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Federal law now requires certain adults in the Medicaid members under the Adult Expansion Group to take part in work or community engagement activities unless they qualify for an exclusion or exception. These individuals were able to enroll in Medicaid through the Affordable Care Act and receive their benefits through Mountain Health Trust.

People must do one or more of the qualifying activities if they do not meet criteria for an exclusion or exception. The qualifying activities are:

• Working (paid, unpaid or in-kind) 80 hours a month OR have an income of at least $580 a month
• Participating in an approved work training program 80 hours a month
• Attending school, college, high school equivalency program (GED), trade program, at least half time. If less than half-time, the hours spent will count toward the 80 hours a month requirement.
• Volunteering doing community service 80 hours a month

OR a combination of any of the above activities that total 80 hours per month.

The start date is January 1, 2027.

However, Medicaid applicants who are affected may have to start meeting the requirements in the month prior to their application. For example, applicants for January 2027 may have to meet requirements in December 2026. 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.

No. Many people will be will qualify for an exclusion or exception, including parents, caregivers, people with disabilities, people in certain substance use or alcohol treatment programs, and pregnant women.

Adults who:

• Are 19–64
• Are not pregnant
• Are not disabled
• Are not on or qualify for Medicare
• Are a Medicaid member under the Adult Expansion Group

Some people will not need to meet the requirements if they qualify for an exclusion or exception.

If any of the following apply to you, you may soon be transitioning to a Medicaid member under the Adult Expansion Group and will also need to meet the Community Engagement requirements:

• 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 the youngest dependent turning 14

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.

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:
  • 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

Some members may qualify for Mandatory Exceptions, which 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

DoHS will automatically check your status to see if you qualify for an exclusion or exception and ask you for more information if needed.

You must report the change to DoHS. You can still meet the new rules with another qualifying activity (education, work training programs, or volunteer community service). If this situation applies to you, please see the Qualifying Activities section of the Resources page to find options for qualifying activities or contact your DoHS office.

You may qualify for an exclusion if you are medically frail and your condition affects your ability to work, go to college, attend certain job-training programs, or volunteer doing community service. The health issue must be severe and complex where it affects your ability to work, attend an educational program like college, do community service, or attend job training programs. For exclusions related to these kinds of health issues, you may need to answer some questions about your condition and/or ask for information from a doctor or provider if DoHS contacts you for more information.

Possibly. If the new requirements apply to you and you don’t meet them, your Medicaid coverage might end, or your application will be denied. You might be able to get health coverage through the Health Insurance Marketplace®, but you might not qualify for financial help to lower your monthly premium.

Visit the WV PATH Portal to make sure your contact information is correct and up to date.

Any of these:

• Being employed 80 hours a month
• Earning at least $580 a month
• Seasonal work (a job that happens only at certain times of the year, like farming or holiday jobs) where the income averages out to $580 a month.
• Unpaid or in-kind work. Some examples may include someone that is the building manager for an apartment complex and gets their rent free or reduced; an unpaid internship; unpaid on-the-job training that is required before employment begins.

Unpaid and in-kind work hours will need to be tracked and available if DoHS asks for more information.

No. Searching for a job only counts if it is part of an approved work program.

Volunteer community service work in your community for 80 hours a month counts if it is for direct benefit of the community. This activity must be done under the supervision of a public or nonprofit organization. The community service cannot be counted if it is for a partisan purpose. Details like hours spent volunteering, description of the activity, and the contact information of someone at the organization must be documented and provided to DoHS if requested. Volunteer West Virginia has information and resources on volunteer opportunities throughout the state.

You may:

• Lose Medicaid coverage
• Need to reapply
• Not qualify for certain tax credits

DoHS is using information it already has or getting access to information from other sources to determine if someone meets the requirements and who may meet an exclusion or an exception. If DoHS cannot make a decision using data they have, DoHS may request more information from members.

Yes. Report changes in: