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Department of Human Services
WV Bureau for Medical Services

WV State Medicaid Plan

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Sections
S10​ MAGI Based Methodologies​
​S88 Residency Requirements
​S89 ​Non-Financial Eligibility Requirements
​S94 ​General Eligibility Process
​ ​      • Attachment 1 Single State Streamline Application
​ ​      ​• Attachment 2 On-line Application​
​ ​ ​
​1.0 ​MEDICAID ADMINISTRATION
​ ​ ​1.1.    Designation and Authority 
​ ​1.2     Organization for Administration
​ ​ 1.3     Assurances
​​
 ​ ​1.5     Pediatric Immunization Program
​ ​ ​
​Updated 1/23
 ​2.0 ​COVERAGE AND ELIGIBILITY
​ ​2.1      Application, Determination of Eligibility and Furnishing Medicaid
​ ​ ​2.2      Coverage and Conditions of Eligibility
​ ​2.3      Residence
​ ​ ​2.4      Blindness
​ ​ ​2.5      Disability​
​ ​ ​2.6      Financial Eligibility
​ ​ ​2.7      Medicaid Furnished Out of State
​ ​ ​
​ ​3.0 ​SERVICES: GENERAL PROVISIONS
​ ​ ​3.1      Amount, Duration, and Scope of Services
​ ​ ​3.2      Coordination of Medicaid with Medicare and Other Insurance
​ ​ 3​.3      Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases
​ ​ ​3.4      Special Requirements Applicable to Sterilization Procedures
​ ​ ​3.5      Families Receiving Extended Medicaid Benefits
​ ​ ​3.7      Services to Families Receiving Extended Medicaid Benefits (Continued)
​ ​ ​
​4.0 ​GENERAL PROGRAM ADMINISTRATION
​ ​ ​4.1      Methods of Administration
​ ​ ​4.2      Hearings for Applicants and Recipients
​ ​ ​4.3      Safeguarding Information on Applicants and Recipients
​ ​ ​4.4      Medicaid Quality Control
​ ​ ​4.5      Medicaid Agency Fraud Detection and Investigation Program
​ ​ ​4.6      Reports
​ ​ ​4.7      Maintenance of Records
​ ​ ​4.8      Availability of Agency Program Manuals
​ ​ ​4.9      Reporting Provider Payments to Internal Revenue Service
​ ​ ​4.10    Free Choice of Providers
​ ​ ​4.11    Relations with Standard-Setting and Survey Agencies
​ ​ 4​.12    Consultation to Medical Facilities
​ ​ ​4.13    Required Provider Agreement
​ ​ ​4.14    Utilization/Quality Control
​ ​ ​4.15    Inspection of Care in Intermediate Care Facilities for Mentally Retarded, Facilities Providing Inpatient Psychiatric Services for Individuals Under 21, and Mental Health Hospitals
​ ​ ​4.16    Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees
​ ​4.17    Liens and Adjustments and Recoveries
​​ ​ ​4.18    Recipient Cost Sharing and Similar Charges
​ ​ ​4.19    Payment for Services
​ ​ ​4.20    Direct Payments to Certain Recipients for Physicians' or Dentists' Services
​ ​ ​4.21    Prohibition Against Reassignment of Provider Claims
​ ​ ​4.22    Third Party Liability
​ ​ ​4.23    Use of Contracts
​ ​ ​4.24   Standards for Payments for Nursing Facility and Intermediate Care Facility for the Mentally Retarded Services
​ ​ ​4.25    Program for Licensing Administrators of Nursing Homes
​Updated 2/23
 ​ ​4.26    Drug Utilization Review Program
​ ​ ​4.27    Disclosure of Survey Information and Provider or Contractor Evaluation
​ ​ ​4.28    Appeals Process
​ ​ 4.29    Conflict of Interest Provisions
​ ​ ​4.30    Exclusion of Providers and Suspension of Practitioners and Other Individuals
​ ​ ​4.31    Disclosure of Information by Providers and Fiscal Agents
​ ​ ​4.32    Income and Eligibility Verification System
​ ​ ​4.33    Medicaid Eligibility Cards for Homeless Individuals
​ ​ ​4.34    Systematic Alien Verification for Entitlements
​ ​ ​4.35    Enforcement of Compliance for Nursing Facilities
​ ​ ​4.36    Required Coordination Between the Medicaid and WIC Programs
​ ​ ​4.38    Nurse Aide Training and Competency Evaluation for Nursing Facilities
​ ​ ​4.39    Preadmission Screening and Annual Resident Review in Nursing Facilities
​ ​ ​4.41    Resident Assessment for Nursing Facilities
​ ​ ​4.42    Employee Education About False Claims Recoveries
​ ​ ​
​ ​5.0 ​PERSONNEL ADMINISTRATION
​ ​ ​5.1    Standards of Personnel Administration
​ ​ ​5.2    (Reserved)
​ ​ ​5.3    Training Programs; Sub professional and Volunteer Programs
​ ​ ​
​ ​6.0 ​FINANCIAL ADMINISTRATION
​ ​ 6​.1    Fiscal Policies and Accountability
​ ​ ​6.2    Cost Allocation
​ ​ ​6.3    State Financial Participation
​ ​ ​
​ ​7.0 ​GENERAL PROVI​SIONS
​ ​ ​7.1    Plan Amendments
​ ​ ​7.2    Nondiscrimination
​ ​ ​7.3    Maintenance of AFDC Effort
​ ​ ​7.4    State Governor's Review
​ ​ ​7.4    Medicaid Disaster Relief for COVID-19 National Emergency
​

