A Guide to WV Medicaid - West Virginia’s Medical Program

West Virginia Medicaid provides healthcare coverage to eligible residents who fall under the low-income threshold. The program's main purpose is to address the healthcare needs of residents who may not be able to afford private health insurance. Funded by the state and federal government, WV Medicaid covers a range of healthcare procedures and pharmaceuticals. As of 2023, 596,525 West Virginians were enrolled in Medicaid.

Finding affordable health insurance that covers your needs doesn't have to be difficult. You could be eligible for West Virginia's state Medicaid program through the West Virginia Department of Health & Human Resources. What does the plan cover, and how can you apply for it?

This guide explains everything you need to know about Medicaid options. With the right information, you can form a decision about your insurance coverage that helps you maintain good health, no matter what ailment or injury occurs. You can greatly benefit from this government-funded health insurance program but also have the option to extend your coverage via a third-party provider. Many West Virginians extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.

Keep reading to learn more about what WV Medicaid covers, how you can apply, and the advantages of extending your coverage.

    What Is WV Medicaid?

    The West Virginia Medicaid program supports eligible residents by providing them with no-cost health insurance. If you apply and meet all the eligibility requirements, you'll receive a medical card that allows you to receive the healthcare you need throughout the community.

    Medicaid members can use this coverage to receive preventative and emergency healthcare services, as well as long-term care in nursing homes or similar facilities. If you're unfamiliar with this program, you're probably wondering, "Is WV Medicaid free?" and, "How is West Virginia Medicaid funded?"

    Since the Medicaid program supports low-income residents, it is free for those who meet the requirements. The program receives funding from both the state and federal government, and these funds allow members to receive the care they need.

    The most recent spending data shows that the federal government contributes 77.7% of the program's overall funds while the state contributes the remaining 22.3%. The Medicaid program accounts for roughly 22% of the state's annual budget, and the funding allocates just over $8,300 to each member.

    Once you enroll in the program, you'll receive your insurance card and can use it for no-cost coverage of various appointments and procedures.

    What Is a West Virginia Medicaid Card?

    West Virginia Medicaid

    Your WV Medicaid card serves as your primary form of insurance. Healthcare providers, including hospital staff, doctor's offices, and pharmacists, need this card to confirm your coverage through the state's Medicaid program. Once you show your card to healthcare personnel, they can bill Medicaid as your insurance provider so you don't receive a bill in the mail, depending on the service or procedure.

    The card contains your Medicaid plan number, which verifies your enrollment. Keep this card in a safe place since you'll need to show it to administrators whenever you seek treatment.

    Applying for West Virginia Medicaid

    If you're wondering how to apply for WV Medicaid, you're in the right place.

    You can visit one of the field offices of the West Virginia Bureau for Medical Services. An office is available in each county, with 55 total locations throughout the state that are open Monday through Friday between 8:00 AM and 5:00 PM.

    If you have a disability that prevents you from visiting a county office, you can call one of the offices directly to speak with a representative about applying for Medicaid. Arrange for an administrator to come to your home and retrieve your application by calling (800) 642-8589. Other ways to apply include:

    • Online: You can visit WV PATH, which is the state's online portal for applying for Medicaid and other programs from the Department of Health & Human Resources. Another option is visiting Healthcare.gov, which lets you explore federal health insurance options, including Medicaid.
    • By mail: Print and mail your completed application to your county field office.
    • Over the phone: Call the Department of Health & Human Resources Customer Service Center hotline at (877) 716-1212. A representative can guide you through the application process.

    Online portals allow you to track your application progress and coverage period, while agency representatives can provide answers and clarity for any questions you have when applying.

    Eligibility Requirements

    Who is eligible for WV Medicaid coverage? Every prospective Medicaid member must be a U.S. citizen, permanent resident, or legal alien, and a full-time resident of West Virginia in need of health insurance. Once you meet these standard requirements, you also have to prove you qualify as a low-income resident.

    The income threshold varies depending on the size of each household. A single-person household must have an annual income of less than $19,392. Add $6,836 to this income cap for each additional person in the household.

    Finally, Medicaid members need to meet any of the following age or health requirements:

    • Pregnant
    • Blind
    • Over the age of 65
    • Responsible for children under the age of 18
    • Disabled or caregiver or someone in the household with a disability

    Before applying for coverage, confirm the requirements via the West Virginia Department of Health & Human Resources Bureau of Medical Services.

    Getting a West Virginia Medicaid Card

    You need to submit a completed application to the Department of Health & Human Services. The application will consist of your contact information, personal identification information like your social security number, and income figures. Once the government agency receives your application, it will take a few days to process your enrollment.

    You'll receive your West Virginia Medicaid card in the mail following enrollment completion. Use an accurate address for the state to send your card, and once you receive it, keep it in a safe place.

