Written by a parent, not a doctor. Nothing here is medical advice.

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West Virginia program

Free health insurance for your child (Medicaid)

West Virginia's free Medicaid plan for children under 19. It can sit behind your work insurance.

What it is

West Virginia's free Medicaid plan for children under 19. It can sit behind your work insurance.

Medicaid covers cancer treatment for children whose families meet the income rules. Your child's age changes the income limit. The state decides who belongs in your child's household and which income counts.

Eligibility rules
  • Your child must live in West Virginia and be under 19. The state checks current monthly income, not just last year’s tax return.
  • From April 1, 2026 the monthly line for a home of three is about $3,700 under age 1, $3,324 at ages 1 to 5 and $3,142 at ages 6 to 18; for four people it is $4,483, $4,015 and $3,795.
  • For three people the line is about $3,142 a month at ages 6 to 18.
  • The lines above already include the state's five-point allowance. Monthly figures are converted from a yearly table, so the worker's count on this month's income is the one that decides.
Why families with work insurance consider Medicaid
  • For covered care approved under Medicaid’s rules, an enrolled doctor cannot pass your work-plan deductible or copay to your child, even if Medicaid pays $0 extra.
  • The hospital can compare the two plans’ cancer teams, medicines, approvals and billing before any coverage change.
What having two plans involves
  • You still manage two insurance cards and the work-plan premium.
  • HIPP can review whether Medicaid will reimburse the work-plan premium after Medicaid approval.
What you get
  • No premium or copays for covered hospital care, chemotherapy, prescriptions and clinic visits.
  • Dental and vision care for your child.
  • Rides to covered appointments, with home nursing available after a separate care assessment.
What the coverage means
  • Children under 21 can receive medically necessary services through EPSDT within Medicaid benefit categories. This does not cover every requested service.
  • Your work plan is billed first. For covered care, the clinic cannot bill you the deductible or copay the work plan left, even when Medicaid pays nothing extra. If a bill arrives anyway, ask the financial counselor to check it before paying.
  • For applications made through December 31, 2026, Medicaid can cover qualifying bills from up to three months before the application month if your child met the rules in each month. For child applications made on or after January 1, 2027, the federal look-back becomes two months. Your social worker can help the eligibility worker check the dates and bills; earlier coverage is not automatic.
If you decide to apply
  1. Ask your social worker to compare Medicaid with your current coverage and, if you choose it, help with WV PATH.
  2. Have your child's identification, Social Security number, address, current income, insurance cards and earlier bills ready.
  3. Ask the counselor whether the hospital can open temporary coverage and whether your cancer team accepts the assigned plan.

Department of Human Services: 1-877-716-1212 · Official page ↗

After you apply
  • Your approval letter gives the coverage dates and the health plan your child has been placed in. Ask the counselor to check that plan against the cancer team before the first visit.
  • The applicable Medicaid decision standards are generally 45 days, or 90 days when disability must be determined, with limited exceptions for documented unusual circumstances. A qualified hospital’s trained staff may start temporary presumptive coverage for an eligible child. It starts on the determination date; without a full application it ends on the last day of the next month, and a full application filed by then keeps it open until the eligibility decision.
  • Children under 19 receive 12 months of continuous Medicaid eligibility after enrollment or renewal, with limited legal exceptions. This federal rule applies from January 1, 2024. Your eligibility worker confirms the renewal date and whether any longer coverage period applies to your child.
Good to know

Your work plan gets billed first. Having both plans means the hospital and pharmacy need both insurance cards.

Other details
  • An income denial for ordinary Medicaid does not decide the separate CDCSP disability route. That route looks at your child’s own money and care needs.
  • If the plan refuses a treatment, you have 60 days to appeal and it usually answers within 30 days, or three when urgent. To keep a service your child already has running during the appeal, the request has to go in before the change date on the letter.

Federal background: Medicaid · Medicaid as second insurance.

Official sources
Ask your social worker

“Could Medicaid reduce our child’s treatment bills, and what would managing two insurance plans involve? If you think it would help, could you help us with the application and check our cancer team?”