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​​
​Updated 10/2020 ​​​Attachments and Supplements ​
​1.1 - A ​Attorney General's Certification 
​ ​1.2 - A ​Organization of Administration
​ ​ ​
​ ​2.1 - A ​Health Maintenance Organization
​2.2 - A ​Groups Covered and Agencies Responsible for Eligibility Determination
​      ​•  Pages 1-9b2 - Mandatory Coverage - Categorically Needy and Other Required Special Groups
​ ​     ​•  Pages 9c-23d - Optional Groups Other than the Medically Needy
​      ​•  Pages 24-26a - Optional Coverage of the Medically Needy
​ ​ ​     ​•  Page 27 -Requirements Relating to Determining Eligibility for Medicare Prescription Drug Low-Income Subsidies
​ ​      ​​•  Supplement 1 - Reasonable Classification of Individuals Under the Ages of 21, 20, 19, and 18
​ ​      ​•  Supplement 3 - Method for Determining Cost Effectiveness of Caring for Certain Disabled Children at Home
​2.6 - A ​Eligibility Conditions and Requirements
​      ​•  Pages 1-3c - General Conditions of Eligibility
​ ​      ​​•  Pages 4-5a - Post Eligibility Treatment of Institutionalized Individuals
​      ​​•  Pages 6-26 - Financial Eligibility
​ ​ ​     ​•  Supplement 1 - Income Eligibility Levels
​ ​      ​•  Supplement 1a - Income Eligibility Levels - Categorically Needy
​      ​•  Supplement 2 - Resource Levels
​ ​      ​•  Supplement 3 - Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered Under Medicaid
​ ​ ​     ​•  Supplement 5 - More Restrictive Methods of Treating Resources with Income Related to the SSI Program
​ ​      ​•  Supplement 5a - Methods of Treating Resources for Individuals with Incomes Related to Federal Poverty Levels
​ ​ ​     ​•  Supplement 6 - Standards for Optional State Supplementary Payments
​ ​      ​•  Supplement 7 -  Income Levels for 1902 (f) States - Categorically Needy Who re Covered Under Requirements More Restrictive than SSI
​ ​      ​•  Supplement 8 - Resource Standards for 1902 (f) States - Categorically Needy
​      ​•  Supplement 8a - More Liberal Methods of Treating Income Under Section 1902 (r)(2) of the Act
​      ​•  Supplement 8b - More Liberal Methods of Treating Resources Under Section 1902 (r)(2) of the Act
​      ​​• Supplement 8c - State Long-Term Care Insurance Partnership
​ ​ ​     ​•  Supplement 9 -  Transfer of Resources
​ ​ ​     ​•  Supplement 9a - Transfer of Assets
​ ​      ​•  Supplement 9b - Transfer of Assets for Less Than Fair Market Value Made on or After February 8, 2006
​ ​      ​•  Supplement 10 - Consideration of Medicaid Qualifying Trusts - Undue Hardship
​ ​ ​     ​•  Supplement 11 - Cost Effectiveness Methodology for Cobra Continuation Beneficiaries
​ ​      ​•  Supplement 12 - Eligibility Under Section 1931 of the Act
​ ​ ​     ​•  Supplement 13 - Spousal Impoverishment - Undue Hardship
​ ​ ​     ​​•  Supplement 16 - Asset Verification System  
​ ​ ​     ​•  Supplement 17 - Home Equity
​      ​​• Supplement 18 -Methodology for Identification of Applicable FMAP Rates
​ ​ ​
​3.1      ​• Attachment 2 - WV Medicaid Redesign Benefit Package
Updated 3/2022
 ​3.1 - A ​Amount, Duration and Scope of M​edical and Remedial Care and Services Provided to the Categorically Needy
​ ​ ​     ​•  Supplement 1 - Case Management Services
​ ​      ​​• Attachment for A, D, and E of Supplement 1 to Attachment 3.1-A 
​ ​     ​• Addendum - School-Based Health Services (Special Education)
​Updated 3/2022
 ​3.1 - B ​Amount, Duration and Scope of Services Pr​ovided for Medically Needy Group(s): All Covered Medically Needy Groups
Updated
9/2023
 ​3.1 - A & 3.1 - B ​Amount, Dur​ation, Scope of Med​ical and Remedial Care And Services Provided to the Medically Needy - Methods of Providing Transportation
Supplement 2 to Attachments 3.1 -A and 3.1 - B Amount, Duration and Scope of Assistance 

