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 Eligibility

Your children are eligible if they:

  • Reside in West Virginia
  • Are under age 19
  • Lost family coverage in the last 3 months (some exceptions apply, click here for more information)
  • Are not eligible for West Virginia Medicaid
  • Income & family size fall within qualifying Income Guidelines
  • Are United States citizens or qualified aliens (Children who are not U.S. citizens must provide verification of their alien status.)

American Indian or Native Alaskan Eligibility

Children who are members of federally recognized American Indian or Native Alaskan tribes are not required to pay co-payments once enrolled in the West Virginia Children’s Health Insurance Program.
If your children are members of a federally recognized American Indian or Native Alaskan tribe, please call the WVCHIP toll-free helpline at 1-877-982-2447 to see if they are eligible for free health insurance coverage.

Click here for a list of federally recognized tribes.

Income Guidelines

WVCHIP income guidelines are based on family size. Family size means the number of parents living with their natural or adopted children plus the number of children under age 19.  See chart here.

Whose Income Is Counted?

Only the income of the child and/or the natural or adoptive parent is counted to qualify. This means income from grandparents, stepparents, or other relatives or adults in the home are not counted as part of the qualifying income level.

- Blended Family
For example, a family of five blended from prior marriages with two children biologically related to the father and one to the mother will have their income counted in two separate qualifying groups. Their income will only be counted as a family of five if one parent has legally adopted their stepchildren.

- Grandparents
Only the income of the child will be counted when being raised by grandparents (unless the child is legally adopted by the grandparents).

- Expecting A Child
If you are expecting a child and would like the child to be counted as a part of your family size to qualify for WVCHIP, the pregnancy must be confirmed with a doctor's statement.  WVCHIP does not cover labor or delivery costs for the child.  After the child has been born and you want to apply for coverage for the child under WVCHIP, you can call the Department of Health & Human Resources, Customer Service Center (DHHR CSC) at 1-877-716-1212.  All claims related to the child will be put on hold by WVCHIP until a social security number has been reported to the DHHR CSC for the child being born.  Please remember to apply for the child's social security card right away and report the social security number immediately upon receiving.

 

Family Size

WVCHIP Gold  
Minimal Co-Pays Only

WVCHIP Blue  
All Co-Pays Apply

WV Premium Plan
All Co-Pays Apply

Per Month
Annual
Per Month
Annual
Per Month
Annual
2
$1,967
$23,595
$2,766
$33,191
$3,933
$47,190
3
$2,474
$29,685
$3,480
$41,757
$4,948
$59,370
4
$2,982
$35,775
$4,194
$50,324
$5,963
$71,550
5
$3,489
$41,865
$4,908
$58,891
$6,978
$83,730
6
$3,997
$47,955
$5,622
$67,457
$7,993
$95,910
7
$4,504
$54,045
$6,336
$76,024
$9,008
$108,090
*  If a family has signed up to have a provider listed as their child's medical home provider, and they go to see that provider, they will be exempt from the $5 copays for their medical appointments. There is a $5 copay for Covered Brand Name Prescriptions.

**Add $3,400 (annually) for each additional member over 8

Click here for information about co-payments.

What types of deductions are allowed if I am self-employed?

Your self-employment income is counted minus allowable business expenses paid. WVCHIP allows the following deductions: employee labor costs, stock and supplies, raw material, seed, fertilizers, repair and maintenance on machinery or property, cost of rental space used for conducting business, interest & taxes, but not principal paid on purchase of capital assets, interest & taxes on a portion of residence used to produce income, advertising costs, utilities, office expenses (stamps, pens, etc.) and legal costs.

What types of documents can I use to verify my income?

  • Paystubs or earning statements for the last thirty days
  • Most recent quarterly or yearly tax return, if self-employed
  • Proof of most recent alimony and/or child support payment or court order, if applicable
  • Proof of most recent payment or current award letter for Social Security, SSI, Worker’s Compensation, Unemployment benefits, Veteran’s benefits, or any other income source
  • If your income is seasonal or highly variable through the year, income is based on what you have earned in the month you are applying. You may also use your yearly tax return  

Is Social Security (SSI) or Social Security Disability (RSDI) income counted for WVCHIP eligibility?

SSI is not countable income and also the person who receives SSI is not counted in the family size. For example, if you have a family of 6 (2 parents and 4 children) and 2 children are receiving SSI, then it would be considered a household of 4. This family would have to fall within the income guidelines of a family of 4 not a family of 6.

RSDI is countable income.  For example, if you have a family of 4 (father receives $1,000 RSDI; mother receives $500 RSDI; and the two children are receiving $250 a piece), the family income would be counted as $1,750 (not $2,000- because one child's income is not counted against the other).  The family would have to fall within the income guidelines of a family of 4.

How Is Income Counted for WVCHIP?

Applications are reviewed based on most recent income received in the month (equal to the past 30 day period). All income shown on your application form will be converted to a monthly basis as shown on this table:

 

Examples On How To Calculate Your Monthly Income
If Your Pay Check Is… To Find Your Monthly Amount (Before Taxes) Monthly Income Result
Weekly
52 checks per year
Multiply by 4.3
$175.35 x 4.3
= $754
Bi-Weekly
26 checks per year
Multiply by 2.15
$350.70 x 2.15
= $754
Semi-Monthly
24 checks per year
Multiply by 2
$377.00 x 2
= $754
Bi-Monthly
6 checks per year
Divide by 2
$500 divided by 2
= $250
Quarterly
4 checks per year
Divide by 3
$750 divided by 3
= $250
Semi-Annual
2 checks per year
Divide by 6
$1,500 divided by 6
= $250
Annual
1 check per year
Divide by 12
$3,000 divided by 12
= $250

Where can my family get health care if we don’t meet the WVCHIP guidelines?

There are many facilities in the state of West Virginia that offer discounted or free services to families who do not have health insurance. Click on one of the resources listed below for more information:

AccessWV
West Virginia Primary Care Association
WV free Clinics and Community Health Centers
Hill-Burton Act
CAP

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