Medicaid agency: BMS
West Virginia Medicaid is administered by the Bureau for Medical Services (BMS), part of the Department of Human Services (DoHS) since the state's former Department of Health and Human Resources split into three successor departments in January 2024. Mountain Health Trust is West Virginia's statewide managed care program under Section 1915(b) authority, covering most adults, children, pregnant women, and SSI-related members through four MCOs: Aetna Better Health of West Virginia, The Health Plan of West Virginia, Wellpoint of West Virginia, and Highmark Health Options of West Virginia. Mountain Health Promise is a separate, single-vendor plan operated exclusively by Aetna Better Health of West Virginia for children and youth in foster care, kinship care, and adoption assistance. West Virginia's sole Section 1115 demonstration, Evolving West Virginia Medicaid's Behavioral Health Continuum of Care, covers substance use disorder treatment plus serious mental illness and serious emotional disturbance; four separate Section 1915(c) waivers round out the portfolio, covering aged and disabled, intellectual and developmental disability, traumatic brain injury, and serious emotional disorder populations. West Virginia's federal work-requirements mandate under H.R. 1, the One Big Beautiful Bill Act, takes effect January 1, 2027, with current members facing their first compliance check at their March 2027 renewal; the state's own 2023 state-level work-requirements statute was never implemented, and compliance runs entirely through the federal mandate. West Virginia is not a plaintiff in the multistate suit challenging CMS's rule implementing the work-requirements mandate.
Per CMS's 2024 managed care enrollment data (the most recent year CMS has published for West Virginia), Mountain Health Trust, the state's primary managed care program, was delivered through three MCOs covering 379,248 members: Aetna Better Health of West Virginia (136,477), Wellpoint West Virginia (145,177), and The Health Plan of West Virginia (97,594). Mountain Health Promise, the state's single-vendor specialized plan for children in foster care, kinship care, and adoption assistance, covered 28,068 members through Aetna Better Health of West Virginia.
Long-term care and Home and Community-Based Services waivers are carved out of managed care and run fee-for-service statewide, outside the four Mountain Health Trust MCOs.
Not integrated into managed care
Behavioral health is administered directly by the MCOs, integrated alongside physical health in both Mountain Health Trust and Mountain Health Promise's capitated contracts; children eligible for the Children with Serious Emotional Disorder waiver are required to enroll in Mountain Health Promise, West Virginia's single-vendor Aetna plan.
Carved in
Dental is carved into the four Mountain Health Trust MCOs' capitation, covering both children's and adult benefits; each MCO may subcontract with its own dental contractor, and no statewide dental administrator is named.
West Virginia runs no third-party commercial pharmacy benefit manager. Point-of-sale pharmacy is carved out of managed care and processed fee-for-service by Gainwell Technologies as fiscal agent, while clinical prior-authorization and edit decisions are made by West Virginia University's School of Pharmacy Rational Drug Therapy Program.
ModivCare is West Virginia's statewide non-emergency medical transportation broker, carved out of MCO capitation and run fee-for-service.
Gainwell Technologies operates West Virginia's Medicaid Management Information System and serves as fiscal agent on its Claims, Encounters, and Financials platform; Maximus is the enrollment broker operating the Mountain Health Trust member portal. BMS has not published a current contract-through-date for either role.
28 agency updates tracked for West Virginia. Available with Pro.
See them with ProHighmark Health Options West Virginia, one of the state's four Medicaid managed care organizations, is partnering with Fortuna Health to launch a digital platform helping its 20,000 members navigate new Medicaid work requirements and more frequent eligibility redeterminations starting in January. The "TurboTax for Medicaid" tool will provide renewal reminders via text, email and voice AI, guided navigation through redetermination, and multilingual live agent support, steering members to the state's PATH portal. HHO's CEO Jason Landers said he expects roughly 20% of eligible members to temporarily lose coverage due to administrative paperwork burdens, not ineligibility. The work requirements, created under the federal reconciliation law known as H.R. 1, will require most expansion adults aged 19-64 to work, train or volunteer 80 hours monthly, affecting an estimated 33,000 West Virginians statewide.
In a commentary piece, the author argues that West Virginia's non-profit hospitals are failing to deliver on the charity care obligations tied to their tax-exempt status as federal Medicaid changes under H.R. 1 threaten to cut enrollment by up to 75,000 people. The author cites West Virginia Hospital Association data showing charity care averages just 0.9% of net patient revenue, with hospitals writing off more in bad debt ($103 million) than they forgave in charity care ($79 million), while inflating "community benefit" totals by including provider tax payments and Medicare shortfalls excluded under Catholic Health Association standards. The piece points to Texas and Oregon as models that condition tax exemption on meeting charity care standards or require financial screening before collections. The author urges West Virginia's upcoming legislative session to mandate true charity care and pre-collection financial screening.
West Virginia Health Right, a free and charitable clinic in Charleston, will host its third annual #WeCareWV Day on Saturday, Oct. 17, offering free medical, dental and vision care with no income restrictions. The clinic expects to treat up to 500 patients and anticipates higher demand this year due to rising health care, food and gas costs, along with many West Virginians dropping ACA coverage after premium subsidies ended. CEO Angie Settle also said the clinic anticipates greater need once new Medicaid work requirements take effect in January, straining its budget for medicines and care. The event relies on roughly 300 volunteers, including medical and dental professionals and students.
Becker's Hospital Review profiles WVU Medicine's provider-sponsored health plan, Peak Health, which now covers more than 80,000 lives across Medicare Advantage, an administrative services organization business, and a planned ACA marketplace product. CFO Nick Barcellona says the system deliberately runs Peak as a cost center rather than a profit center, and all member hospitals operate with Peak on a capitated basis, putting the system at financial risk for population health rather than volume. The design has cut administrative friction, including denials and prior authorizations, and the system is consolidating care navigator roles across plan and hospital sides. Peak plans to add a dual special needs plan next year and expand into the ACA marketplace, while leadership stresses population-health strategies must be tailored locally rather than applied uniformly.
Gov. Patrick Morrisey announced more than $8 million in awards from West Virginia's federal Rural Health Transformation Program funds. Community Care of West Virginia, a federally qualified health center, will receive $1.1 million for telehealth upgrades, a mobile healthcare unit, workforce training, and an apprenticeship program. The Minnie Hamilton Health Center will get $4 million for a mobile healthcare unit, drone supply delivery, and AI-supported clinical documentation, while $3.2 million will fund AI ambient listening technology at five hospitals, a telehealth hub for rural skilled nursing residents, and staffing support through Vandalia Health. West Virginia received $199 million total under the program, created by the One Big Beautiful Bill Act, for 2026.
10 active waivers tracked for West Virginia. Available with Pro.
See them with ProNo active solicitations currently tracked for West Virginia.
8 managed care contracts tracked for West Virginia. Available with Pro.
See them with Pro28 bills tracked for West Virginia. Available with Pro.
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