Understanding the Changes Coming to Medicaid

What you need to know
and what to expect

This site explains the new Community Engagement requirements for West Virginia.

Woman using a drill press Woman using a drill press

This site explains the new Work and Community Engagement rules for West Virginia adults in the Medicaid Expansion group.

The West Virginia Department of Human Services (DoHS) wants to help you understand:


What the new rules are
Whether they apply to you
What you need to do to keep your Medicaid coverage

We know this is a 
big change

We’ve worked to make the information as clear as possible. We’re here to help.

Chicken Farmer Chicken Farmer
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What Are the Community Engagement Requirements?

In July 2025, the federal government passed H.R.1, or the “The One Big Beautiful Bill Act,” which requires certain Medicaid members under the Adult Expansion Group to complete at least 80 hours of work or approved community activities per month unless they qualify for an exclusion or exception.

These activities are required for some adults to keep getting Medicaid through Mountain Health Trust. These individuals were able to enroll in Medicaid through changes made by the Affordable Care Act. If you receive your Medicaid through the Mountain Trust Health, your healthcare services are provided through one of the following managed care organizations:

  • Aetna Better Health of West Virginia
  • Highmark Health Options
  • The Health Plan of West Virginia
  • Wellpoint West Virginia (formerly UniCare)
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Those who do not qualify for an exclusion or exception can meet the requirements by:

Completing 80 hours per month of any of the below activities or a combination of them:

  • Working (paid, unpaid or in-kind) or have an income of at least $580 per month
  • Participating in an approved work training program
  • Attending school, college, high school equivalency program (GED), trade program, at least half-time
  • Volunteering doing community service

Enrolling in school (including higher education, high school, GED, and career or technical education or trade/skill programs such as welding, cosmetology, etc ) at least half-time

If you are less than half-time, the hours in educational activities will still count towards the 80-hour requirement.

Seasonal workers’ average income over 6 months must equal or be over $580 a month. This amounts to at least $6,960/year.

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You can mix and match activities to reach 80 hours per month

Examples might include:

Example 1

I spend 80 hours each month helping at a local food bank through its volunteer program. My Medicaid is due for renewal in May 2027.  

I meet the requirements. I will need to continue to volunteer, or I need to be working or enrolled in education during the next review period, to continue to receive my benefits.

Student

I am a full-time high school student graduating in May 2027 and am starting school full-time again in August 2027.

I already meet community engagement requirements through enrollment in a qualifying educational program at least half-time.

Career and Technical Education Student

I am enrolled full-time in a two-year welding program at a technical college. I am due for Medicaid renewal in December 2027. I graduate in May 2028.  

I meet the requirements for this renewal period. I will still meet the requirements for my June 2028 renewal, but will need to be working, volunteering, attending a work training program, or enrolled in education for my December 2028 renewal.  

Self-employed

I own a small landscaping business and am self-employed. I work approximately 90 hours in March 2027 but earn only $400 that month. I am due for Medicaid renewal in May 2027. 

Since I am working over the 80 hours required per month, I will be compliant with the new rules at the time of my renewal. 

In-Kind Work 

I manage the property where I live in exchange for reduced rent. I spend approximately 85 hours each month cleaning common areas, maintaining the property, and performing other duties. I am due for Medicaid renewal in June 2027.  

I meet the requirements for my review period. I should keep a record of my hours doing this unpaid work in case I need to provide additional information if I am asked by the DoHS.

GED Program

I do not have a high school diploma and am enrolled in a state-approved GED program. I attend the program full-time and am due for Medicaid renewal in August 2027. 

I already meet the community engagement requirement through enrollment in a qualifying high school equivalency program at least half-time. I may need to be working, volunteering, attending a work training program, or enrolled in education to meet the requirements in the future.

When do the new rules start?

January 1, 2027

Applicants may need to meet requirements one month before applying, for example, December 2026 for January 2027 coverage. Current members with March 2027 renewals will need to complete at least 80 hours of work or other approved activities (or a combination of activities) to keep their coverage or meet an exclusion or exception for all or part of at least one month since their last renewal. Beginning in January 2027, renewals for some members will also be scheduled more often – every six months rather than every 12 months.

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Who Is Affected?

Volunteers packaging canned food items.

Ways that you may be affected

Examples might include:

Former Foster Care

I was in foster care until I aged out at age 21, and I am turning 26 in August 2027.

I am excluded from the requirements at this time. I might need to be working, volunteering, or enrolled in education by January 2028 for my 6-month renewal in February.

Recently Incarcerated

I was released from jail in September 2027, and I am due for Medicaid renewal in October 2027.

I am excluded from the requirements at this time. I might need to be working, volunteering, or enrolled in education by March 2028 for my 6-month renewal in April.

Caretaker Relative

I provide regular care to my 72-year-old mother, who has a disability and needs help with daily activities such as bathing, dressing, and preparing meals. I am due for Medicaid renewal in September 2027.

I am excluded from the requirements while I am providing regular care to my mother. If circumstances change, I might need to be working, volunteering, attending a work training program, or enrolled in education in the future.

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Exclusions & Exceptions

Van Driver

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Reporting Your Information

Warehouse Worker

DoHS will look at the information it already has to see if you:

  • Meet the Community Engagement requirements, or
  • Qualify for an exclusion or exception

If DoHS needs more information, you will get a request in writing by U.S. Mail, or online in your PATH account if you choose to go paperless. DoHS may ask for:

  • Pay stubs
  • Records of the number of hours of unpaid or in-kind work
  • Education information about the number of hours attending a program
  • List of volunteer hours, name of the organization where you did the community service, types of activities you did, contact name and phone number of someone at the organization who can verify your community service hours
  • Work training program hours

You can send this information online, in person, or by mail.

If DoHS asks for information, you must respond within 30 days, or you may lose your Medicaid coverage.

If you are not contacted, you do not need to send anything.

How to Report Changes or Update Your Information

You must tell DoHS if anything changes, such as:

Income, job changes, or education enrollment
New address
Someone moving in or out of the home
Marriage, divorce, pregnancy, or adoption

You do not need to do anything today. But if DoHS asks for information, or if you need to report a change, you can contact the Customer Service Reporting Center:

  • By phone: 1-877-716-1212
  • By e-mail: osacsrc@wv.gov
  • By fax: 304-558-1869
  • By mail (U.S. Postal Service): P.O. Box 1668, Charleston, WV 25326-1668

You can also report changes, apply for benefits, and complete reviews at www.wvpath.wv.gov.

Find your local office at https://dohs.wv.gov/field-offices

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