2027 Medicaid New Community Involvement Eligibility Changes

The West Virginia Department of Human Services (DoHS) is reminding Medicaid members to take steps now to prepare for new federal eligibility requirements that will take effect in 2027.

In July 2025, the federal government passed H.R.1, which requires that certain Medicaid members under the Adult Expansion Group will have to be working or engaged in  approved community activities unless they qualify for an exclusion or exception in order to continue to receive Medicaid benefits.

So, beginning on Jan. 1, 2027, certain adults ages 19 through 64 who are enrolled in the Medicaid Adult Expansion Group will be required to complete 80 hours per month of work or other qualifying activities to maintain their Medicaid coverage.

Qualifying activities may include employment, participation in a work program, education, or volunteering. Members may combine activities to meet the 80-hour monthly requirement. They may also meet the requirement by earning at least $580 per month. Seasonal workers may qualify based on their six-month average income.
Medicaid members are encouraged to:

• Keep information up to date. Review and update contact, household, and eligibility information with the Department of Human Services.
• Report changes in employment, income, or household circumstances through WV PATH.
• Complete Medicaid eligibility reviews and provide the requested information by the stated deadlines.
• And visit  wvmedicaidhelp.org to learn more about qualifying activities, exemptions, reporting requirements and important timelines.

Some individuals are excluded from the community engagement requirements. Individuals who meet an approved exclusion are not required to meet the community engagement requirement as long as their exclusion is present for all or part of at least one month of a renewal period.

If you contact them, DoHS will check your status to see if you qualify for an exclusion or exception and ask you for more information if they need it. You can report changes, apply for benefits and complete eligibility reviews through WV PATH at www.wvpath.wv.gov

Just to clarify, these new regulations only apply to certain Medicaid recipients, and not to people receiving Medicare.