    Renewing or Replacing Your WV Medicaid Card

    West Virginia's Department of Health & Human Resources issues Medicaid cards once a year. If you happen to lose yours, you can request a replacement by calling the agency's Customer Service Center hotline at (877) 716-1212. You can also visit your county field office to make the request.

    The program sends out renewal notices to members as their coverage end date approaches. Fill out your renewal information and send it back promptly before your coverage ends.

    West Virginia Medicaid Coverage

    What is WV Medicaid coverage you can receive? As a Medicaid member, you have access to no-cost healthcare services in a variety of sectors, including dental and vision care. Discover all of the services that your state insurance program covers below.

    Dental

    West Virginia Medicaid provides extensive dental coverage for members under the age of 21. They may receive no-cost dental care for preventative appointments and screenings, as well as orthodontic, prosthodontic, periodontic, and maxillofacial surgery procedures.

    If you're over the age of 21, you can still receive dental coverage through the state's health insurance program. You'll have continued coverage for emergency dental procedures to correct fractures, treat infections, and address traumatic oral injuries. Preventative and diagnostic care require prior authorization, and coverage is limited to $1,000 worth of care per calendar year.

    If you have more serious dental issues and require more trips to the dentist, investing in private dental plans in West Virginia is advisable.

    Prescription Drugs

    All Medicaid members can receive free prescription drugs that appear on the program's preferred drug list. If your doctor prescribes a medication that is not on this list, it doesn't mean that you can't receive the drug. The prescription may appear on the Medicaid drug formulary and require prior authorization for the coverage to kick in.

    New medications must undergo annual review before they can appear on the preferred drug list. Review is not necessary if the Food and Drug Administration gives a drug priority status.

    You can review the current preferred drug list and see which medications have automatic coverage through West Virginia Medicaid.

    Extended Health Care

    WV Medicaid covers more than your dental and physical healthcare needs. Your coverage also includes mental and behavioral health services, including counseling for substance abuse. Use the state's provider directory to find a professional that accepts Medicaid.

    Your Medicaid card lists helpful phone numbers on the back that you can call for assistance with your physical or mental health. A licensed professional counselor, social worker, or psychiatrist can work with you to improve your mental health and treat any underlying issues.

    As well, in the event of an accident or onset of an illness, many patients require additional care, but they go without because of financial concerns, lack of coverage, and restricted access. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.

    Travel and Out of State Coverage

    Your Medicaid coverage is exclusive to providers in West Virginia, with a few exceptions. You can visit a provider that has "border status" and practices within 30 miles of the state's border. You can reach out to the Bureau of Medical Services for approval prior to seeking out-of-state care.

    Medicaid also accepts out-of-state coverage when you need to receive emergency medical treatment while traveling. For example, if your appendix bursts on a trip and you need an emergency appendectomy, your insurance will cover the procedure. Non-emergency care, such as out-of-state nutritional counseling, does not fall under your coverage.

    If you intend on traveling outside of West Virginia, or outside the United States for leisure, always invest in proper travelers insurance.

    Students & Seniors

    Assuming they meet the eligibility requirements, West Virginia children and senior citizens can receive Medicaid coverage. Students under the age of 21 can receive health insurance through West Virginia Medicaid and be exempt from co-payments for all services. Working families that are not eligible for Medicaid may still receive affordable health insurance through the West Virginia Children's Health Insurance Program.

    Seniors and those with disabilities can receive long-term care at no cost via WV Medicaid. This coverage includes:

    • Nursing home care
    • Special facilities for those with intellectual and developmental disabilities
    • Traumatic brain injury waiver services

    Coverage for Subgroups

    Certain subgroups can receive Medicaid benefits, including women with breast or cervical cancer. Prospective members must receive their diagnosis through a Centers for Disease Control program and be under the age of 65 with no other form of health insurance. If you meet these requirements, you can receive coverage regardless of your annual income.

    Learn about the other subgroups that may receive coverage below.

    Native Americans and Alaska Natives

    Aboriginal groups like Native Americans and Alaska natives are eligible for Medicaid coverage as long as they meet the state's requirements. If you fall under this group, make sure you include your tribal document with your application to verify your identity. Along with the standard insurance coverage, aboriginals have the advantage of being exempt from co-payments for all services.

