Last updated: July 14, 2026
Bottom line
West Virginia families can apply for Medicaid and the West Virginia Children’s Health Insurance Program (WVCHIP) at any time of year. Start with WV PATH, or use the BMS application guide if you need a paper form, a county office, or phone help.
Medicaid may cover eligible adults, children, pregnant women, older adults, and people with disabilities. WVCHIP may cover children under 19 and some pregnant women who do not qualify for Medicaid. If neither program fits, check a Marketplace plan or ask a clinic about a sliding fee.
This guide is about finding coverage and care. It does not diagnose illness or replace advice from a licensed health professional.
Get urgent help now
- Call 911 or go to the nearest emergency room for severe chest pain, trouble breathing, heavy bleeding, possible poisoning, a serious injury, or another life-threatening problem.
- Call or text 988 for suicide, mental health, or substance use crisis support. The WV 988 site explains how the service works.
- Use Help4WV for 24-hour mental health and addiction support and treatment referrals.
- Call 211 or text your ZIP code to 898-211 for local food, shelter, utility, transportation, and health referrals through West Virginia 211.
If you need help with several bills or basic needs at once, the emergency help guide gives more West Virginia starting points.
Where to start
You have little income
Apply for Medicaid now. Do not wait for Open Enrollment. The state must review your income, household, age, pregnancy, disability, and other facts.
Your child needs coverage
Apply for Medicaid and WVCHIP even if you think your pay is too high. Children have different rules from adults.
You are pregnant
Report the pregnancy on the application. Ask for a review under Medicaid and WVCHIP maternity coverage.
You have no insurance
Call a community health center or free clinic. Ask about same-week care, a sliding fee, and what proof to bring.
Quick reference
| If you need | Start here | Reality check |
|---|---|---|
| Coverage for yourself | West Virginia Medicaid | Income is only one part of the decision. Apply and let DoHS review the case. |
| Coverage for a child | Medicaid or WVCHIP | A child may qualify even when a parent does not. |
| Pregnancy care | Medicaid or WVCHIP maternity | Report the pregnancy and any birth or pregnancy end as soon as possible. |
| Private insurance help | HealthCare.gov | Outside Open Enrollment, you usually need a Special Enrollment Period. |
| Care before coverage starts | Health center or free clinic | Sliding fees vary. Ask about cost before the visit. |
| A ride to care | Medicaid or WVCHIP NEMT | Routine rides normally need five business days’ notice. |
How to apply in West Virginia
The fastest starting point for most families is WV PATH. It accepts applications for Medicaid, WVCHIP, SNAP, and several other DoHS programs. You can also apply through a local office found on the DoHS field office page.
For application questions, call the DoHS Customer Service Center at 1-877-716-1212. The state also provides paper forms through the BMS application page. Start the application even if one document is missing, then ask what proof you must send and the due date.
You may apply for Medicaid or WVCHIP all year. A family does not need to wait for the yearly Marketplace enrollment period. The national Medicaid and CHIP guide explains the basic program differences.
West Virginia Medicaid
West Virginia Medicaid is public health coverage for people who meet a program category and its financial and nonfinancial rules. The current Medicaid member guide lists children, pregnant women, adults ages 19 through 64, people who receive Supplemental Security Income, former foster youth, and people who are aged, blind, disabled, or medically needy among the groups that may qualify.
For many children, pregnant women, and adults, eligibility uses Modified Adjusted Gross Income and household size. Other Medicaid groups may have asset, disability, age, or medical-need rules. This is why a simple online income chart cannot decide every case.
What Medicaid may cover
Covered care can include doctor visits, hospital care, prescriptions, lab work, pregnancy care, behavioral health care, family planning, children’s preventive care, dental services, and non-emergency medical transportation. Limits and prior approval rules can apply. Read the plan notice before scheduling costly care.
Managed care and provider networks
Most members receive care through Mountain Health Trust. Keep both the state medical card and the health-plan card. Before a visit, ask the office whether it takes your exact plan, not only “Medicaid.” If a doctor is not in network, call the plan for another provider.
Medicaid rules change in 2026 and 2027
West Virginia says some noncitizen eligibility rules are scheduled to change on October 1, 2026. Beginning January 1, 2027, some adults ages 19 through 64 in the Medicaid expansion group may have to complete 80 hours of work or approved community activity each month unless exempt. Current members are expected to face the new activity rules at their scheduled 2027 renewal, beginning with renewals due in March 2027.
Do not close your own case because you think a new rule applies. Read every state notice, keep your contact details current, and check the official new Medicaid rules page. Rules and exemption details may be updated before they take effect.
