S10 - MAGI Based Methodologies
S88 - Residency Requirements
S89 - Non-Financial Eligibility Requirements
S94 - General Eligibility Process
1.0 Medicaid Administration
- 1.1 Designation and Authority
- 1.2 Organization for Administration
- 1.3 Assurances
- 1.5 Pediatric Immunization Program
2.0 Coverage and Eligibility
- 2.1 Application, Determination of Eligibility and Furnishing Medicaid
- 2.2 Coverage and Conditions of Eligibility
- 2.3 Residence
- 2.4 Blindness
- 2.5 Disability
- 2.6 Financial Eligibilty
- 2.7 Medicaid Furnished Out of State
3.0 Services: General Provisions
- 3.1 Amount, Duration, and Scope of Services
- 3.2 Coordination of Medicaid with Medicare and Other Insurance
- 3.3 Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases
- 3.4 Special Requirements Applicable to Sterilization Procedures
- 3.5 Families Receiving Extended Medicaid Benefits
- 3.7 Services to Families Receiving Extended Medicaid Benefits (Continued)
4.0 General Program Administration
- 4.1 Methods of Administration
- 4.2 Hearings for Applicants and Recipients
- 4.3 Safeguarding Information on Applicants and Recipients
- 4.4 Medicaid Quality Control
- 4.5 Medicaid Agency Fraud Detection and Investigation Program
- 4.6 Reports
- 4.7 Maintenance of Records
- 4.8 Availability of Agency Program Manuals
- 4.9 Reporting Provider Payments to Internal Revenue Service
- 4.10 Free Choice of Providers
- 4.11 Relations with Standard-Setting and Survey Agencies
- 4.12 Consultation to Medical Facilities
- 4.13 Required Provider Agreement
- 4.14 Utilization/Quality Control
- 4.15 Inspection of Care in Intermediate Care Facilities for Mentally Retarded, Facilities Providing Inpatient Psychiatric Services for Individuals Under 21, and Mental Health Hospitals
- 4.16 Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees
- 4.17 Liens and Adjustments and Recoveries
- 4.18 Recipient Cost Sharing and Similar Charges
- 4.19 Payment for Services
- 4.20 Direct Payments to Certain Recipients for Physicians' or Dentists' Services
- 4.21 Prohibition Against Reassignment of Provider Claims
- 4.22 Third Party Liability
- 4.23 Use of Contracts
- 4.24 Standards for Payments for Nursing Facility and Intermediate Care Facility for the Mentally Retarded Services
- 4.25 Program for Licensing Administrators of Nursing Homes
Updated 2/23
- 4.26 Drug Utilization Review Program
- 4.27 Disclosure of Survey Information and Provider or Contractor Evaluation
- 4.28 Appeals Process
- 4.29 Conflict of Interest Provisions
- 4.30 Exclusion of Providers and Suspension of Practitioners and Other Individuals
- 4.31 Disclosure of Information by Providers and Fiscal Agents
- 4.32 Income and Eligibility Verification System
- 4.33 Medicaid Eligibility Cards for Homeless Individuals
- 4.34 Systematic Alien Verification for Entitlements
- 4.35 Enforcement of Compliance for Nursing Facilities
- 4.36 Required Coordination Between the Medicaid and WIC Programs
- 4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities
- 4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities
- 4.41 Resident Assessment for Nursing Facilities
- 4.42 Employee Education About False Claims Recoveries
5.0 Personnel Administration
- 5.1 Standards of Personnel Administration
- 5.2 (Reserved)
- 5.3 Training Programs; Sub professional and Volunteer Programs
6.0 Financial Administration
- 6.1 Fiscal Policies and Accountability
- 6.2 Cost Allocation
- 6.3 State Financial Participation
7.0 General Provisions
- 7.1 Plan Amendments
- 7.2 Nondiscrimination
- 7.3 Maintenance of AFDC Effort
- 7.4 State Governor's Review
- 7.4 Medicaid Disaster Relief for COVID-19 National Emergency
Updated 10/2020
Attachments and Supplements
1.1 - A Attorney General's Certification
1.2 - A Organization of Administration
2.1 - A Health Maintenance Organization
2.2 - A Groups Covered and Agencies Responsible for Eligibility Determination
- Pages 1-9b2 - Mandatory Coverage - Categorically Needy and Other Required Special Groups
- Pages 9c-23d - Optional Groups Other than the Medically Needy
