West Virginia Medicaid Office

West Virginia Medicaid office (BMS)

West Virginia splits Medicaid responsibility across two bureaus inside the Department of Human Services (DoHS): the Bureau for Medical Services (BMS) writes policy and pays providers for Medicaid and the West Virginia Children's Health Insurance Program (WVCHIP), and the Bureau for Family Assistance (BFA) runs eligibility through the state's network of DoHS county offices. The two were a single agency — the Department of Health and Human Resources (DHHR) — until the 2024 reorganization that broke DHHR into DoHS and the Department of Health.

Where to call for what

BMS headquarters

BMS occupies Room 251 of the Capitol complex at 350 Capitol Street, Charleston, WV 25301. The bureau publishes provider manuals, Medicaid State Plan amendments, and the Mountain Health Trust managed-care contract documents on bms.wv.gov; apply-and-renew traffic moves through WV PATH, not through Charleston. Day-to-day intake — paper applications, change reports, in-person interviews — happens at the local DoHS office in each of West Virginia's 55 counties (the field-office map lives at dohs.wv.gov/field-offices).

Who qualifies for West Virginia Medicaid?

West Virginia is one of 41 states that accepted ACA Medicaid expansion. The agency tests eligibility month to month against federal income and household rules, and the program is structured around the same MAGI vs. non-MAGI split used in most states: MAGI categories (children, pregnancy, parents, expansion adults) ignore assets and run off the household tax-filing unit; non-MAGI categories (older adults, Aid to the Aged Blind and Disabled, long-term care) apply both an income and a resource test.

Who BMS covers

• Children under 19 — most through Medicaid; WVCHIP covers children whose family income is above the Medicaid threshold but still modest.
• Pregnant women and 12-month postpartum coverage — pregnancy MAGI category continues coverage through the year after delivery.
• Parents and caretaker relatives — low-income family category for adults caring for a child in the home.
• Adults 19–64 under the expansion category — covered up to 138% of the federal poverty level under the Alternative Benefit Plan.
• Aged, blind, or disabled adults — non-MAGI track; resource test still applies and SSI recipients are automatically eligible.
• Members enrolled in Medicare — Medicare Premium Assistance Programs (QMB, SLMB, QI-1) pay Part A/Part B premiums and cost-sharing depending on the tier.
• Long-term care and HCBS waiver applicants — separate financial and clinical tests; the applicant must require a nursing-facility level of care.

Renewals run every 12 months — and the state has to pace them

BMS confirms that most Medicaid and WVCHIP benefits renew on a 12-month cycle, with DoHS reaching members by mail, phone, and email. The state deliberately schedules renewal months across the year because CMS prohibits any state from running more than one-ninth of its Medicaid caseload through renewal in a single month — a guardrail that protects local offices from a renewal pile-up that could push members off coverage by paperwork failure rather than ineligibility.

If your coverage closes, you have 90 days to get it back

The BMS FAQ documents the federal reinstatement window: if a case closes during renewal and the member returns all required information within 90 days of the closure date, coverage can be reinstated without a fresh application as long as the member is still eligible. After 90 days the member has to reapply, and a coverage gap is likely.

Work requirements are coming

BMS posted a "New Community Engagement Requirements" banner on the bureau homepage. West Virginia is implementing a work or community-engagement requirement for a portion of the Medicaid population; the bureau directs members to its New Medicaid Rules Are Coming page for current rules and exemption categories before relying on a specific date.

West Virginia Medicaid income standards

BMS doesn't publish a consumer-facing income chart with current dollar figures on bms.wv.gov — eligibility budgets sit inside the Income Maintenance Manual maintained by the Bureau for Family Assistance, and they shift every January when the federal poverty level (FPL) updates. The percentages below are the structural FPL standards that the federal Medicaid statute and West Virginia's state plan use; the corresponding dollar figures change annually and are best confirmed by calling DoHS at 1-877-716-1212 or asking a local DoHS office.

FPL standards by category

Medicare Premium Assistance Programs

West Virginia's Medicare Premium Assistance Application gives BMS three tiers of help with Medicare cost-sharing — these have separate income and resource ceilings that are also published in the Income Maintenance Manual:

• Qualified Medicare Beneficiary (QMB) — pays Medicare Part A and Part B premiums plus copays and deductibles.
• Specified Low-Income Medicare Beneficiary (SLMB) — pays only the Medicare Part B premium.
• Qualified Individual (QI-1) — pays the Medicare Part B premium for members who do not have other Medicaid.

