Medicaid
Apply or Screen Online! | Report Your Changes OnlineMedicaid provides medical care in the community or in an institutional setting, such as a nursing home, to individuals who otherwise may not be able to afford the care. A variety of services are provided, according to state and federal guidelines, depending upon the individual or family circumstances. Recipients of Supplemental Security Income (SSI) automatically qualify for Medicaid. In addition, other individuals or families may apply for and receive Medicaid, if eligible and it is provided under a number of coverage groups. Medicaid is administered at the federal level by the Centers for Medicare and Medicaid Services (CMS) under the US Department of Health and Human Services.
There are many ways to qualify to receive Medicaid. Some of these coverage groups are mandatory ,i.e., required by CMS to be provided by each state, and some are optional. With the combination of the mandatory and optional coverage groups, and those for which West Virginia has received waivers from federal requirements, West Virginia offers coverage to a wide range of groups.
MEDICAID CITIZENSHIP AND IDENTITY REQUIREMENTS
Effective July 1, 2006, before an individual can receive Medicaid, he must provide proof of his U.S. citizenship and his identity. All Medicaid applicants or recipients will be asked to provide documents to verify U.S. citizenship and identity. If a person receives Medicaid, a reasonable amount of time will be given to show this verification at the time of his redetermination. Medicaid coverage will continue while the person obtains the documentation. The proof of citizenship must only be provided once.
The following documents listed are some of those you may use to prove citizenship and/or identity.
Proof of Citizenship and Identity (No other proof required):
- U.S. Passport; Certificate of Naturalization (N-550 or N-570); or
- A Certificate of Citizenship (N-560 or n-561).
Proof of Citizenship (Separate Proof of Identity Required):
- A U.S. public birth record;
- A final adoption decree; evidence of civil service employment;
- An official military record of service;
- or U.S. census records.
Proof of Identity:
- Driver’s license with a photograph or other identifying information;
- School Identification Card with a photograph;
- U.S. military card or draft record;
- ID card issued by the federal, state or local government with the same information listed on the driver’s license;
- Military Dependent’s ID card; or
- Native American Tribal document.
If you need more information about this requirement, you may contact your local DHHR office or Client Services toll free at 1-800-642-8589 or in Charleston at 304-558-2400.
COVERAGE GROUPS FOR FAMILIES AND CHILDREN
AFDC MEDICAID - Families and children who are considered deprived of parental support and care due to the absence, incapacity or unemployment of a parent(s). Income and assets must be under the limits for AFDC/U cash assistance which were in effect as of 7/16/96 . Asset limit is $1,000.
AFDC-RELATED MEDICAID - Families and children who are considered deprived of parental support and care due to the absence, incapacity or unemployment of a parent(s). If income or assets exceed the limits for AFDC Medicaid, the family may become eligible by incurring medical expenses which “spend down” its income to a Medically Needy Income Level. The asset limits are $2,000 for 1 person and $3,000 for 2. Above 2 persons, $50 is added to the limit for each person.
CHILDREN WITH DISABILITIES COMMUNITY SERVICES – A child with a disability who has been denied Supplemental Security Income (SSI) due to the excess income and/or assets of a parent(s) may qualify for Medicaid if the cost of care at home is less than the cost of institutionalization. The income limit is 300% of the current SSI level which is $1,869, effective January 2007. The asset limit is $2,000. Only the income of the child is counted.
POVERTY-LEVEL PREGNANT WOMEN AND INFANTS UNDER AGE ONE - Pregnant women and children under age one with family income at or below 150% of the current Federal Poverty Level (FPL). No asset test. Children born to Medicaid eligible mothers remain eligible for 1 year after birth without the need for a Medicaid application when the child remains in the home with the mother.
POVERTY-LEVEL CHILDREN AGES 1 - 5 - Children who were born on or after 10/1/83 and with family income at or below 133% of the current FPL. No asset test.
POVERTY-LEVEL CHILDREN AGES 6 - 18 - Children who were born on or after 10/1/83 and with family income at or below 100% of the current FPL. No asset test.
QUALIFIED CHILD - Children under age 19, regardless of birth date. Waivers allow West Virginia to disregard all income between the AFDC/U payment level as of 7/16/96 and 100% of the FPL + $1. Countable income cannot exceed the payment level of the AFDC/U program as of 7/16/96 . No asset test.
WV CHIP – Although WV CHIP is not a Medicaid coverage group, DHHR takes applications and determines eligibility for children who may qualify. The child must be under age 19 and family income must be at or below 200% of the current FPL. Additional information about WV CHIP is available online at www.wvchip.org/
COVERAGE GROUPS FOR ADULTS
SSI-RELATED MEDICAID - Aged, blind or disabled individuals who do not qualify financially for SSI, may qualify for this coverage group by “spending down” income to an established income level by use of incurred medical expenses. Assets must also be within established limits which are $2,000 for 1 and $3,000 for 2.
