Medicaid Unwinding in West Virginia: What You Need to Know If You Lose Coverage
Key takeaways:
Medicaid renewals in West Virginia are changing because of the end of the COVID-19 public health emergency (PHE) on May 11, 2023. This will lead to a loss of coverage through a process called unwinding.
During the PHE, Medicaid renewals were automatic and enrollees had continuous coverage. As part of the unwinding process, automatic renewals for Medicaid and Children’s Health Insurance Program (CHIP) coverage stopped nationwide on March 31, 2023.
West Virginia has started to determine who is currently eligible for Medicaid. Make sure the West Virginia Department of Health and Human Resources (DHHR) has your current contact information if you’re enrolled in the state’s program. If the DHHR can’t reach you or you no longer qualify for Medicaid, you could lose coverage as early as May 1, 2023.
The U.S. Department of Health and Human Services declared a public health emergency (PHE) for COVID-19 in January 2020, which was renewed a dozen times through February 2023.
During the COVID PHE, Medicaid enrollees were able to keep their health insurance coverage without eligibility reviews. That’s because states and territories were required to provide continuous coverage during this period.
But the PHE is ending on May 11, 2023, along with automatic renewals for Medicaid enrollees. Because of this, somewhere between 93,000 to nearly 138,000 West Virginians could lose Medicaid or Children’s Health Insurance Program (CHIP) coverage, according to a state estimate.
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West Virginia is already reviewing Medicaid and CHIP enrollees to determine who is eligible for coverage, through a process called redetermination. If you or your family members no longer qualify for Medicaid or CHIP — known as WVCHIP in West Virginia — you could lose coverage as early as May 1, 2023.
Here’s how to prepare for Medicaid changes in West Virginia and what to do if you lose your coverage.
Why is Medicaid changing nationwide?
When the PHE ends, COVID will remain a public health priority, but not a public health emergency. As part of this process, Medicaid renewals will no longer be automatic and cases will be reviewed for eligibility. This is called the unwinding of Medicaid, and millions of people nationwide risk losing coverage.
The unwinding process will affect Medicaid in every state, the District of Columbia, and five U.S. territories.
What’s happening with Medicaid renewal in West Virginia?
As mentioned previously, the end of automatic enrollment means that somewhere between 93,000 to nearly 138,000 West Virginians could lose Medicaid or CHIP coverage, according to an estimate from the West Virginia Department of Health and Human Resources (DHHR). If you’re enrolled in Medicaid in the state, the DHHR has a redetermination plan that can tell you more about how the state intends to handle the unwinding process.
The DHHR began mailing renewal letters in February 2023 and will continue the redetermination process for a year. This is why it’s important for the agency to have your current contact information.
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You can confirm or update your contact information by:
Visiting your West Virginia PATH (People's Access To Help) self-service account
Sending an email at dhhrbcfchangectr@wv.gov
Calling the DHHR customer service center at 1-877-716-1212, 9AM to 5PM (ET), Monday through Friday
If you miss the deadline to submit your renewal packet, you will have 90 days to provide the necessary information and be reinstated (if eligible) without having to reapply for coverage. After 90 days, you will need to reapply for Medicaid benefits and will likely have a gap in coverage.
If you are no longer eligible for Medicaid or CHIP, your coverage will end on the last day of your renewal month.
What should I do if I lose my Medicaid coverage in West Virginia?
If West Virginia doesn’t renew your Medicaid coverage during the redetermination process, you will no longer be able to use your benefits, which could leave you temporarily uninsured.
Through April 2024, the West Virginia DHHR will review eligibility for everyone receiving Medicaid coverage. In order to receive Medicaid in West Virginia, you must meet all of the following criteria:
You are a West Virginia resident.
You are a U.S. citizen, permanent resident, or legal resident.
You need assistance accessing low-cost healthcare or insurance coverage.
Your annual household income before taxes are withheld meets the limit for your household size.
And you must be one of the following:
Pregnant
In charge of caring for a child 18 years old or younger
Blind
65 years or older (under certain conditions)
Person with a disability or a household member of someone who has a qualifying disability
Recipient of Supplemental Security Income (SSI)
If you no longer meet the eligibility guidelines, West Virginia won’t renew your Medicaid coverage. But the DHHR will transfer your application to the federally facilitated marketplace to be evaluated for other healthcare coverage.