    Military

    Veterans, active military members, and their families can also receive coverage via the state Medicaid program, although there are no differences in coverage. You can enroll by meeting income and citizenship requirements and using a military ID in your application. Valid forms of identification include:

    • U.S. military card or draft record
    • U.S. Coast Guard Merchant Mariner card
    • Military dependent's ID card

    What West Virginia Medicaid Does Not Cover

    Now that you know what WV Medicaid covers, take a look at some of the services and treatments that aren't covered:

    Elective cosmetic procedures, including plastic surgery
    Sterilization for Medicaid members under the age of 21
    Non-medically necessary procedures
    Injuries or illnesses that come with benefits or settlements, such as worker's compensation
    Sports-related devices
    Home custodial care
    Services deemed experimental or for research

    It is also important to note that the West Virginia burial assistance program will only put forth $1000 toward the cost of funerals. Given the rising cost of burial and related costs, ensure that your family is secured with comprehensive funeral insurance.

    Common Procedures and WV Medicaid Eligibility

    Medicaid members expect many common treatments and medications to fall under their insurance coverage. However, not every procedure is eligible for full coverage. Get a clear picture of what is and isn't covered below.

    Dental
    X-Rays and Exams Preventative dental screenings, including cleanings, X-rays, and exams, are available to Medicaid members at no cost. Members under the age of 21 can receive dental and orthodontic care with no limits. The plan also covers the cost of orthodontic treatment, such as braces. If you're over the age of 21, you can also receive diagnostic dental care, including X-rays once a year and cleanings every six months. However, Medicaid will only cover restorative treatments, like crowns or fillings, up to $1,000, and you'll have to pay exceeding amounts out of pocket.
    Wisdom Teeth Tooth extractions like wisdom teeth surgery fall under your Medicaid coverage.
    Vision
    Eye Exams Children and adults can see a practitioner for routine eye exams every year under West Virginia Medicaid.
    Glasses If you need glasses or contact lenses, Medicaid will cover the costs in certain cases. Children under the age of 21 can receive one pair of glasses per year and contact lenses at no cost, depending on the diagnosis. As an adult, your coverage includes medical contact lenses and a pair of glasses following cataract surgery.
    Laser Eye Surgery Unless a doctor deems it medically necessary, laser eye surgery is not part of your Medicaid coverage.
    Surgery
    Rhinoplasty Elective plastic surgery of the nose is not available through WV Medicaid. However, this procedure may be eligible for coverage if a provider deems it medically necessary. Instances where rhinoplasty is medically necessary are if you have a deviated septum or experience a traumatic injury to the face.
    Breast Reduction Breast reduction surgery or removal of breast implants must also be proven medically necessary. Women who experience severe back pain could have a doctor sign off on this surgery as a necessary procedure.
    Hospital
    Hospital stays All inpatient and outpatient procedures at a West Virginia hospital will come at no cost to you as a Medicaid member. The only exceptions are organ and tissue transplant surgeries apart from corneal transplants. Transplants must take place at a hospital that accepts Medicaid, and patients need to receive prior authorization.
    Ambulance transportation West Virginia Medicaid covers emergency transportation, including ambulance rides to the hospital. This includes air ambulance transportation, though out-of-state coverage requires prior authorization.
    Giving birth Pregnant women with Medicaid insurance can give birth in the hospital at no cost, although home births are not part of the state's coverage plan. Other maternity services Medicaid covers include prenatal care and post-partum care up to 60 days after delivery.
    Therapy and Counselling
    Treatment for behavioral health is available via WV Medicaid. This includes counseling for those suffering from mental illness and substance abuse disorders, inpatient psychiatric care, and psychological evaluations and treatment. Treatments may require prior or continuing authorization to receive coverage.
    Sexual Health
    Gynecologist Women can see a gynecologist for routine exams and screenings. Coverage includes mammograms, pap smears, and pelvic exams.
    Erectile Dysfunction You'll have to pay out of pocket to receive erectile dysfunction medication since this type of medication is not included in West Virginia's preferred drug list.
    Birth Control (including IUD) Contraceptives like birth control pills, patches, and intrauterine devices are available as prescription medication for Medicaid members. This also includes emergency birth control, also known as the morning-after pill. Abortions are not eligible for Medicaid coverage in West Virginia.
    Fertility Treatment West Virginia Medicaid offers coverage for various family planning services. However, this does not include fertility treatments like artificial insemination and in-vitro fertilization therapy.
    Specialist Services
    Dermatologist Visit an in-network dermatologist for preventative screenings and full-body skin exams at no cost to you. Any medically necessary surgical procedure the doctor performs, such as a skin biopsy or mole removal, falls under your coverage as well. Your insurance will not pay for cosmetic procedures like chemical skin peels or dermal filler injections.
    Physiotherapy Rehabilitation services like physical therapy are available to help you regain strength and mobility after an injury. Medicaid will pay for up to 20 visits with an occupational or physical therapist per year.
    Massage Therapy Massage therapy is not part of the state's current coverage. However, coverage includes chiropractic care as an alternative.
    Podiatry and Foot Care If you see a podiatrist to treat a fracture or other acute injury on your foot, WV Medicaid will cover the cost. Routine foot care and treatment of flat foot and foot subluxation are not part of your coverage, so prepare to pay an out-of-pocket fee for these services.
    Allergist and Allergy Testing In-office and telehealth visits with an allergist and subsequent testing for allergies remain a part of the state's insurance coverage.
    Sleep Physician Services and CPAP Machines Say a doctor diagnoses you with sleep apnea and wants to give you a CPAP machine to monitor your breathing while you sleep. As long as you have authorization from a physician, your insurance will cover the cost of the machine and other pieces of Durable Medical Equipment, such as oxygen machines.