BMS recommends applying for QMB / SLMB / QI-1 using the Medicare Premium Assistance Application rather than the All-Programs Application, even though either form will work.

How to apply for West Virginia Medicaid

BMS recommends WV PATH for most applications. The state's online portal at wvpath.wv.gov screens for Medicaid, WVCHIP, SNAP, and TANF in a single submission and routes the case to the right DoHS bureau for processing.

Four documented application channels

• WV PATH (online) — the recommended method of application for most types of healthcare coverage. Create an account, complete the application, upload documents, check status, report changes, and renew through the same login.
• DoHS Customer Service Center — call 1-877-716-1212 to start an application, report a change, or ask about a pending case.
• Paper application by mail to your local county office — print, complete, and mail one of the BMS forms (listed below) to the DoHS office serving your county.
• In person at a local DoHS office — every county has at least one office; most local hospitals and primary care clinics also have staff trained to take applications on a member's behalf.

Which BMS paper form do you need?

If you cannot leave home

BMS lets disabled applicants request a home visit by an eligibility worker. Call your local DoHS office, or call the Office of Client Services toll-free at 1-800-642-8589 to arrange one.

If you already receive SSI

BMS flags this clearly: anyone receiving a check from Supplemental Security Income is automatically eligible for Medicaid and should receive a medical card from DoHS without filing a separate Medicaid application.

If Medicaid isn't a fit — the Marketplace handoff

Applicants found ineligible for Medicaid or WVCHIP have their application referred to the Federally Facilitated Marketplace; the Marketplace will send a notice with next steps. For free Marketplace enrollment help, BMS points members to the federal helpline at 1-800-318-2596 (TTY 1-855-4325) and to the WV Navigator program at (304) 356-5834. Federal Medicaid decision deadlines remain: up to 45 days for non-disability applications, up to 90 days for applications based on disability.

What West Virginia Medicaid covers

Almost every West Virginia Medicaid and WVCHIP member receives care through Mountain Health Trust, the state's managed-care program — now operated under the MAXCare brand by Maximus Customer Service Center as of July 1, 2025. The MCO assigns a primary care provider (PCP) at enrollment, and members can change the plan or the PCP at any time by calling MAXCare at 1-800-449-8466. A separate program — Mountain Health Promise — serves children and youth in foster care, kinship care, and adoption assistance under a single specialty MCO.

Auto-assignment and the 90-day change window

When DoHS approves Medicaid or WVCHIP, MAXCare auto-enrolls the member into a health plan and mails a welcome letter naming the plan. Members who would rather pick a different plan have 90 days from the start date of coverage to change without cause; after 90 days, plan changes generally require an annual open-enrollment window or a "with cause" reason. Coverage with the new plan begins the first day of the month after the change is processed.

Federally required Medicaid benefits

• Doctor, hospital, urgent-care, and emergency services
• Prescription drugs (covered by BMS for Mountain Health Trust members through a state Preferred Drug List)
• Lab work, X-rays, and diagnostic imaging
• Pregnancy care and 12 months of postpartum coverage
• Behavioral health, including outpatient counseling, inpatient psychiatric care, and substance use disorder treatment
• Family planning and reproductive health services
• Non-emergency medical transportation to covered appointments

West Virginia HealthCheck (EPSDT)

HealthCheck is West Virginia's name for the federal EPSDT mandate. Children under 21 enrolled in Medicaid or WVCHIP receive any medically necessary screening, diagnostic, or treatment service — including dental, vision, hearing, and behavioral health services that adult Medicaid does not always cover. BMS lists HealthCheck on the member hub alongside transportation, prior authorizations, and the tobacco cessation services benefit.

Specialty programs alongside managed care

• Mountain Health Promise — specialty MCO for children and youth in foster care, kinship care, and adoption assistance.
• Aged & Disabled, Traumatic Brain Injury, and Intellectual/Developmental Disabilities waivers — Home and Community-Based Services for members who meet a nursing-facility level of care but want to remain in the community.
• Substance Use Disorder Waiver — listed on the BMS homepage as an Office of Managed Care initiative.
• Alternative Benefit Plan — the benefit package for the Medicaid expansion adult group, with its own coverage chart published by BMS.

If you're already approved, don't lose the card

Members keep their state Medicaid ID card even after enrolling in Mountain Health Trust — both the state card and the MCO's plan-specific card need to be shown at each provider visit because some services (notably long-term services and supports) remain billed under fee-for-service Medicaid rather than the MCO.

Other state Medicaid pages