West Virginia Medicaid Application

In 2014, Medicaid covered 29 percent of the people of West Virginia’s inhabitants. This figure was up from 21 percent in the prior year. In May 2013, Governor Earl Ray Tomblin chose to expand Medicaid, providing protection to approximately 91,500 working residents in the state. The movement to expand Medicaid cut the number of uninsured residents from 12 percent to 6 percent following the expansion.

West Virginia Medicaid gives low income residents the opportunity to seek medical attention through the use of a medical card supplied to them. In order to apply for Medicaid insurance coverage, residents may use the WVInRoads system. Under the Affordable Care Act, West Virginia received federal funding beginning in 2014 to pay for the costs of recently covered residents, many of which were functioning full-time, but without the alternative for employer-sponsored health insurance coverage.

Due to the new guidelines for eligibility, between 2013 and 2015, the state saw an increase in Medicaid enrollment of approximately 193,000 residents. In 2017, the state will begin paying some of the costs to provide medical benefits to its own residents, but this figure won’t go over 10 percent.

As of April 2016, the total monthly Medicaid and CHIP enrollment reached 568,478 residents.

What is Covered Under Medicaid

Under West Virginia Medicaid, the following services are available for covered individuals and families:

Who’s Covered Under Medicaid

West Virginia Medicaid offers health insurance coverage for the following groups of people:

• Aged, blind, and disabled individuals
• Adults with incomes that are up to 138 percent of the federal poverty level
• Children in households earning 300 percent of the federal poverty level are CHIP eligible
• Pregnant women with earnings of up to 158 percent of the federal poverty level
• Social Security Income beneficiaries
• Medically needy individuals
• Children under the age of 19

Eligibility for coverage under the Medicaid program is largely dependent on your medical needs and level of income.

How to Apply for Medicaid Coverage

In order to apply for coverage under the Medicaid program in West Virginia, residents can use the InRoads website. Persons already receiving SSI benefits are automatically eligible for coverage under Medicaid and aren’t required to fill out an application.

Residents can also apply for Medicaid benefits using the healthcare.gov site. Applications can also be obtained by calling the Federal Call Center at 1-800-318-2596.

In order to get help with the application process, residents can contact 1-877-716-1212 or use the state’s InRoads website to get more information. Completed and signed applications can be mailed to the local county office discovered using the state’s site.

After the Medicaid Application

In the event you qualify for Medicaid coverage, you will be sent a notification letter stating your eligibility or if the local office requires more information from you in order to create a decision. If approved, you’ll be given a medical card at around the beginning of each month. Keeping all appointments with the Department of Health and Human Resources (DHHR) will make certain that your benefits won’t stop during the times that you remain eligible for coverage.

Approved applicants are required to present their medical cards to medical service providers at the time of service. This requirement is in addition to any other medical cards that you might have, public or private.

If your card is lost, you’re responsible for notifying your county DHHR office so as to receive a replacement card.

Hearings on Application Decisions

Appeals can also be available for people who feel that their applications for coverage were not handled within a reasonable time period. In the event that you feel that you have been treated unfairly regarding the application process, you can direct an appeal to your county’s DHHR office.

Appeals also apply to those who have had their benefits cut, reduced, or terminated for any reason. Through a reasonable hearing, you have the right to appeal any denial or reduction decision. If you are denied Medicaid benefits, you will be given a letter notifying you of this explanation and a form which could be used to start the appeal process.

In case you have an excessive amount of medical bills, but your income exceeds the required thresholds, you may nevertheless be approved for Medicaid benefits. You can ask your representative in the DHHR office in order to ascertain your eligibility for coverage.