West Virginia Medicaid Application
In 2014, Medicaid covered 29 percent of the people of West Virginias inhabitants. This figure was up from 21 percent in the prior year. In May 2013, Governor Earl Ray Tomblin chose to expand Medicaid, providing protection to approximately 91,500 working residents in the state. The movement to expand Medicaid cut the number of uninsured residents from 12 percent to 6 percent following the expansion.
West Virginia Medicaid gives low income residents the opportunity to seek medical attention through the use of a medical card supplied to them. In order to apply for Medicaid insurance coverage, residents may use the WVInRoads system. Under the Affordable Care Act, West Virginia received federal funding beginning in 2014 to pay for the costs of recently covered residents, many of which were functioning full-time, but without the alternative for employer-sponsored health insurance coverage.
Due to the new guidelines for eligibility, between 2013 and 2015, the state saw an increase in Medicaid enrollment of approximately 193,000 residents. In 2017, the state will begin paying some of the costs to provide medical benefits to its own residents, but this figure wont go over 10 percent.
As of April 2016, the total monthly Medicaid and CHIP enrollment reached 568,478 residents.
What is Covered Under Medicaid
Under West Virginia Medicaid, the following services are available for covered individuals and families:
Whos Covered Under Medicaid
Dual Eligible Medicare And Medicaid Plans In West Virginia
If you are eligible for West Virginia Medicaid and are also over the age of 65, diagnosed with ALS or ESRD, or have been receiving SSDI for at least 25 months, you may be dual eligible. Dual eligibility means that you can obtain coverage from both Medicaid and West Virginia Medicare. Dual eligible beneficiaries usually qualify for a special enrollment period, which means you can enroll in a dual-eligible special needs plan during any time of year.
Dual eligible special needs plans, or DSNPs, are a form of Medicare Advantage, a type of Medicare plan that provides extra benefits like dental, vision, hearing, and more to those who qualify. Through a West Virginia DSNP plan, you can have all of the major benefits you need at little or no cost. To find out if you qualify and for help selecting a DSNP plan, contact Medicare Plan Finder at 833-438-3676.
West Virginia Medicaid Mailing Address
West Virginia Medicaid Street: PO Box 3767State: West VirginiaZip Code: 25337-3767
Apply-for-Medicaid-Online.com is a leading hub that provides the best and most updated information for West Virginia Medicaid and West Virginia state health insurance.
Our users may find new information for West Virginia Medicaid and West Virginia state health insurance, and usually share it with us, helping us help other users. If you find new data for West Virginia Medicaid, we would appreciate if you dropped us a quick message via the contact us page form or the comments form below.
We always make sure to confirm any new information as soon as it is released and publish it for free for the benefits of you and all users who wish to apply to West Virginia Medicaid and West Virginia state health insurance.
This Apply-for-Medicaid-Online.com website was created as a completely independent website that is not affiliated with West Virginia Medicaid, West Virginia state health insurance or any state or federal office, department, agency, board, or commission.
State: West Virginia
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How To Apply For Medicaid
Enter your zip code to get started.
DHHR is dedicated to providing the Medicaid programs while keeping a good balance between the resources and number of applicants. The purpose is to provide appropriate medical programs and quality of health care services to all West Virginians.
Under the Medicaid program, the health insurance is offered to Supplemental Security Income beneficiaries, Children not above 18 years of age, families with low income, senior citizens, legally blind and people with certain disabilities.
Unitedhealthcare Senior Care Options Plan
UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.
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You Have Chosen To Enroll In
- What is D-SNP?
A dual eligible plan is a type of health insurance plan for people who have both Medicaid and Medicare. It works together with your Medicaid health plan. You’ll keep all your Medicaid benefits. Most dual plans also give you more benefits and features than you get with Original Medicare. All for a $0 plan premium.
- Who is eligible?
You must be eligible for Medicare and have full Medicaid coverage in one of the following categories: FBDE, QDWI, QI, QMB, QMB PLUS, SLMB, SLMB PLUS
Are you 65 years or older but dont qualify? Find Medicare Advantage, Medicare Supplement or Prescription Drug Plans at uhc.com/medicare
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The Medicare Annual Enrollment Period happens once a year in the fall. If you qualify for a dual eligible plan, you may not have to wait.
You may be able to enroll right away if you
- Are 65 and newly eligible for Medicare or have a qualifying disability
- Are retiring and losing your current coverage
- Have moved out of your current Medicare plan’s service area
- Have a chronic condition like diabetes or chronic heart failures
- Receive Medicaid benefits
Looking for the federal governments Medicaid website? Look here at Medicaid.gov.