- Pages 24-26a - Optional Coverage of the Medically Needy
- Page 27 - Requirements Relating to Determining Eligibility for Medicare Prescription Drug Low-Income Subsidies
- Supplement 1 - Reasonable Classification of Individuals Under the Ages of 21, 20, 19, and 18
- Supplement 3 - Method for Determining Cost Effectiveness of Caring for Certain Disabled Children at Home
2.6 - A Eligibility Conditions and Requirements
- Pages 1-3c - General Conditions of Eligibility
- Pages 4-5a - Post Eligibility Treatment of Institutionalized Individuals
- Pages 6-26 - Financial Eligibility
- Supplement 1 - Income Eligibility Levels
- Supplement 1a - Income Eligibility Levels - Categorically Needy
- Supplement 2 - Resource Levels
- Supplement 3 - Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered Under Medicaid
- Supplement 5 - More Restrictive Methods of Treating Resources with Income Related to the SSI Program
- Supplement 5a - Methods of Treating Resources for Individuals with Incomes Related to Federal Poverty Levels
- Supplement 6 - Standards for Optional State Supplementary Payments
- Supplement 7 - Income Levels for 1902 (f) States - Categorically Needy Who re Covered Under Requirements More Restrictive than SSI
- Supplement 8 - Resource Standards for 1902 (f) States - Categorically Needy
- Supplement 8a - More Liberal Methods of Treating Income Under Section 1902 (r)(2) of the Act
- Supplement 8b - More Liberal Methods of Treating Resources Under Section 1902 (r)(2) of the Act
- Supplement 8c - State Long-Term Care Insurance Partnership
- Supplement 9 - Transfer of Resources
- Supplement 9a - Transfer of Assets
- Supplement 9b - Transfer of Assets for Less Than Fair Market Value Made on or After February 8, 2006
- Supplement 10 - Consideration of Medicaid Qualifying Trusts - Undue Hardship
- Supplement 11 - Cost Effectiveness Methodology for Cobra Continuation Beneficiaries
- Supplement 12 - Eligibility Under Section 1931 of the Act
- Supplement 13 - Spousal Impoverishment - Undue Hardship
- Supplement 16 - Asset Verification System
- Supplement 17 - Home Equity
- Supplement 18 -Methodology for Identification of Applicable FMAP Rate
3.1 Attachment 2 - WV Medicaid Redesign Benefit Package
Updated 3/2022
3.1 - A Amount, Duration and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy
- Supplement 1 - Case Management Services
- Attachment for A, D, and E of Supplement 1 to Attachment 3.1-A
- Addendum - School-Based Health Services (Special Education)
Updated 3/2022
3.1 - B Amount, Duration and Scope of Services Provided for Medically Needy Group(s): All Covered Medically Needy Groups
Updated 1/2025
3.1 - A & 3.1 - B
- Amount, Duration, Scope of Medical and Remedial Care And Services Provided to the Medically Needy - Methods of Providing Transportation
- Supplement 2 to Attachments 3.1-A and 3.1-B, Amount, Duration and Scope of Assistance
- Supplement 2 to Attachments 3.1-A and 3.1-B, Chiropractic Services
- Supplement 3 to Attachments 3.1-A and 3.1-B, Medicated Assisted Treatment
Updated 7/2023
3.1 - C
- Alternative Benefits Benchmark Equivalent Quality Package
- Supplement 1 to Attachent 3.1 - C Medicaid Redesign Eligibility Groups: Children's Covered Group
- Supplement 2 to Attachment 3.1 - C West Virginia Medicaid Redesign Children's Benefit Packages
- Supplement 3 to Attachment 3.1 - C West Virginia Medicaid Member Agreement
- Supplement 4 to Attachment 3.1 - C Wraparound Services: Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services
Updated 3/2022
3.1 - D Methods of Providing Transportation
3.1 - E Standards for the Coverage of Organ Transplant Procedures
3.1 - H Health Homes
Updated 9/2017
Statewide Health Home for Bipolar disorder at risk for Hepatitis B & C
Updated 9/2017
Pilot Health Home for Pre-diabetes, diabetes, obesity and at risk for anxiety and/or depression
3.1 - L Alternative Benefit Plan
3.2 - A Coordination of Title XIX with Part A and Part B of Title XVIII
Updated 1/2025
4.5 Recovery Audit Contractor
4.11 - A Standards for Institutions
