West Virginia Medicaid Income Limits by Eligibility Group

Most adults in West Virginia qualify for Medicaid if their household income is at or below 138% of the federal poverty level, which comes to roughly $22,025 a year for a single person in 2026. Pregnant women and young children qualify at higher thresholds, and seniors and people with disabilities follow a separate set of rules. The West Virginia Medicaid income limits below are set as percentages of the federal poverty level (FPL), which the U.S. Department of Health and Human Services updates each January.¹

2026 Income Limits by Eligibility Group

The percentage of FPL that applies depends on the applicant’s age, whether they’re pregnant, and the size of the household.²

Adults Ages 19 to 65

Adults without a disability qualify with household income up to 138% FPL. In 2026 dollars:

Single adult: $22,025 per year
Family of 2: $29,863 per year
Family of 3: $37,702 per year
Family of 4: $45,540 per year

These are the baseline figures. A built-in 5% disregard, explained further down, pushes the effective cutoff slightly higher for applicants who land just over the limit.

Pregnant Women

Pregnant women qualify with household income up to 190% FPL. Medicaid counts the unborn child as a household member, so the minimum family size is two.² For 2026:

Family of 2: $41,116 per year
Family of 3: $51,908 per year
Family of 4: $62,700 per year

Coverage continues for up to 12 months after delivery regardless of any income change during that period.

Children

Younger children qualify at higher income thresholds than older children:²

Infants under age 1: 163% FPL (up to $35,273 a year for a family of two, or $44,532 for a family of three)
Children ages 1 through 5: 146% FPL (up to $31,594 a year for a family of two, or $39,887 for a family of three)
Children ages 6 through 18: 138% FPL, the same threshold as adults

Children in families slightly above these limits may still qualify for the West Virginia Children’s Health Insurance Program (WVCHIP), which uses higher income cutoffs.

Seniors and People With Disabilities

People who are 65 or older, blind, or have a disability fall under a separate Medicaid track with its own income rule and, unlike most other categories, an asset test.

The income limit is 300% of the maximum federal Supplemental Security Income (SSI) payment. In 2026, the SSI payment for an individual is $994 per month, which puts the Medicaid income limit at $2,982 per month, or about $35,784 per year.³ The same limit applies to both nursing facility care and home and community-based waiver services.⁴

The asset limits are $2,000 for an individual and $3,000 for a couple.⁵ Not everything counts. Your home, one vehicle, personal belongings, and certain other property are typically excluded. When one spouse enters a nursing facility and the other stays in the community, the at-home spouse keeps a protected share of the couple’s combined assets. The federal minimum for 2026 is $32,532 and the maximum is $162,660.

How Your Income Is Counted

For adults, children, and pregnant women, eligibility is based on Modified Adjusted Gross Income (MAGI). MAGI begins with the income you’d report on your federal tax return, including wages, self-employment earnings, and Social Security benefits.⁶

Several income sources are excluded entirely. Child support you receive, Veterans Affairs benefits, workers’ compensation, and scholarships used for educational expenses are all left out of the MAGI calculation.⁶ If a meaningful share of your household money comes from any of these sources, your countable income for Medicaid can be noticeably lower than your take-home pay.

The 5% Disregard

West Virginia applies a 5% FPL disregard to the highest income limit a person could qualify under. In practice, that bumps the effective ceiling up by five percentage points of the poverty level. For a single adult, the official limit is 138% FPL, but with the disregard, someone with income up to roughly 143% FPL may still qualify.⁶ The disregard only kicks in when your income exceeds the standard limit but sits inside that 5% buffer. If you’re clearly under the line, it doesn’t come into play.

Household Size

Household size decides which FPL figure your income is measured against, and a larger household means a higher dollar limit. MAGI household rules generally follow tax filing rules: if you’d claim someone as a dependent on your return, they’re usually part of your Medicaid household. Children under 19 are handled slightly differently and are always counted in their parents’ household, regardless of tax filing status.

If You’re Over the Limit: Spend-Down

Someone who earns too much for regular Medicaid but faces heavy medical bills may still qualify through West Virginia’s Medically Needy program, often called spend-down. This option is aimed primarily at aged, blind, or disabled individuals whose income exceeds the standard limit.

If your income is above the Medically Needy Income Limit (MNIL), you can subtract qualifying medical expenses until your remaining income drops to or below that limit. The state uses a six-month window, called the Period of Consideration, to decide whether your expenses close the gap.⁷

Expenses that count include health insurance premiums, Medicare copayments and deductibles, prescription costs, doctor and hospital bills, dental work, and eyeglasses. Even an unpaid balance on an older medical bill can count, as long as that portion wasn’t already used in a previous period. Medicaid eligibility starts on the day your accumulated expenses meet or exceed the spend-down amount.⁷

A Note on Non-Income Requirements

Income is the biggest factor, but it isn’t the only one. You also need to be a West Virginia resident and a U.S. citizen or qualifying immigrant, with documentary proof of both citizenship and identity on file.⁸ One point worth clearing up: for MAGI-based groups (most adults, children, and pregnant women), there is no asset test. You won’t be asked about savings accounts, vehicles, or property. Asset limits apply only to the aged, blind, and disabled categories and to long-term care Medicaid.

1
Federal Register. Annual Update of the HHS Poverty Guidelines
2
Bureau for Medical Services. Your Guide to Medicaid 2025
3
Social Security Administration. SSI Federal Payment Amounts for 2026
4
WV Bureau for Family Assistance. Medicaid for Long Term Care Eligibility and Requirements
5
WV Bureau for Family Assistance. Medicaid Eligibility and Requirements
6
WV Department of Human Services. WV Income Maintenance Manual Chapter 7 – Income Modified Adjusted Gross Income (MAGI) Methodology
7
WV Department of Human Services. WV Income Maintenance Manual – SSI-Related Medicaid (Medically Needy, Optional) Spenddown
8
Centers for Medicare and Medicaid Services. HHS Issues Citizenship Guidelines for Medicaid Eligibility