What Is West Virginia Medicaid Fax Number
West Virginia Medicaid fax number where you can send fax messages including application forms for West Virginia state health insurance is 866-521-6882.
Are you looking for additional information for West Virginia Medicaid and West Virginia state health insurance? Do you need any assistance with West Virginia Medicaid? Please contact us and we will be happy to help you with any Medicaid application related matter.
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You May Qualify For A Dual Health Plan If:
- You are under age 65 and qualify on the basis of disability or other special situation OR you are at least 65 years old and receive extra help or assistance from your state.
- You’re a U.S. citizen or a legal resident who has lived in the U.S. for at least five consecutive years.
- You live in the plan’s service area.
Before selecting a specific dual health plan, review the plans full or partial Medicaid coverage requirements.
Behavioral Health Homes In West Virginia
The first WV Health Home started in July of 2014 in southern West Virginia. It is a Behavioral Health Home with a focus on bipolar WV Medicaid beneficiaries who have a high risk of developing Hepatitis B or C. There are now Behavioral Health Homes available all across the state of West Virginia.
The Behavioral Health Home provides individualized, well-managed treatment options. West Virginia Behavioral Health Homes coordinate care by referring you to the best community and social support services , promoting a healthy lifestyle, and providing transitional care for when you are transitioning between providers or moving from a facility back to your home. Health Home services come at no cost to eligible Medicaid beneficiaries.
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Unitedhealthcare Connected General Benefit Disclaimer
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.
You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.
Language Line is available for all in-network providers.
Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.
Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.
Expansion Under The Affordable Care Act
As of March 2022, 38 states and the District of Columbia have accepted the Affordable Care Act Medicaid extension 12 states have not. Among adults aged 18 to 64, states that expanded Medicaid had an uninsured rate of 7.3% in the first quarter of 2016, while non-expansion states had a 14.1% uninsured rate. Following a 2012 Supreme Court ruling, which held that states would not lose Medicaid funding if they did not expand Medicaid under ACA, several states rejected the option. Over half the national uninsured population lives in those states.
The Centers for Medicare and Medicaid Services estimated that the cost of expansion was $6,366 per person for 2015, about 49 percent above previous estimates. An estimated 9 to 10 million people had gained Medicaid coverage, mostly low-income adults. The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered in states that rejected the Medicaid expansion.
Studies of the impact of Medicaid expansion rejections calculated that up to 6.4 million people would have too much income for Medicaid but not qualify for exchange subsidies. Several states argued that they could not afford the 10% contribution in 2020. Some studies suggested that rejecting the expansion would cost more due to increased spending on uncompensated emergency care that otherwise would have been partially paid for by Medicaid coverage,
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West Virginia Medicaid Expansion
With the Affordable Care Act in 2010 came a major West Virginia Medicaid expansion that resulted in a 21% decline in the amount of uninsured West Virginians. The expansion allowed people living at up to 138% of the Federal Poverty Level to have access to Medicaid . This allows people who are employed and earning too much to qualify for Medicaid but still not making enough to cover healthcare to have coverage.
The Wv Medicaid Formulary And Prescription Drug Coverage
The West Virginia Medicaid program has a comprehensive prescription drug program. The drugs on the preferred drug list will act as your formulary. Youll also find information about prior authorization, meaning that there are certain drugs that you will need to have Medicaid approve before you retrieve your prescription at the Medicaid rate.
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Where Do You Sign Up For Medicaid In Virginia In Person
For candidates wondering where to apply for Medicaid in West Virginia when in-person help is needed, there is assistance available. Begin by printing out Medicaid application forms in West Virginia online if there is a working computer with internet access nearby.
Applicants can choose to fill out an application for Medicaid as much as or as little as they would like based on the amount of assistance required. Be sure to prepare the Medicaid application required items. Then, locate the nearest West Virginia Department of Health and Human Resources online. Next, phone the office to check when the ideal time is for a visit.
When applicants arrive at a nearby DHHS office, simply request assistance with health care paperwork, and ask the necessary questions. When finished, reviewed and signed, hand in Medicaid applications to a local worker for processing, or feel free to mail them personally. Note that to apply for Medicaid by mail can take some extra time, as applicants must account for mail transmission as well as sorting prior to being vetted.