Why I’m asking: I want treatment covered with fewer bills and a clear understanding of how two plans work together.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File on WV PATH with this month's income and any insurance cards, and name the months that already have bills.

Your social worker

The oncology social worker or financial counsellor helps you file and asks whether the hospital can open temporary coverage the same day.

The care team

Nothing for ordinary child Medicaid. Medical records are needed only for the disability route.

Who decides
The Department of Human Services checks income; a managed-care plan then runs the coverage.
Ask your social worker
“Can you help me file on WV PATH today, ask about temporary coverage while we wait, and check that the oncology team is in the plan we are assigned?”

How to apply

First step: Apply at wvpath.wv.gov or call 1-877-716-1212 this week, and ask the hospital counsellor today about temporary coverage.

  1. Apply on WV PATH this week and give this month's income.
  2. Ask the hospital's financial counsellor today about temporary coverage while the application is decided.
  3. List the months that already have bills so the look-back covers the admission.

Official application / program page ↗

Where it starts: Apply on WV PATH, by phone, or at a local DoHS office. Ask the hospital's financial counsellor the same day whether the hospital can open temporary coverage.

What to gather

  • Your child's birth certificate or identification and Social Security number
  • A West Virginia address
  • This month's income for each parent in the tax household
  • Insurance cards, if any
  • Hospital bills from the months before you apply

How long: West Virginia does not publish a decision deadline for Medicaid. Ask the worker for a date and write it down.

What a yes looks like

A notice with coverage dates and a managed-care plan. Check the oncology team is in that plan before you use it.

What a no looks like, and the next move

Read why: income, a missing document, or the wrong category. If it is income, ask for the disability route by name and appeal by the date on the notice.

Watch out

  • Do not cancel a work plan to apply: your child can have both, and Medicaid pays second.
  • West Virginia counts the tax household and this month's income, not last year's return.
  • If income is too high, ask in the same conversation about the Children with Disabilities Community Service Program, which counts only your child's money.

Dates that change this

2026-04-01: The income figures come from the 2026 Medicaid guide, which says in terms that it is not Medicaid policy. Treat them as the published columns, and let the worker do the sum.

2003-07-01: The posted rule reaching back three months before you apply is from 2003 and is the only version on the site. Ask the worker to confirm the months before you count on them. (not yet confirmed against the final rule)

2024-01-01: A qualified hospital can open temporary Medicaid for a child, but West Virginia does not publish which hospitals have signed up. Ask your hospital's financial counsellor. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full coverage with no premium for a child. For four people the lines are $4,483 under age 1, $4,015 at ages 1 to 5 and $3,795 at ages 6 to 18.

  • $3,795/month — Ages 6 to 18, family of 4, published 138% column
  • $3,142/month — Ages 6 to 18, family of 3, published 138% column
  • $4,015/month — Ages 1 to 5, family of 4, published 146% column
  • $4,483/month — Under age 1, family of 4, published 163% column

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Anything medically necessary for a child under 21, through EPSDT · Private duty nursing and personal care when approved · Rides to appointments, with meals and lodging on long trips · Dental and vision

Legal protection: Other insurance is no bar: Medicaid pays second

What it costs the family: No premium and no copayments for a child.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
MAGI household; the 2026 guide columns of 163 / 146 / 138 percent, which sit five points above the base percentages of 158 / 141 / 133 because of the state plan's five-point allowance
Insurance status condition
none: Medicaid is secondary to private insurance
Residency
West Virginia
Continuous eligibility
unknown: no state continuous-eligibility sentence was located
Retroactive months
three under the posted plan, which is dated 2003
Processing standard
unknown: no promptness deadline was located

Decisions this site cannot make: DoHS eligibility determination through WV PATH · Hospital presumptive eligibility, where the hospital has elected it

Expect friction on: Managed-care plan is assigned automatically since July 1, 2025; check the oncology team is in it

The trap: Do not cancel a work plan to apply. West Virginia says plainly that you can have other insurance and Medicaid, and Medicaid pays what the other plan does not, up to its own limits.

Where I read this

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