West Virginia State Medicaid Plan
Medicaid State Plan Under Title XIX of the Social Security Act Medical Assistance Program.
The West Virginia Medicaid State Plan is a comprehensive written document that describes
the nature and scope of the Medicaid program. It outlines current Medicaid eligibility standards,
policies, and reimbursement methodologies to ensure the state program receives matching
federal funds under Title XIX of the Social Security Act. This State Plan outlines how the
Medicaid program is implemented in West Virginia.
Approved State Plan Amendments will be posted as updates are made to the plan. An updated
plan will be posted at the beginning of each calendar year. The plan on this website is for
informational purposes only and is not legally binding.
Bureau for Medical Services
The Bureau for Medical Services (BMS) is the designated single state agency responsible for the administration of the State’s Medicaid program. BMS provides access to appropriate health care for Medicaid-eligible individuals.
Authorized under Title XIX of the Social Security Act, Medicaid is an entitlement program financed by the state and federal governments and administered by the states. The West Virginia Medicaid program is administered by the Department of Health and Human Resources (DHHR).
Federal financial assistance is provided to states for coverage of medical services for specific groups of citizens.
Mission Statement
The Bureau for Medical Services is committed to administering the Medicaid Program, while maintaining accountability for the use of resources, in a way that assures access to appropriate, medically necessary, and quality health care services for all members; provide these services in a user friendly manner to providers and members alike; and focus on the future by providing preventive care programs.
Eligibility For Medicaid
Determining Eligibility for Medicaid
Except in the case of pregnant women and children up to age 19 years, eligibility for Medicaid is based on categorical relatedness, income and assets.
Categorical relatedness means that an applicant must be a member of a family with a child who is deprived of support due to the absence, incapacity, or unemployment of a parent(s). If the applicant has no children under the age of 18, the individual must be age 65 or over, blind or disabled.
The Second factor considered is an applicant’s income and assets. Income is any money a family or individual receives such as wages, pensions, retirement benefits or support payments. Assets include money in the bank, property other than the homestead, and the cash or loan value of certain life insurance.
When applying for Medicaid, you will be asked about your income and assets you own. DHHR staff will inform you of any documentation needed at the time of your application.
The eligibility of pregnant women and children up to the age of 19 for Medicaid is determined solely on income. There is no asset test. Pregnant women must provide a medical statement confirming pregnancy.
What is “Spenddown”?
Individuals and families who are INELIGIBLE for medical assistance (Medicaid) at the time of application because of income higher than the “protected level” may become eligible under the “spenddown” process.
The process of subtracting your medical bill from your family income in order to become eligible for Medicaid is call “spenddown”. The month of application, plus five months, equals a period of spenddown consideration. You may use current payments OR the unpaid balance on “old” medical bills in order to meet spenddown and achieve eligibility at the earliest possible time
