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.
This site explains the new Community Engagement requirements for West Virginia.
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:
We know this is a
big change
We’ve worked to make the information as clear as possible. We’re here to help!
We know this is a
big change
We’ve worked to make the information as clear as possible. We’re here to help!
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.
These activities are required for some adults to keep getting Medicaid through Mountain Health Trust. 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)
Those affected can meet the requirements by:
Completing a combined total of 80 hours or more per month of any of the following:
- Working
- Participating in a work program
- Attending school
- Volunteering
Enrolling in school (including higher education and career or technical education) at least half-time.
Earning at least $580 a month.
If work is seasonal, the average income over 6 months must equal or be over $580 a month. This amounts to at least $6,960/year.
You can mix and match activities to reach 80 hours per month
Examples might include:
Example 1
50 Hours: Working as a barista
30 Hours: Volunteering at a church food pantry
Example 2
Enrolled in a welding program at least half-time.
Example 3
72 Hours: Volunteering with a residential shelter
8 Hours: Grocery clerk
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. The new requirements will not apply to current Medicaid members until their regularly scheduled renewal in 2027, beginning with those due in March 2027.
Applicants may need to meet requirements one month before applying, for example, December 2026 for January 2027 coverage. The new requirements will not apply to current Medicaid members until their regularly scheduled renewal in 2027, beginning with those due in March 2027.
Who Is Affected?
The new Community Engagement requirements apply only to those in the Medicaid members under the Adult Expansion Group. These are adults between the ages of 19 and 64 who have a low income and get health insurance through West Virginia Medicaid. These individuals are not enrolled in Medicare, are not pregnant, and they must also be U.S. citizens or meet immigration rules.
“Low income” means earning less than about $21,610 a year for one person or $44,380 a year for a family of 4.
If you meet any of the following criteria, you may soon be transitioning to a Medicaid member under the Adult Expansion Group and may also need to meet the Community Engagement rules:
- Children who are turning 19
- Women in the 12-month postpartum period
- Those who aged out of foster care at age 18, up to age 21, and are turning 26
- Parent or caregiver with youngest dependent turning 14
Ways that you may be affected
Examples might include:
Example 1
I’ll need to enroll in Medicaid in 2027.
I might need to be working, volunteering, or enrolled in education to qualify for Medicaid.
Example 2
I’m due for Medicaid renewal in March 2027.
I might need to be working, volunteering, or enrolled in an education program for at least 80 hours in a month since my last renewal.
Example 3
I’m due for Medicaid renewal in December 2026.
I might need to be working, volunteering, or enrolled in education by May 2027 for my 6-month renewal in June.
Example 4
My youngest child just turned 14 and I am due for Medicaid renewal in March 2027.
I might need to be working, volunteering, or enrolled in education by February 2027.
Example 5
I was recently released from jail, and I am due for Medicaid renewal in October 2027.
I might need to be working, volunteering, or enrolled in education to qualify for Medicaid by September 2027.
Example 6
I was in foster care until I aged out at age 21, and am turning 27 in August 2027.
I might need to be working, volunteering, or enrolled in education to qualify for Medicaid by July 2027.
Exemptions
Who does not have to meet the community engagement requirements?
You may be exempt if you are:
- Under age 26 and aged out of foster care at age 18, up to age 21
- Recognized as an American Indian or Alaska Native and are eligible for Indian Health Service
- A parent or caregiver of:
- A child aged 13 and younger, or
- Someone with a disability
- A veteran with a total disability rating
- Medically frail or have serious health needs, such as:
- Blindness or disability
- Serious mental health conditions
- Substance use disorder
- Major physical or developmental disabilities
- Already meeting SNAP or TANF work requirements
- In drug or alcohol treatment
- Incarcerated or have been recently released (within 90 days)
- Pregnant or within 12 months after pregnancy (12 months post-partum)
DoHS will automatically check your status to see if you qualify for an exemption and ask you for more information if needed.
Short-Term Exception for Temporary Hardships
Some individuals may get a short-term exception from having to meet the Community Engagement requirements if something serious has happened, such as:
- Being in the hospital or a nursing home
- Needing to travel far for major medical care
- Living in a county with a declared emergency
You may need to tell DoHS if any of these apply to you.
Reporting Your Information
DoHS will look at the information it already has to see if you:
- Meet the Community Engagement requirements, or
- Qualify for an exemption
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
- School records
- Proof of volunteer hours or work 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 or job changes
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
