those who lost coverage, you can reapply at any time if your circumstances change.

WV Medicaid provides comprehensive benefits, often with little to no cost-sharing for you. Covered services include doctor visits, immunizations, wellness visits, specialist visits, urgent and emergency care, hospital care, lab and X-ray services, pregnancy services, family planning, chiropractic services, physical and occupational therapy, speech and hearing services, and behavioral healthcare, including mental health and substance use disorder services. Dental benefits for adults aged 21 and over are limited to $2,000 over a two-year period. West Virginia also has several Home and Community-Based Services (HCBS) waivers, like the Aged and Disabled Waiver, the Intellectual/Developmental Disabilities Waiver, and the Traumatic Brain Injury Waiver, which help individuals receive care in their homes and communities rather than in institutions. Telehealth services are also covered, allowing you to access care remotely through interactive audio and video systems.

When applying for WV Medicaid, be prepared to provide documentation such as proof of identity, Social Security numbers, income, and assets. While the state aims to process applications within 45 days, or 90 days if you have a disability, it can take longer if additional information is needed. During the recent unwinding period, many individuals lost coverage due to procedural errors, highlighting the importance of responding promptly to any requests for information. If you have questions about your application or need assistance, you can contact your local Department of Human Services (DoHS) office or Client Services. A concrete action step you can take is to visit the WV PATH website to start your application or check your eligibility.

West Virginia Medicaid Income Limits 2026

The following table shows the key income thresholds for West Virginia in 2026:

If your household income falls below the 138% FPL column, you qualify for WV Medicaid. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.

West Virginia has some of the highest marketplace premiums in the country, with the benchmark Silver plan averaging $752/month. The upside: higher premiums mean larger subsidies for eligible residents, so out-of-pocket costs after credits may be similar to cheaper states.

Marketplace Insurance in West Virginia

West Virginia residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in West Virginia costs approximately $752/month for a 40-year-old in 2026.

Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in West Virginia might pay after subsidies:

These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.

West Virginia participates in the federal marketplace at HealthCare.gov. During the application, your income is evaluated for both Medicaid eligibility and marketplace subsidy amounts simultaneously.

West Virginia adopted Medicaid expansion, bringing WV Medicaid coverage to low-income adults who previously had no affordable option. The transition between Medicaid and marketplace coverage is handled through HealthCare.gov.

How to Apply for WV Medicaid

1. Online application — Start at HealthCare.gov. Your Medicaid eligibility is checked automatically when you enter your income details.
2. State Medicaid office — Apply directly through West Virginia's Medicaid agency at any time during the year. Unlike marketplace insurance, Medicaid has no enrollment deadline.
3. Phone assistance — Call West Virginia's Medicaid helpline for guided help completing your application.
4. In-person help — Visit your county human services office or a local navigator for face-to-face support.

To complete your application, you'll need income documentation (pay stubs, tax returns), a West Virginia address for residency verification, Social Security numbers for household members, and information about existing coverage.

Frequently Asked Questions

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