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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.

Medically frail individuals are those with medical conditions that make it difficult to comply with community engagement requirements. This includes individuals who are blind or disabled; with disabling mental disorders; with substance use disorder and have been in recovery for less than five years; with serious or complex medical conditions; or with a physical, intellectual, or developmental disability that significantly impairs their ability to perform one or more activities of daily living.

If you have a history of substance use, you may be excluded from the community engagement requirement under one of the following two categories:

• Medical Frailty
  • You may qualify for a medical frailty exclusion if you have a substance use disorder (SUD) diagnosis and are within five years of recovery.

• Participating in an alcohol or drug addiction treatment program
  • You may qualify for an exclusion based on participation in a drug or alcohol treatment program if the program provides treatment that can lead to the rehabilitation of individuals struggling with substance use disorder at the time of your application or redetermination. Examples could include participating in intensive outpatient services and clinically or medically managed inpatient services, provided by community behavioral health centers or other approved providers.

If you lose Medicaid solely because you did not meet the community engagement requirements, you can reapply. You can do any of the four qualifying activities for 80 hours in the month prior to a new application. If you lose Medicaid because your income is too high, you may qualify for coverage through the Health Insurance Marketplace at Healthcare.gov. If you lose coverage because you were not compliant with the new rules, you can apply for marketplace coverage but will not be eligible for the tax credits to help pay the premiums for the marketplace insurance plan.

Yes, you have the right to appeal any Medicaid eligibility decision. If you do not agree with any decision, you may request a Fair Hearing and/or Pre-Hearing Conference within 90 days of the effective date of the action. If you wish to request continued benefits, you must ask for a Fair Hearing or Conference before the date of proposed closure or reduction. Continued benefits only apply to closures and decreases in benefits. The form to request a Fair Hearing and/or Pre-Hearing Conference is available on the denial or closure notice, but you may request it by phone or in person.

Legal Aid of West Virginia (1-866-255-4370) represents income-eligible residents in DoHS fair hearings.

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.

Members with seasonal income can meet the community engagement requirement by completing 80 hours in a month. Members can show they met this requirement by checking if their average monthly income over the past six months is at least $580 for the month. If you do not complete 80 hours of seasonal work, you can combine activities such as volunteering and school to reach the monthly total.

Self-employed individuals have often been required to report income to show financial eligibility. This income is reported on the application or redetermination form. You may be required to provide documentation, such as tax records, to verify this information. If that shows income of at least $580 in a month (through self-employment or other forms of employment), you are deemed compliant with the community engagement requirements. If you do not have income (including self-employment) of at least $580, you can provide documentation of hours worked. Many gig-work platforms provide records of both earnings and time logged on the platform.

For example:

• Jeff is self-employed and works odd jobs as a handyman. Jeff’s work hours vary from week to week. Jeff keeps track of his work and files his taxes as required. His monthly income is $590. Jeff meets community engagement requirements through his monthly income, which is over the $580 threshold.
• Rhonda provides a dog-walking service for 10 hours a week and makes $350. She also walks her landlord’s dog each day for a $300 reduction in her rent. Rhonda meets the Community Engagement requirements by combining her self-employed work with “in-kind” work for her landlord, which together is over the $580 threshold for her monthly income.

If you are enrolled in a college, career and technical education program, and are attending at least half-time, you may not need to do anything unless asked. Your information may be verified automatically. If the information can’t be verified electronically, you can prove that you meet the requirements by providing a transcript or school schedule showing half-time or full-time attendance. If you don’t attend at least half-time, education hours will still count toward the 80-hour requirements. If needed, you can also combine school with other activities, such as work or volunteering, to meet the monthly requirements.

Some examples of volunteering include:

• Volunteering at a food bank
• Mentoring or tutoring youth
• Supporting seniors through meal delivery
• Cleaning public parks or grounds

Volunteer work must be completed under the supervision of the organization. Attending community or school events, joining a club, or volunteering for a political candidate do NOT count toward the requirement.

Yes. Court-ordered community service still benefits the community and may be used toward the 80-hour community engagement requirements.

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: