The West Virginia Department of Health and Human Resources administers the state Medicaid program through the state Bureau for Medical Services. Funding for the West Virginia Medicaid program comes from a combination of federal and state Medicaid funds. According to the Bureau for Medical Services mission statement, its focus is not only on providing medically necessary and appropriate health care services, but also encouraging preventive care to avoid future health problems.
Applications
Any West Virginia residents receiving Supplemental Security Income benefits automatically qualify for Medicaid. All other residents must apply at the local Department of Health and Human Resources offices during weekday business hours. Appointments may be made ahead of time. Those with physical disabilities unable to access a Department of Health and Human Resources office may request a home visit for the purpose of filling out the application.
Eligibility
Eligibility for Medicaid funding depends on income, assets, and "categorical relatedness." The Department of Health and Human Resources defines this as applicants who are members of families with "a child who is deprived of support due to the absence, incapacity, or unemployment of a parent(s)." Applicants without children under age 18 can only qualify for Medicaid if disabled, blind or over age 65 and meeting income restrictions. Exceptions include pregnant women and children under age 19, who qualify for Medicaid based on income only with assets not taken into consideration.
Spend-downs
Those not qualifying for Medicaid due to income over the eligibility level may still receive assistance for current medical bills by using a process called spend-down. Amounts due on medical bills are subtracted from monthly income to bring it to eligible levels. Spend-downs may be used for six months, from the time of application and five additional months. By law, applicants may use either current medical bills or any unpaid amount on older medical expenses for spend-down qualification.
Mountain Health Trust
In West Virginia, Medicaid contracts with three managed care service providers for recipients under the umbrella of Mountain Health Trust. These providers do not include pharmacy, long-term care, emergency medical transportation, or behavioral or mental health services. In 2011, the managed care providers are Unicare, the Carelink Health Plans, and the Health Plan of the Upper Ohio. At that time, approximately 170,000 people received medical care through the Mountain Health Trust.