Mountain Health Trust And The West Virginia Health Bridge Alternative Benefit Plan
Mountain Health Trust and the West Virginia Health Bridge Alternative Benefit Plan are the managed care organizations for the West Virginia Medicaid program. Once accepted into the program, you will receive a packet in the mail which will tell you which MCO program you are in. The main differences between the two programs are a few coverage limits. For example, the Health Bridge program does not include nursing home coverage and has a limit of 24 chiropractic treatments per year. On the other hand, the Health Bridge program allows for 30 physical and occupational therapy visits per year instead of the traditional 20, and 100 home health visits instead of 60. Whichever program you qualify for, you will receive detailed information about your coverage limits in the mail upon your acceptance.
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Unitedhealthcare Dual Complete Plans
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711, or use your preferred relay service for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
West Virginia Medicaid Office
Below is the contact information for the Medicaid office in West Virginia. They can assist you with questions or concerns about the West Virginia Medicaid program, including the eligibility requirements and Medicaid enrollment in West Virginia. You can view their site online at dhhr.wv.gov/bms/Pages/default.aspx. To find out if you are eligible for this program, West Virginia Medicaid eligibility.
The Medicaid program in West Virginia covers basic medical care. This may include doctor services, inpatient hospital care, laboratory and x-ray services, inpatient short-term skilled nursing or rehabilitation-facility care, outpatient hospital or clinic care, short-term home healthcare, ambulance service and prescription drugs for people not covered by Medicare. We suggest contacting the Medicaid office to find out specifically what coverage is provided as it can be different in each state.
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How To Apply For Medicaid Online In West Virginia
Online Medicaid applications are popular in West Virginia and other U.S. states due to their convenience. To apply for Medicaid online, candidates must have access to a working computer with an internet connection and an updated web browser. An online application for Medicaid can be accessed through the inROADS portal in West Virginia. To start the process, applicants must create a new account. In order to do so, follow these five steps:
- Enter full name and date of birth
- Create a user ID and a password
- Select a total of two secret questions and accompanying answers
- Provide an email address or a phone number
- Electronically sign the User Acceptance Agreement
The Medicaid application process can ensue once an inROADS account is activated. Apply for Medicaid by entering all of the required information asked. Do not skip any sections, and be as comprehensive as possible. For any questions, dial the inROADS customer service line.
For those skeptical about filing an online application for Medicaid, the West Virginia Department of Health and Human Resources assures users that the inROADS portal is secure and that all information is kept private throughout the process.
Discover all of the steps you must take when applying for Medicaid by .
What Is West Virginia Medicaid Number
West Virginia Medicaid number where you can call and speak to West Virginia state health care agent regarding West Virginia Medicaid Application is .
West Virginia Medicaid hours of operation regarding West Virginia Medicaid Application are Monday through Friday, from 8:30 am to 4:30pm, closed on State holidays, but the best calling hours for West Virginia Medicaid to call regarding West Virginia Medicaid Application are 11:00 am to 3:00 pm.
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West Virginia Consumer Assistance
West Virginia no longer operates a Consumer Assistance Program under the Affordable Care Act, however, the West Virginia Offices of the insurance Commissioner continues to provide assistance to consumers with health insurance questions or problems. You can contact them at 1-888-879-9842.
The agencies listed below can help you take advantage of some of these protections and benefits and they can answer your questions about different types of coverage.
If you need health insurance, be sure to check out HealthCare.govs Plan Finder. It will help you find and compare health care coverage options in your area.
If you have questions about insurance you bought for yourself and/or your family, or you have insurance provided by an employer who does business only in West Virginia, contact:
West Virginia Department of InsuranceWest Virginia Lottery Building
The Cost Of West Virginia Medicaid
Some beneficiaries will be charged small co-payments for some services*. Pregnant women, kids under 21, and Native Americans are exempt from co-payments. There are no co-payments required for long-term care, hospice, family planning, breast and cervical cancer treatments, or emergency services. Co-payments will never exceed 5% of your household income. They usually range between $0 and $4 for doctor or specialist services and up to $75 for hospital services.
There are out-of-pocket maximums based on your income and the Federal Poverty Level :
- Tier 1: Up to 50% of the FPL Max $8 out-of-pocket
- Tier 2: 50-100% of the FPL Max $71 out-of-pocket
- Tier 3: At or above 100% of the FPL Max $143 out-of-pocket
*Co-payments for prescription drugs are the same for everybody and will range from $0 to $3.
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