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 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)
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.
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.
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 must also be U.S. citizens or meet immigration rules. Certain people may qualify for exclusions or exceptions (see below list for more information) and not have to comply with the new rules.
“Low income” means earning less than about $22,025 a year for one person or $45,540 a year for a family of four.
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
- People turning 26 who have aged out of foster care
- Parent or caregiver with youngest dependent turning 14

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.
Exclusions & Exceptions

Who does not have to meet community engagement requirements?
Some individuals are excluded from the community engagement requirements. Individuals who meet an approved exclusion are not required to meet the community engagement requirement as long as their exclusion is present for all or part of at least one month of a renewal period.
Exclusions
Specified Exclusions excuse members from having to meet the requirements. Exclusions may apply to members who:
- Are pregnant now or were pregnant within the last 12 months
- Are a parent, guardian, family caregiver, or caretaker relative of a child under the age of 14 or someone of any age who is disabled
- Are 19 to 25 and have aged out of foster care
- Are in a drug or alcohol treatment program from certain types of healthcare providers
- Are an American Indian or Alaska Native
- Are a veteran with a total, or 100%, disability rating as determined from the VA
- Are a member of a household that gets SNAP (food assistance) and are subject to SNAP work requirement rules
- Get TANF/WVWORKS (cash assistance) and already meet their work requirement rules
- Are in jail or prison when it’s time to renew
- Have a medically frail condition or health needs that prevent the person from working or participating in the other community engagement activities (education, working, training programs, community service). Those conditions include having:
- Blindness or disability
- Physical, cognitive, or developmental disabilities that make daily tasks hard
- Serious or complex health conditions that require regular care
- Disabling mental health conditions such as schizophrenia, or major depression
- Substance use disorder and have been in recovery for less than five years
Exceptions
Exceptions may fulfill the community engagement requirement for the months that they apply to you. Members may qualify for an exception if they:
- Are under 19 years old
- Were an inmate (in jail or prison) at any point within the three months prior to the application or renewal
- Qualify for Medicare Part A or are enrolled in Medicare Part B
- Qualify for Medicaid under a mandatory coverage group sometime known as traditional Medicaid for example, low-income children, etc.
Beginning in January 2027, renewals for some members will be scheduled more often – every six months rather than every 12 months.
DoHS will automatically check your status to see if you qualify for an exclusion or exception and ask you for more information if needed.
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 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