BREAST AND CERVICAL CANCER – Women who are diagnosed with breast or cervical cancer by a Centers for Disease Control (CDC) program may qualify for Medicaid coverage when certain other non-financial requirements are met. The individual must be under age 65 and cannot be enrolled in Medicare or have other creditable health insurance. If all requirements for the coverage group are met, there is no income or asset test.
QUALIFIED MEDICARE BENEFICIARIES (QMB) - Medicare recipients with income at or below 100% for the current FPL and assets no greater than $4,000 for 1 and $6,000 for 2 qualify for payment of the Medicare, Part B, premium and payment of Medicare co-payments and deductibles.
SPECIFIED LOW-INCOME MEDICARE BENEFICIARIES (SLIMB) - Medicare recipients with income over 100% and at or below 120% for the current FPL and assets no greater than $4,000 for 1 and $6,000 for 2 qualify for payment of the Medicare, Part B, premium.
QUALIFIED INDIVIDUAL 1 (QI-1) - Medicare recipients with income above 120% and at or below 135% for the current FPL and assets no greater than $4,000 for 1 and $6,000 for 2 qualify for payment of the Medicare, Part B, premium if the individual does not qualify for coverage under any other Medicaid group.
QUALIFIED WORKING DISABLED INDIVIDUALS (QDWI) - Former recipients of Social Security Disability benefits and Medicare, with earnings which exceed Social Security limits, may qualify for payment of the Medicare, Part A, premium if income is at or below 200% FPL and assets are below $4,000.
MEDICAID WORK INCENTIVE (M-WIN) - This Medicaid coverage group is for individuals who are disabled and are under age 65. Individuals who meet the Social Security disability requirement and who are employed may qualify when total gross income is at or below 250% FPL and when unearned income is at or below the current SSI Payment Level. The asset limit is $2,000 for an individual and $3,000 for an individual with a spouse, but the program provides more liberal asset disregards to help individuals qualify. The individual must pay a $50 enrollment fee and a monthly premium based on his income. Coverage may continue during some periods of temporary unemployment or when a disability condition improves.
MEDICAID COVERAGE FOR LONG TERM CARE
Online screening through inROADS!SSI-RELATED MEDICAID WHICH PAYS NURSING HOME CARE
This is Medicaid coverage which pays for care for aged, blind or disabled persons in a nursing home, as well as other medical expenses not covered by Medicare or other private health insurance. The individual must meet certain medical criteria, as well as the financial requirements listed below. Eligible individuals with income must contribute to the cost of care, but some allowance is permitted for the expenses of a spouse who remains in the community. In addition, some assets of the couple are protected for the community spouse and are not counted to determine eligibility for the individual in the nursing home.
INCOME LIMIT
300% of the Maximum SSI Payment for One Person – $1,869, effective January 2007. Persons with income in excess of the 300% limit may qualify for Medicaid payment if monthly nursing care costs exceed the Medicaid Medically Needy Income Limit and all other requirements are met.
ASSET LIMIT
- $2,000 Individual
- $3,000 Couple
HOME AND COMMUNITY BASED CARE FOR AGED, BLIND AND DISABLED INDIVIDUALS – HCB WAIVER
This Medicaid coverage pays for in home care for aged, blind or disabled persons who require the same level of care provided in a nursing home, but who chose to receive the care at home. The care may be directed by a case management agency or the individual himself. The individual must meet certain medical criteria, as well as the financial requirements listed below. Some assets of a couple are protected for the spouse who does not need nursing home or home and community based care and these assets are not counted to determine eligibility for the individual who needs care in the home.
INCOME LIMIT
300% of the Maximum SSI Payment for One Person – $1,869, effective January 2007
ASSET LIMIT
- $2,000 Individual
- $3,000 Couple
INTERMEDIATE CARE FACILITY/MENTAL RETARDATION – ICF/MR
This Medicaid coverage pays for institutional care for individuals who have mental retardation. The individual must meet certain medical criteria, as well as the financial requirements listed below. Eligible individuals with income must contribute to the cost of care.
INCOME LIMIT
300% of the Maximum SSI Payment for One Person – $1,869, effective January 2007. Persons with income in excess of the 300% limit may qualify for Medicaid payment if monthly cost of care in the facility exceeds the Medicaid Medically Needy Income Limit and all other requirements are met.
ASSET LIMIT
- $2,000 Individual
MENTAL RETARDATION/DEVELOPMENTAL DISABILITY – MR/DD WAIVER
This Medicaid coverage pays for in-home care for those with mental retardation or a developmental disability which could be provided in a medical or psychiatric hospital or nursing home. The individual must meet certain medical criteria, as well as the financial requirements listed below.
INCOME LIMIT
300% of the Maximum SSI Payment for One Person – $1,869, effective January 2007
ASSET LIMIT
- $2,000 Individual