Supplement 2 to Attachments 3.1-A and 3.1-B, Chiropractic Services
Supplement 3 to Attachments 3.1-​A and 3.1-B, Medicated Assisted Treatment

​Updated  1/2023
 ​

​     ​

​Updated 7/2023
 ​3.1 - C ​Alternative Benefits Benchmark Equivalent Quality Package​
Supplement 1 to Attachent 3.1 - C Medicaid Redesign Eligibility Groups: Children's Covered Groups
Supplement 2 to Attachment 3.1 - C West Virginia Medicaid Redesign Children's Benefit Packages
Supplement 3 to Attachment 3.1 - C West Virginia Medicaid Member Agreement 
Supplement 4 to Attachment 3.1 - C Wraparound Services: Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services
Updated 3/2022
​3.1 - D
​Methods of Providing Tra​nsportation
​ ​3.1 - E ​Standards for the Coverage of Organ Transplant Procedures
​3.1 - H ​Health Homes

​Updated 9/2017

 ​ ​Statewide Health Home for Bipolar disorder at risk for Hepatitis B & C
​Updated 9/2017 ​ ​Pilot Health Home for Pre-diabetes, diabetes, obesity and at risk for anxiety and/or depression
​3.1 - L ​Alternative Benefit Plan
​ ​3.2 - A ​Coordination of Title XIX with Part A and Part B of Title XVIII
​ ​ ​
​Updated​ 2/2023
 ​4.5 ​Recovery Audit ​Contractor
​ ​4.11 - A ​Standards for Institutions
​ ​4.16 - A ​Interrelationships with State Health and State Vocational Rehabilitation Agencies and with Title V Grantees
​ ​4.17 - A ​Liens and Adjustments or Recoveries
​ ​4.18 - A ​Charges Imposed on Categorically Needy for Services Other Than Those Provided Under Section 1905 (a) (1)
​4.18 - C ​Charges Imposes on the Medically Need for Services Other Than Those Provided Under Section 1905 (a) (1) through (5) and (7) Act
​4.19 - A ​Inpatient ​Hos​pital Services  
​ ​ ​   ​•  Supplem​ent 1 - Transition Percentage for Operating Payments
​ ​   • Supplement 2 - Transition Percentage for Capitol Payment Amounts

​Updated 9/2017

 ​4.19 - A -1 ​Payments for Medical and Remedial Care and Services-Inpatient Hospitals Services - Disproportionate Share Hospitals 
​ ​4.19 - A -2 ​Payment for Medical and Remedial Care and Services-Inpatient Psychiatric Facility Services for Individual Under 22 Years of Age
​ ​ ​

