Quick summary

• New rules are coming: Starting Jan. 1, 2027, West Virginia is starting a "Work and Community Engagement" program for certain adults on Medicaid.
• The 80-hour rule: If this applies to you, you must complete 80 hours of work, school, caregiving, or volunteering each month to keep your Medicaid coverage.
• You might be exempt: Many people are automatically excused including pregnant members and the medically frail.
• No immediate action needed: If you have Medicaid, these rules won't affect you until your 2027 renewal date. The earliest renewals start March 2027.
• Watch your mail: The State will check records. If you get a letter asking for proof, you must reply within 30 days to keep coverage.  

Medicaid changes are happening in West Virginia

Starting January 1, 2027, West Virginia is introducing a new program called Work and Community Engagement.

Under these rules, some adults on Medicaid will need to complete 80 hours each month of work, school, or volunteering to keep their coverage.

We know that changes to your Medicaid coverage can feel stressful and confusing. You don’t have to figure this out alone. We’re here to walk you through exactly what you need to do or you can find more information through West Virginia Medicaid Help.

Who this may affect

These new rules only apply to the following:

• Adults between the ages of 19-64, who are part of the Medicaid Expansion group (low-income adults who are not on Medicare and are not pregnant)
• Women leaving 12-month postpartum period
• Parents/guardians whose youngest dependent turns 14

Still not sure if you are affected? Take the eligibility quiz below.

You might be exempt (excused) from these rules

Many people will not have to do the 80 hours of monthly activities. The State of West Virginia will check your records to see if you qualify for an exemption.

You do not have to meet the 80-hour rule if you are:

• Medically frail: The State will decide if you are medically frail based on serious, ongoing health needs, physical or developmental disabilities, mental health conditions, or a substance use disorder.
• A parent or caregiver: If you take care of a child under the age of 14, or if you care for a family member with a disability.
• Pregnant: This includes the full duration of your pregnancy and the 12 months after your baby is born.
• A veteran: If you have a total disability rating.

Ways to meet your 80-hour monthly goal

If you are required to participate, meeting your 80-hour monthly goal is flexible. You can hit your hours using just one activity, or you can mix and match different activities to make it work for your schedule.

Activities that count toward your hours include:

• Working a job: This includes regular, part-time, or seasonal work. (Note: If you earn at least $580 a month before taxes, you automatically meet the rule, even if your hours are lower).
• Going to school: Taking college courses or job-training classes at least half-time.
• Volunteering: Helping out at a local church, food pantry, community shelter or other state-approved community organizations.
• Official State programs: Participating in a formal, state-approved work or job-search program.

Important note on job searching: Looking for work on your own does not count toward your 80 monthly hours. To get credit for job-hunting or resume building, you must do it through an approved state program like WorkForce West Virginia.

What you need to do and when

Mark your calendar

These dates matter for your Medicaid coverage, but remember: you may not need to take immediate action today.

• December 2026: If you are a new applicant applying for Medicaid to start in January 2027, you may need to show you met the requirements this month.
• March 2027: If you already have Medicaid, these rules will not affect you until your regular renewal date in 2027. The very first renewals under these rules begin in March 2027.

Watch your mailbox and online account

The West Virginia Department of Human Services (DoHS) will look at your information automatically.

1. If they need proof of your hours or your exemption, they will send you a letter in the mail or a message to your WV PATH online account.
2. If you get a letter, you must respond within 30 days. If you do not reply, you could lose your healthcare.
3. If you do not get a letter, you do not need to send anything.

Let Highmark Health Options help you take action

We cannot submit your paperwork for you, but we can teach you exactly how to do it.

Navigating State websites and phone lines can be overwhelming. Let our team be your guide. When you call us, we will sit on the phone with you and walk you through:

1. How to log into or create your WV PATH online account.
2. How to report changes to your income, job, or address so you stay covered.
3. Where to send your pay stubs, school records, or volunteer hours.
4. How to contact the State’s Customer Service Reporting Center directly at 1-877-716-1212.
   

We speak your language. If you need an interpreter or need this information in another language, just let us know when you call. It is completely free.

Free community resources for you

If you need help finding a job, volunteer hours, or training, we can connect you with local partners:

• Jobs & Hope West Virginia - Helps individuals affected by the opioid crisis with job training and employment for workforce re-entry.
• Volunteer West Virginia - Supports state-wide volunteer efforts and community service initiatives in West Virginia.
• Workforce West Virginia - A resource for job seekers to find employment, explore careers, and access training programs.
• WV 211 Resources - Connects West Virginians with free, confidential community resources for food, housing, utilities, healthcare, and more.

Visit the WV resource center to find additional opportunities and support.

Frequently asked questions

General questions about new rules

Who must participate and who is excused

Deadlines and reporting your hours

Getting help and support

Get support for West Virginia Medicaid changes

Visit the official West Virginia Medicaid Changes website for FAQs, exemptions, eligibility details and updates.