West Virginia Medicaid Program Overview
Enrollment, funding, and managed care facts for West Virginia Medicaid.
Get West Virginia's Medicaid Fee Schedule →Enrollment
West Virginia Medicaid covered approximately 0.49-0.53M people. Two independent sources give different figures for different reporting periods: KFF's monthly enrollment tracker reports 486,392 for West Virginia as of May 2026, while CMS's 2024 Medicaid Managed Care Enrollment and Program Characteristics report cites 533,405 total Medicaid enrollees (2024 data). The gap is consistent with the ongoing post-pandemic continuous-enrollment 'unwinding,' not a data-quality problem. West Virginia's own Bureau for Medical Services (BMS) 2025 HB4217 annual report separately reports 401,650 members enrolled in its two managed-care programs (Mountain Health Trust + Mountain Health Promise) as of December 31, 2025, and about 485,956 unique members served through MCOs during all of CY2025 -- consistent in magnitude with both cited figures but not a total-Medicaid-population count, so not used to adjust the range.
Funding & federal match
West Virginia has adopted ACA Medicaid expansion, effective 2014-01-01.
For FFY2026 (Oct 1, 2025 - Sep 30, 2026), West Virginia's Federal Medical Assistance Percentage (FMAP) is 74.22%.
Waivers
West Virginia operates Medicaid managed care under the Evolving West Virginia Medicaid's Behavioral Health Continuum of Care, a Section 1115 demonstration waiver. Project No. 11-W-00307/3. Five-year extension approved effective January 1, 2025 through December 31, 2029 (retitled from the original 2017 'Creating a Continuum of Care for Medicaid Enrollees with Substance Use Disorder' demonstration). Covers SUD treatment in Institutions for Mental Disease (IMD), peer recovery support specialist services, and now adds SMI IMD authority, health-related social needs (HRSN) housing supports, Quick Response Teams, and limited coverage for certain incarcerated individuals for up to 90 days pre-release.
Frequently Asked Questions
Get West Virginia's Free Medicaid Fee Schedule
Request actual West Virginia Medicaid reimbursement rates by billing code — free, delivered as a CSV.
Sources
- KFF State Health Facts - Total Monthly Medicaid & CHIP Enrollment
- CMS - Medicaid Managed Care Enrollment and Program Characteristics, 2024
- MACPAC - MACStats: Medicaid and CHIP Data Book, February 2026 (Exhibit 6, compiling HHS Federal Register FMAP notices)
- KFF State Health Facts - Federal Matching Rate (FMAP) and Multiplier
- KFF State Health Facts - Status of State Action on the Medicaid Expansion Decision
- healthinsurance.org - Medicaid eligibility and enrollment in West Virginia
- West Virginia Waiver Programs - Section 1115 Demonstration
- CMS - Approval Letter, Evolving West Virginia Medicaid's Behavioral Health Continuum of Care (11-W-00307/3)
Data last verified 2026-09-17. Also see our free Medicaid Fee Schedule tool.