4.16 - A Interrelationships with State Health and State Vocational Rehabilitation Agencies and with Title V Grantees
4.17 - A Liens and Adjustments or Recoveries
4.18 - A Charges Imposed on Categorically Needy for Services Other Than Those Provided Under Section 1905 (a) (1)
4.18 - C Charges Imposes on the Medically Need for Services Other Than Those Provided Under Section 1905 (a) (1) through (5) and (7) Act
4.19 - A Inpatient Hospital Services
- Supplement 1 - Transition Percentage for Operating Payments
- Supplement 2 - Transition Percentage for Capitol Payment Amounts
Updated 9/2017
4.19 - A -1 Payments for Medical and Remedial Care and Services-Inpatient Hospitals Services - Disproportionate Share Hospitals
4.19 - A -2 Payment for Medical and Remedial Care and Services-Inpatient Psychiatric Facility Services for Individual Under 22 Years of Age
Updated 9/2023
4.19 - B Payments for Medical and Remedial Care and Services
- Supplement 1 - Methods and Standards for Establishing Payment Rates-Other Types of Care
- Supplement 2 - Payment Adjustment for Other Provider Preventable Conditions
4.19 - D Methods and Standards for Determining Payment Rates for State-Owned Long Term Care Facilities (SNF, ICF, and ICF/MR Facilities)
4.19 - D-1 Methods and Standards for Determining Payment Rates for Non-State-Owned Nursing Facilities Excludes State-Owned Facilities
4.19 - D-2 Methods and Standards for Determining Payment Rates for Intermediate Care Facilities for Mentally Retarded
4.19 - E Timely-Claims Payment
4.22 - A Requirements for Third Party Liability - Identifying Liable Resources
4.22 - B Requirements for Third Party Liability - Payment of Claims
4.22 - C State Method on Cost Effectiveness of Employer-Base Group Health Plans
4.30 Sanctions for MCOs and PCCMs
4.32 - A Income and Eligibility Verification System Procedures: Requests to Other State Agencies
4.33 - A Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
4.34 - A Requirements for Advance Directives Under State Plans for Medical Assistance
4.35 - A Eligibility Conditions and Requirements-Enforcement of Compliance for Nursing Facilities
4.35 - B Eligibility Conditions and Requirements-Termination of Provider Agreement
4.35 - C Eligibility Conditions and Requirements-Temporary Management
4.35 - D Eligibility Conditions and Requirements-Denial of Payment for New Admission
4.35 - E Eligibility Conditions and Requirements-Civil Money Penalty
4.35 - F Eligibility Conditions and Requirements-State Monitoring
4.35 - G Eligibility Conditions and Requirements-Transfer for Residents with Closure of Facility
4.35 - H Eligibility Conditions and Requirements-Additional Remedies
4.38 Disclosure of Additional Registry Information
4.38 - A Collection of Additional Registry Information
4.39 Definition of Specialized Services
4.39 - A Categorical Determinations
4.42 - A False Claims Act Attachment
4.43 - A Medicaid Integrity Program Efforts
4.44 Prohibition on Payments to Entities Outside the US
4.46 Provider Screening and Enrollment
5.1 - A Standards of Personnel Administration
7.2 - A Nondiscrimination
7.4 - A Recissions to the State's Disaster Relief for COVID-19 National Emergency Attachment
7.7 - A Vaccine and Vaccine Administration
7.7 - B COVID-19 Testing
7.7 - C COVID-19 Treatment
S14 AFDC Income Standards
S21 Presumptive Eligibility by Hospitals
Updated 7/2023
Eligibility Groups - Mandatory
S25 Parents and Other Caretaker Relatives
S28 Pregnant Women
S30 Infants and Children Under Age 19
S32 Adult Group
S33 Former Foster Care Children
Eligibility Groups - Optional Coverage
S50 Individuals above 133% of FPL
S51 Optional Coverage of Parents and Other Caretaker Relatives
S52 Options for Coverage Reasonable Classification of Individuals under 21
S53 Children With Non-IV-E Adoption Assistance
S54 Optional Targeted Low Income Children
S55 Individuals With Tuberculosis
S57 Independent Foster Care Adolescents
S59 Individuals Eligible for Family Planning Services
Cost Sharing
G1 to G3 Medicaid Cost Sharing