WVCHIP for children and pregnant women
WVCHIP provides coverage to children through their 19th birthday and to some pregnant women over 19 who have no other health coverage and are not eligible for Medicaid. Residence, income, household size, citizenship or immigration rules, and insurance status matter. The official WVCHIP eligibility page shows current income groups and cost-sharing levels.
Some families pay only small copays, while higher-income groups may have more copays or a monthly premium. Do not use the top income number as a promise of approval. Household and tax rules can change the result.
The 2026 WVCHIP member guide says children receive 12 months of continuous enrollment after approval. Pregnant members are covered through pregnancy and for 12 months after the pregnancy ends. Report a birth promptly so the newborn can be reviewed for Medicaid or WVCHIP.
Call the WVCHIP helpline at 1-877-982-2447 for questions about eligibility, premiums, copays, cards, or renewal.
Marketplace plans when public coverage does not fit
If Medicaid and WVCHIP do not fit, check HealthCare.gov. Marketplace plans may include a premium tax credit based on expected yearly household income. Compare the monthly premium, deductible, copays, prescription list, doctor network, and total yearly cost.
Open Enrollment runs from November 1 through January 15. The official Marketplace enrollment dates page lists when coverage can start. Outside that period, a move, marriage, birth, adoption, loss of coverage, or another event may open a Special Enrollment Period. Check the special enrollment rules before waiting.
WV Navigator provides free help with Marketplace, Medicaid, and CHIP applications. You can also call HealthCare.gov at 1-800-318-2596.
Care if you do not have insurance
You do not have to wait for a final coverage decision before asking for basic care. Start with a community health center, free clinic, local health department, or hospital billing office.
- Use the federal health center finder to search by ZIP code. Health centers use sliding fees based on income and family size.
- The West Virginia health centers map lists medical, dental, behavioral health, and other sites around the state.
- The state free clinic list can help uninsured adults find charitable care.
Ask the clinic whether it accepts uninsured patients, whether a sliding fee is available, what the first visit may cost, and what proof to bring. A sliding fee can lower a bill, but it does not always make care free.
Pregnancy, postpartum, and children’s care
Apply for coverage as soon as you know you are pregnant. Medicaid and WVCHIP maternity coverage can continue for 12 months after pregnancy for eligible members. The pregnancy and newborn guide covers more help with prenatal care, postpartum support, and newborn needs.
West Virginia’s maternal health programs include Right From the Start and other maternal and child services. Ask whether care coordination or home visiting is available in your county.
West Virginia WIC helps eligible pregnant, breastfeeding, and postpartum women, infants, and children under 5 with nutrition, breastfeeding support, healthy foods, and referrals. WIC is not insurance. Start at the West Virginia WIC page, then use the West Virginia WIC guide for practical next steps.
Children enrolled in Medicaid receive preventive screening and medically necessary follow-up through West Virginia’s HealthCheck program. Ask the child’s doctor about well visits, development, hearing, vision, dental care, vaccines, and any needed referrals.
For breast and cervical screening, the cancer screening program may help eligible low-income women who are uninsured or underinsured. Age, income, insurance, and medical rules apply.
Dental care and rides
Dental coverage
Medicaid members under 21 have broad dental benefits. Adults 21 and older have emergency dental care plus diagnostic, preventive, and restorative services. The current member guide says those adult non-emergency services may require prior approval and have a $2,000 limit per member per two fiscal years. Costs above the limit are the member’s responsibility.
Before treatment, ask whether the dentist takes your exact plan, whether prior approval is needed, how much of the benefit remains, and what you may owe. The West Virginia dental help page lists more ways to look for care.
Rides to covered care
Medicaid and WVCHIP members may use non-emergency medical transportation for covered care when they meet the trip rules. The official NEMT member page says Modivcare handles non-ambulance trips.
Call 1-844-549-8353 Monday through Friday, 7 a.m. to 6 p.m. Routine trips normally require five business days’ notice. Have the member ID, pickup address, provider address, appointment time, and any mobility needs ready. The transportation help guide covers other ride options.
Documents and details to gather
You can start before every paper is ready. Save a copy or clear photo of anything you send. Use the full documents checklist when you are applying for several programs.
| What to gather | Examples | Why it may be needed |
|---|---|---|
| Identity | Photo ID, birth certificate, school record | Shows who is applying. |
| West Virginia address | Lease, utility bill, shelter letter, mail | Helps prove state residence. |
| Household details | Names, birth dates, relationships, tax filing plan | Household rules affect eligibility. |
| Income | Pay stubs, employer letter, benefit notice, self-employment records | Programs count income in different ways. |
| Pregnancy | Clinic or doctor statement, expected due date | Pregnancy can change the coverage group. |
| Other insurance | Insurance card, employer offer, termination notice | Shows current or recent coverage. |
| Case notices | Denial, renewal, closure, proof request | Shows the reason and deadline. |
Common mistakes to avoid
- Do not assume a child is over income because an adult was denied.