    Extending WV Medicaid Coverage

    Supplementing your Medicaid coverage with a plan from a third-party provider can provide you maximum health benefits. You'll maintain all the advantages of West Virginia Medicaid and find affordable coverage for services that aren't available to you through your current plan. How is this possible?

    Insurdinary lets you search and compare health insurance plans that meet your budget and medical needs. You can easily find extended coverage for everything that Medicaid doesn't cover and search for affordable plans if you need insurance but don't qualify for Medicaid. Our search tool maps out third-party insurance providers that your dentists and doctors accept and gives you a clear picture of the premiums, co-payments, and other essential information.

    Why extend your coverage if Medicaid covers most of your medical services? You can reap the following benefits:

    • Access to out-of-network providers: Private insurance grants you the ability to visit physicians and specialists who don't practice in your current network. You'll have more freedom in your healthcare decisions.
    • Various procedures or medications at little to no cost: With WV Medicaid as your primary insurance, you're limited to its medical coverage. Say you want to undergo fertility treatments or a cosmetic procedure that Medicaid won't cover. Your secondary insurance can pick up the costs.
    • Greater flexibility with treatment schedule: Many healthcare services, like specialist visits or physical therapy appointments, have coverage limits with Medicaid. A third-party plan may eliminate caps on your service so you can receive the care you need.

    In addition to health insurance, Insurdinary helps people like you secure affordable policies for car, home, pet, and life insurance, among others. Supplement your West Virginia Medicaid coverage for optimum healthcare benefits. Get started today and receive quotes from trusted insurers.

    FAQ’s

    How long does it take to get approved for West Virginia Medicaid?

    The approval timeline for West Virginia Medicaid varies based on individual circumstances, but on average, the process takes around 30 to 45 days. Urgent cases may be expedited for quicker processing.

    What are the methods to apply for West Virginia Medicaid?

    You can apply for West Virginia Medicaid through multiple channels: online, in person, by mail, or at a local Department of Health and Human Resources office. Ensure you provide necessary documents such as proof of income, household size, and residency when submitting your application.

    Does West Virginia Medicaid cover the expenses of funerals?

    No, West Virginia Medicaid primarily provides healthcare coverage and does not include benefits for funeral expenses. If you're seeking assistance with funeral costs, you may want to explore options like funeral insurance.

    Who is eligible for West Virginia Medicaid?

    Eligibility for West Virginia Medicaid is determined by factors such as income, household composition, and other considerations. Typically, the program extends coverage to low-income individuals, families, pregnant women, children, elderly individuals, and those with disabilities.

    What is West Virginia Medicaid?

    West Virginia Medicaid is a program designed to offer medical coverage to eligible low-income residents of the state. Funded jointly by federal and state resources, its aim is to ensure access to essential healthcare services for those who qualify.

    What other types of insurance does Insurdinary offer?

    Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:

    References

    1. https://ballotpedia.org/Medicaid_spending_in_West_Virginia
    2. https://dhhr.wv.gov/bms/Pages/Field-Offices.aspx
    3. https://dhhr.wv.gov/bms/Members/Apply/Pages/default.aspx
    4. https://www.wvpath.wv.gov/
    5. https://www.healthcare.gov/
    6. https://www.benefits.gov/benefit/1645
    7. https://dhhr.wv.gov/News/2015/Pages/Medicaid-Card-Changing-from-Monthly-to-Annual-Card-April-1.aspx#:~:text=If%20a%20member%20loses%20or,a%20Letter%20of%20Creditable%20Coverage.
    8. https://dhhr.wv.gov/bms/BMSPUB/Documents/Guide%20to%20Medicaid%202022.pdf
    9. https://chip.wv.gov/eligibility/Pages/default.aspx
    10. https://dhhr.wv.gov/bfa/programs/Documents/Medicaid%20Eligibility%20and%20Requirements.pdf
    11. https://www.healthplan.org/application/files/4416/6214/0187/Medicaid_Member_Handbook_SFY23_08072022.pdf
    12. https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/west-virginia/pdf/abhwv_member_mountain_health_trust_handbook.pdf
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