​Updated 9​/2023

 ​4.19 - B ​Payments for Medi​cal​ and Remedial Care and Services   
Page 26 -​ Medica​​ted As​sisted​​​ Treatment​
​ ​ ​   ​• Supplement 1 - Methods and Standards for Establishing Payment Rates-Other Types of Care
​ ​ ​   • Supplement 2 - Payment Adjustment for Other Provider Preventable Conditions​

​​
 ​4.19 - D ​Methods and Standards for Determining Payment Rates for State-Owned Long Term Care Facilities (SNF, ICF, and ICF/MR Facilities)
​ ​4.19 - D - 1 ​Methods and Standards for Determining Payment Rates for Non-State-Owned Nursing Facilities Excludes State-Owned Facilities 
​ ​4.19 - D -2 ​Methods and Standards for Determining Payment Rates for  Intermediate Care Facilities for Mentally Retarded
​ ​4.19 - E ​Timely-Claims Payment
​ ​4.22 - A ​Requirements for Third Party Liability - Identifying Liable Resources
​ ​4.22 - B ​Requirements for Third Party Liability - Payment of Claims
​ ​4.22 - C ​State Method on Cost Effectiveness of Employer-Base Group Health Plans
​ ​4.30 ​Sanctions for MCOs and PCCMs
​ ​4.32 - A ​Income and Eligibility Verification System Procedures: Requests to Other State Agencies
​ ​4.33 - A ​Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
​ ​4.34 - A ​Requirements for Advance Directives Under State Plans for Medical Assistance
​ ​4.35 - A ​Eligibility Conditions and Requirements-Enforcement of Compliance for Nursing Facilities
​ ​4.35 - B ​Eligibility Conditions and Requirements-Termination of Provider Agreement
​ ​4.35 - C ​Eligibility Conditions and Requirements-Temporary Management
​ ​4.35 - D ​Eligibility Conditions and Requirements-Denial of Payment for New Admission
​ ​4.35 - E ​Eligibility Conditions and Requirements-Civil Money Penalty
​ ​4.35 - F ​Eligibility Conditions and Requirements-State Monitoring
​ ​4.35 - G ​Eligibility Conditions and Requirements-Transfer for Residents with Closure of Facility
​ ​4.35 - H ​Eligibility Conditions and Requirements-Additional Remedies
​ ​4.38 ​Disclosure of Additional Registry Information
​ ​4.38 - A ​Collection of Additional Registry Information
​ ​4.39 ​Definition of Specialized Services
​ ​4.39 - A ​Categorical Determinations
​ ​4.42 - A ​False Claims Act Attachment
​ ​4.43 - A ​Medicaid Integrity Program Efforts
​ ​4.44 ​Prohibition on Payments to Entities Outside the US
​ ​4.46 ​Provider Screening and Enrollment 
​ ​ ​
​ ​5.1 - A ​Standards of Personnel Administration
​ ​ ​
​ ​7.2 - A ​Nondiscrimination
​ ​7.4 - A
 ​Recissions ​to the State's Disaster Relief for COVID-19 National Emergency 
Attachment 
​


​7.7 - A

Vaccine and Vaccine Administration
​


​7.7 - B

COVID-19 Testing 
​
​7.7 - C
​COVID-19 Treatment​
​S14 ​AFDC Income Standards
​S21 ​Presumptive Eligibility by Hospitals
​Updated 7/20​23
 ​ ​Eligibility Groups - Mandatory
​S25 ​Parents and Other Caretaker Relatives
S28 ​Pregnant Women
​S30 ​Infants and Children Under Age 19
​S32 ​Adult Group
​S33 ​Former Foster ​Care Children​
​ ​ ​Eligibility Groups - Optional Coverage
​S50 ​Individuals above 133% of FPL
​S51
 ​Optional Coverage of Parents and Other Caretaker Relatives

​​
​S52
​Options for Coverage Reasonable Classification of Individuals under 21​

​S53 ​Children With Non-IV-E Adoption Assistance
​S54 ​Optional Targeted Low Income Children
​S55 ​Individuals With Tuberculosis
​S57 ​Independent Foster Care Adolescents
​S59 ​Individuals Eligible for Family Planning Services
​ ​ ​Cost Sharing
​G1 to G3 ​Medicaid Cost Sharing
Bureau for Medical Services | 350 Capitol Street | Room 251 | Charleston, WV 25301 | Phone: (304) 558-1700
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