- Do not ignore PATH messages, letters, texts, or email. A proof request may have a deadline.
- Do not report only take-home pay when the form asks for gross income.
- Do not schedule expensive dental or specialist care until the provider checks coverage and prior approval.
- Do not wait until the last day to request a routine medical ride.
- Do not cancel old coverage until you know the start date of new coverage.
If you are denied, delayed, billed, or closed
Read the whole notice. Find the reason, effective date, missing proof, and appeal instructions. Call the office and ask what facts were used. If the notice is wrong, follow the appeal steps before the deadline.
| Problem | First step | What to ask |
|---|---|---|
| Proof is missing | Call DoHS | What exact proof is missing, where do I send it, and what is the deadline? |
| Eligibility denial | Read appeal rights | How do I request a hearing, and can I submit more proof? |
| Service denied | Call the health plan | Was prior approval required, and how do I appeal? |
| Unexpected bill | Call the provider | Was the claim sent to the correct plan with the correct member number? |
| Coverage ended | Check renewal status | Can the case be reopened, or do I need a new application? |
The current Medicaid guide says you may appeal an application decision, an unreasonable delay, or a reduction, suspension, or termination of a covered service. The notice should explain the process. The benefits problem guide can help you organize your next steps.
Phone scripts
Calling DoHS
Hello, I applied for health coverage for my household. Please tell me the current case status, what proof is missing, where to send it, and the deadline. Can you also confirm my mailing address and phone number?
Calling a clinic
Hello, I do not have active insurance yet. Do you take uninsured patients? Do you use a sliding fee, what may the first visit cost, and what income papers should I bring?
Calling a health plan
Hello, I need an in-network provider for this type of care. Can you give me names of offices accepting patients and tell me whether I need a referral or prior approval?
Calling about a ride
Hello, I need transportation to a covered appointment. I have the member ID, pickup address, provider address, appointment time, and mobility needs ready. Can you help me schedule the trip?
Resumen en español
Si vive en West Virginia y necesita seguro médico, solicite Medicaid o WVCHIP por medio de WV PATH. Puede solicitar estos programas durante todo el año. Si está embarazada, informe el embarazo. Si su hijo necesita seguro, solicite aunque usted no califique. Si no tiene seguro ahora, llame a un centro de salud o clínica gratuita y pregunte por una tarifa según sus ingresos. Para una crisis de salud mental, llame o mande un texto al 988.
FAQ
Can single mothers in West Virginia get Medicaid?
Yes, when they meet a Medicaid coverage group and its rules. Income, household size, age, pregnancy, disability, residency, and other facts may matter. Apply and let DoHS make the decision.
Can my child get WVCHIP if I do not qualify?
Possibly. Children have different income rules from adults. WVCHIP may cover a child under 19 who is not eligible for Medicaid and meets the other program rules.
Can I apply for Medicaid or WVCHIP any time?
Yes. Medicaid and WVCHIP accept applications all year. The November 1 through January 15 period applies to Marketplace plans, not Medicaid or CHIP.
Does pregnancy coverage continue after birth?
Eligible Medicaid and WVCHIP maternity members can receive coverage through pregnancy and for 12 months after the pregnancy ends. Report the birth or pregnancy end promptly.
Can Medicaid or WVCHIP help with rides?
Yes, eligible members may receive non-emergency transportation to covered care. Routine rides normally require five business days’ notice, and trip rules apply.
What should I do after a denial?
Read the notice, check the reason and deadline, ask what proof was used, and follow the appeal or fair-hearing steps. Keep copies of everything you send.
About this guide
This guide uses official federal, state, local, and other high-trust nonprofit and community sources mentioned in the article.
A Single Mother is independent and is not a government agency, benefits office, lender, law firm, medical provider, or tax advisor.
Program rules, funding, local availability, and eligibility can change. Always confirm details with the official program before you apply or make decisions.
Verification: Last verified July 14, 2026, next review October 14, 2026.
Corrections: If you see something wrong or outdated, email suggestions@asinglemother.org.
Disclaimer: This article is for general information only. It is not legal, financial, medical, tax, immigration, disability, safety, or government-agency advice.