West Virginia's Department of Human Services says some Medicaid members in the Adult Expansion Group will face new community-engagement requirements beginning January 1, 2027.
The rules apply to certain low-income adults ages 19 through 64. They do not apply to every Medicaid member: DoHS says exclusions and exceptions may apply, including for some pregnant or postpartum members, caregivers, people with certain health needs, people receiving specified other benefits and other groups described in its guidance.
For people who must meet the requirement, DoHS describes 80 hours a month of work or approved community activity. Qualifying activity can include paid, unpaid or in-kind work, approved job training, qualifying education and volunteer service. The agency also lists monthly income of at least $580 as an alternative. People may combine qualifying activities.
The timing can depend on an individual's application or renewal. DoHS says an applicant may need qualifying activity in the month before applying, and that some current members with March 2027 renewals will need to document activity since their prior renewal. Some renewals will move to six-month intervals beginning in 2027.
DoHS says it will first use information it already has to check whether a member meets the requirement or qualifies for an exclusion or exception. If more information is needed, it says the member will receive a written request by mail or through a paperless WV PATH account. The agency says people who receive a request should respond within 30 days.
Residents should use the DoHS Medicaid changes guide to review whether the rules may apply to them rather than assuming eligibility from this article. The guide includes exceptions, documentation details and contact options. DoHS lists the Customer Service Reporting Center at 1-877-716-1212 for individual questions.