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

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West Virginia program

Children's insurance above the Medicaid limit (WVCHIP)

WVCHIP is West Virginia's health insurance for children whose families earn too much for Medicaid.

What it is

WVCHIP is West Virginia's health insurance for children whose families earn too much for Medicaid.

WVCHIP covers children above the Medicaid income limit. Existing medical insurance generally blocks entry, but an unused offer from work does not. The same healthcare application checks Medicaid and WVCHIP.

Eligibility rules
  • Your child must be under 19 and live in West Virginia. Existing coverage generally bars enrollment.
  • The March 2026 table sets Gold at 150%, Blue at 211% and Premium at 300% of poverty. For four people, those monthly figures are $4,125, $5,803 and $8,250.
  • No extra five-point amount has been added to these published WVCHIP columns.
  • Federal CHIP rules prohibit a waiting period after a child leaves other coverage. Existing medical insurance can still block a new WVCHIP enrollment. Before any coverage change, your social worker and the eligibility office can confirm the start date, doctors and medicines so treatment is not interrupted.
What you get
  • In the paid band, coverage costs $35 monthly for one child or $71 for two or more.
  • The same covered benefits as Medicaid, including hospital care, chemotherapy and prescriptions.
  • Twelve months of enrollment after approval.
What the coverage means
  • Gold and Blue have no monthly premium, but some visits and prescriptions have copays. For example, specialist or non-PCP visits generally cost $5 in Gold and $15 in Blue; Blue also lists a $25 inpatient hospital copay. Premium coverage costs $35 a month for one child or $71 for two or more, plus applicable copays. The plan can check the costs for your child’s actual care.
  • The paid band begins above 211% of poverty. An employer’s offer by itself is different from a child already enrolled in that coverage.
If you decide to apply
  1. Ask the hospital's financial counselor to go through WV PATH with you.
  2. Have current income and insurance details ready, including whether your child actually uses an employer plan.
  3. Ask the counselor to check the exact health plan against your child’s cancer team.

Department of Human Services takes the application and decides: 1-877-716-1212 · Official page ↗

After you apply
  • A decision usually takes about two weeks after a complete application.
  • Approved coverage starts on the first day of the application month, or the next month when coming off other insurance.
Good to know

Having the same covered benefits as Medicaid does not mean having the same doctors. Dropping work coverage can also affect when WVCHIP starts.

Other details
  • Gaining other insurance after enrollment does not end the 12-month continuous coverage period.

Federal background: Children’s Health Insurance Program (CHIP).

Official sources
Ask your social worker

“Could our child qualify for WVCHIP, what would it cost, and would our cancer team accept the plan? If it is a better fit, could you help us compare the start dates and apply?”

Why I’m asking: I want affordable coverage without interrupting treatment or losing access to our cancer team.

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

Apply on WV PATH, say honestly what insurance your child has today, and pay the monthly charge if you are in the paid band.

Your social worker

The hospital's financial counsellor can file with you and check that the oncology team is in the plan.

The care team

Nothing.

Who decides
The Department of Human Services decides, and WVCHIP runs the coverage through a managed-care plan.
Ask your social worker
“We earn too much for Medicaid. Can we be screened for WVCHIP on the same application, and which band would we be in?”

How to apply

First step: Apply at wvpath.wv.gov or call 1-877-716-1212; one form covers both programmes.

  1. Apply on WV PATH; the same form covers Medicaid and WVCHIP.
  2. If a parent is offered a plan at work but has not enrolled, say so: the offer alone does not close this door.
  3. Check the oncology team is in the plan you are assigned.

Official application / program page ↗

Where it starts: Apply on WV PATH or through the same healthcare application used for Medicaid.

What to gather

  • Proof of West Virginia residence
  • This month's household income
  • Any insurance cards

How long: The state's own estimate is about two weeks after a complete application. That is an estimate, not a deadline.

What a yes looks like

A notice naming the band, the start date and any monthly charge, and 12 months of enrolment.

What a no looks like, and the next move

If the reason is other insurance, ask exactly which coverage the worker counted. If it is income, ask for the disability route by name.

Watch out

  • An employer offer is not coverage: say your child is not enrolled.
  • The paid band starts above 211 percent of the poverty line, not 200.
  • Same benefits as Medicaid does not prove the same specialist network. Check the oncology team before you use the plan.

Dates that change this

2026-03-01: Income limits are the table marked effective March 2026. The day of the month is not printed and the next change date is not published.

The numbers and the rules

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

What it is worth

WVCHIP Gold and Blue have no monthly premium but some copays. Premium adds $35 a month for one child or $71 for two or more.

  • $4,125/month — Gold band upper limit, family of 4
  • $5,803/month — Blue band upper limit, family of 4
  • $8,250/month — Premium band upper limit, family of 4
  • $35/month — Monthly premium, one child enrolled
  • $71/month — Monthly premium, two or more children enrolled

Covers: The same benefits Medicaid gives a child · Hospital, chemotherapy and prescriptions · 12 months of enrolment once approved

Legal protection: Getting other insurance after enrolment does not end the 12-month period

What it costs the family: Gold and Blue have $0 monthly premiums, with applicable copays. Premium adds $35 a month for one child or $71 for two or more, plus applicable copays. The 2026 plan lists specialist/non-PCP visits at $5 Gold or $15 Blue and a $25 Blue inpatient copay.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
Gold at or under 150 percent, Blue at or under 211 percent, Premium at or under 300 percent of the poverty line; no separate five-point column is published here
Insurance status condition
existing medical insurance generally bars enrolment; an employer offer alone does not
Residency
West Virginia
Continuous eligibility
12 months
Waiting period
Federal CHIP rules prohibit a waiting period after other coverage ends. Existing coverage and the application determine the actual enrollment start date.
Processing standard
the agency's own estimate is about two weeks after a complete application

Decisions this site cannot make: DoHS eligibility determination through WV PATH

Expect friction on: Automatic managed-care assignment since July 1, 2025 · Benefits match Medicaid, but the specialist network is not proved to be the same

The trap: Being offered a plan at work does not shut this door; being enrolled in one generally does. And once a child is enrolled here, getting other insurance later does not end the 12-month period.

Where I read this

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