If you lose coverage but believe you still qualify, you should reapply for Medicaid in West Virginia. You may be uninsured for a while if you reapply for Medicaid and need to wait to be approved again. In that case, you may want to look into free and low-cost healthcare options. You can also use free GoodRx coupons to save on your prescription medications.
If you don’t plan to reapply for Medicaid and aren’t eligible for another government healthcare program, you should see if you qualify for coverage elsewhere. Depending on your circumstances, you may be able to find health insurance through one of these options:
Affordable Care Act (ACA) marketplace: You may be able to find an ACA plan for $10 or less per month if you qualify for a premium subsidy. If you lose your Medicaid coverage, you’ll be able to get an ACA plan during an unwinding special enrollment period from March 31, 2023 to July 31, 2024. During this time, you can buy an insurance plan on the ACA marketplace.
Employer plan: You may want to take advantage of employer-sponsored healthcare if you have a job that offers health insurance benefits.
Medicare: If you have a qualifying disability or condition — such as end-stage renal disease or ALS (amyotrophic lateral sclerosis), commonly referred to as Lou Gehrig’s disease — you can enroll in Medicare at any age.
Partner’s plan: If you have a spouse or domestic partner who has insurance, you may be able to join their plan during an open enrollment or special enrollment period.
Special plans: Short-term insurance can be a great choice if you think a better option, like job-based health insurance, will be available soon. You may also consider alternative and limited-benefit plans, such as fixed indemnity, accident, cost-sharing, and catastrophic insurance plans.
Student health plan: If you’re enrolled in a college or university, you may be eligible for a campus health plan.
U.S. Department of Veterans Affairs (VA): If you are an active-duty service member or a veteran, you may qualify for TRICARE coverage or VA benefits and services.
West Virginia Medicaid resources
Here are some sites where you can learn more about Medicaid in West Virginia and upcoming changes related to the end of the PHE:
West Virginia Medicaid office: The West Virginia DHHR oversees Medicaid in the state.
West Virginia Medicaid self-service portal: You can log in to your Medicaid account 24/7 through the West Virginia PATH portal to confirm or update your contact information.
West Virginia Medicaid unwinding FAQs: Get answers to frequently asked questions about the end of continuous Medicaid coverage.
The bottom line
Automatic Medicaid renewals stopped on March 31, 2023 in advance of the COVID-19 public health emergency (PHE) expiring in May.
The West Virginia Department of Health and Human Resources (DHHR) is spending a year reviewing Medicaid eligibility for enrollees. If you’re enrolled in the state’s program, you should receive a renewal letter asking for information to determine if you or your family members are still eligible. So it’s important to confirm or update your contact information in your West Virginia PATH (People's Access To Help) account to ensure that you receive mail and electronic notifications.
If you lose your Medicaid coverage, you may still qualify for health insurance elsewhere. Your options may include Affordable Care Act (ACA) marketplace plans, Medicare, or job-based insurance.
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References
Administration for Strategic Preparedness and Response. (2020). Determination that a public health emergency exists.
Administration for Strategic Preparedness and Response. (2023). Renewal of determination that a public health emergency exists.
Benefits.gov. (n.d.). West Virginia Medicaid.
Medicaid.gov. (n.d.). Unwinding and returning to regular operations after COVID-19.
Tolbert, J., et al. (2023). 10 things to know about the unwinding of the Medicaid continuous enrollment provision. Kaiser Family Foundation.
U.S. Department of Veterans Affairs. (2022). VA & TRICARE information.
West Virginia Bureau for Medical Services. (n.d.). Applying for healthcare: Medicaid, West Virginia Children’s Health Insurance Program or private insurance at the health insurance marketplace.
West Virginia Bureau for Medical Services. (n.d.). State report on plans for prioritizing and distributing renewals following the end of the Medicaid continuous enrollment provisions.
West Virginia Bureau for Medical Services. (2023). Urgent! West Virginia Medicaid members, don't risk losing your coverage, update your contact information now!
West Virginia Department of Health and Human Resources. (2022). Sample renewal notice packet.
West Virginia Department of Health and Human Resources. (2023). DHHR’s Bureau for Medical Services seeks to help members with healthcare coverage.
