West Virginia Medicaid Income Limits

Updated August 2026

West Virginia expanded Medicaid under the ACA. The expansion added coverage for adults ages 19–64 who were previously ineligible, and it has driven West Virginia's high enrollment rate — nearly 36% of the state's population. Income limits vary by coverage group and, for children, by age.

West Virginia Medicaid income limits by coverage group (2026)

Coverage group	FPL %	Approx. monthly limit (household of 1)	Approx. monthly limit (household of 4)
Adults 19–64 (ACA expansion)	138% FPL	~$1,836/mo	~$3,795/mo
Children under 19 (Medicaid, age-tiered) + WVCHIP	138%–163% FPL (Medicaid); up to 300% FPL (WVCHIP)	Varies by age — see table below	Varies by age — see table below
Pregnant women	190% FPL	N/A — min. household size 2 (incl. unborn)	~$5,225/mo
Parents and caretaker relatives	Varies	Varies	—
Individuals with SSI / aged, blind, disabled	SSI-linked or medically needy	Varies	—

Adults 19–64 (ACA expansion)

FPL %: 138% FPL
Approx. monthly limit (household of 1): ~$1,836/mo
Approx. monthly limit (household of 4): ~$3,795/mo

Children under 19 (Medicaid, age-tiered) + WVCHIP

FPL %: 138%–163% FPL (Medicaid); up to 300% FPL (WVCHIP)
Approx. monthly limit (household of 1): Varies by age — see table below
Approx. monthly limit (household of 4): Varies by age — see table below

Pregnant women

FPL %: 190% FPL
Approx. monthly limit (household of 1): N/A — min. household size 2 (incl. unborn)
Approx. monthly limit (household of 4): ~$5,225/mo

Parents and caretaker relatives

FPL %: Varies
Approx. monthly limit (household of 1): Varies
Approx. monthly limit (household of 4): —

Individuals with SSI / aged, blind, disabled

FPL %: SSI-linked or medically needy
Approx. monthly limit (household of 1): Varies
Approx. monthly limit (household of 4): —

West Virginia children's coverage by age: Medicaid and WVCHIP

West Virginia's children's Medicaid income limit is tiered by age, and WVCHIP (the state's separate CHIP program) extends coverage further for families whose income is too high for Medicaid. Figures below are the Bureau for Medical Services' published 2026 guidelines.

Age group / program	FPL threshold	Annual limit (household of 1)	Annual limit (household of 4)
Children ages 0–1 (Medicaid)	163% FPL	$26,016/yr	$53,796/yr
Children ages 1–6 (Medicaid)	146% FPL	$23,304/yr	$48,180/yr
Children ages 6–19 (Medicaid)	138% FPL	$22,032/yr	$45,540/yr
WVCHIP (top tier, Premium Plan)	Up to 300% FPL	—	$99,000/yr

Children ages 0–1 (Medicaid)

FPL threshold: 163% FPL
Annual limit (household of 1): $26,016/yr
Annual limit (household of 4): $53,796/yr

Children ages 1–6 (Medicaid)

FPL threshold: 146% FPL
Annual limit (household of 1): $23,304/yr
Annual limit (household of 4): $48,180/yr

Children ages 6–19 (Medicaid)

FPL threshold: 138% FPL
Annual limit (household of 1): $22,032/yr
Annual limit (household of 4): $45,540/yr

WVCHIP (top tier, Premium Plan)

FPL threshold: Up to 300% FPL
Annual limit (household of 1): —
Annual limit (household of 4): $99,000/yr

No asset test for MAGI-based West Virginia Medicaid

MAGI-based West Virginia Medicaid — covering adults under the expansion, children, and pregnant women — has no asset test. Savings, vehicles, and home equity are not counted. This applies to all ACA expansion coverage.

Long-term care Medicaid programs (nursing facility care and HCBS waivers for elderly and disabled individuals) operate under a different standard. These programs have an asset limit and use spousal impoverishment protections from federal law (42 U.S.C. § 1396r-5) when one spouse enters a nursing facility.

West Virginia operates a Medicaid estate recovery program. The state may seek reimbursement from the estates of members who received nursing facility or certain long-term care services at age 55 or older. West Virginia's 60-month look-back period for asset transfers applies to long-term care applications. Consult a West Virginia-licensed elder law attorney before making asset transfers.

West Virginia's pregnant women coverage — 190% FPL

West Virginia covers pregnant women and their newborns at 190% FPL. Because the household size includes the unborn child, a pregnant woman applying alone is counted as a household of two — income up to $41,124/year ($3,427/month) in 2026 qualifies. A pregnant woman with income between 138% and 190% FPL qualifies through this pregnancy-specific threshold rather than the adult expansion category. Coverage continues for 12 months postpartum. If income exceeds 190% FPL, marketplace coverage with premium tax credits may be the next option. West Virginia DHHS can help screen for eligibility at 1-877-716-1212.

Medicare Savings Programs (QMB) in West Virginia

West Virginia has one of the highest Medicaid enrollment rates in the country, and that reach extends to Medicare beneficiaries too, through three Medicare Savings Programs (MSPs) administered by the Bureau for Medical Services (BMS) rather than Medicare itself. These use their own income limits, separate from the expansion, children's, and pregnancy limits described above.

Program	Situation	Monthly income limit
QMB	Individual	$1,350
QMB	Married couple	$1,824
SLMB	Individual	$1,616
SLMB	Married couple	$2,184
QI	Individual	$1,816
QI	Married couple	$2,455

QMB

Situation: Individual
Monthly income limit: $1,350

QMB

Situation: Married couple
Monthly income limit: $1,824

SLMB

Situation: Individual
Monthly income limit: $1,616

SLMB

Situation: Married couple
Monthly income limit: $2,184

QI

Situation: Individual
Monthly income limit: $1,816

QI

Situation: Married couple
Monthly income limit: $2,455

Qualified Medicare Beneficiary (QMB) is the most complete tier: it pays the Part A premium for those who owe one, the full $202.90 monthly Part B premium in 2026, and every Medicare deductible, coinsurance, and copayment. Federal law prohibits any provider from billing a QMB enrollee for these costs, a rule that holds statewide regardless of whether the provider participates in West Virginia Medicaid.

Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) enrollees receive help with the Part B premium only. QI operates on a capped annual federal allotment awarded first-come, first-served, and enrollees must reapply every year — West Virginians near the QI income limit should apply as early in the year as they can. All three MSP tiers bring automatic Extra Help enrollment, which limits 2026 covered-drug costs to $12.65 per prescription.