Your children
are eligible if they:
- Live in West Virginia
- Are 18 or younger
- Don’t have health insurance
now and haven’t had it
in the past six months (for the Basic CHIP Plans) or the past twelve months for the CHIP Premium Plan (some
exceptions apply, click
here for more information)
- Are not eligible for the
West Virginia State Employee
Health Insurance – PEIA
- Are not eligible for West
Virginia Medicaid
- Live in families meeting
WVCHIP Income Guidelines
- Are United States citizens
or qualified aliens (Children
who are not U.S. citizens must
provide verification of their
alien status.)
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.
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 and 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 |
Group A
Drug Co-Pays Only |
Group B
All Co-Pays Apply |
Premium Plan
All Co-Pays Apply
|
Per Month |
Annual |
Per Month |
Annual |
Per Month |
Annual |
2 |
$1,750 |
$21,000 |
$2,334 |
$28,000 |
$2,567 |
$30,800 |
3 |
$2,200 |
$26,400 |
$2,934 |
$35,200 |
$3,227 |
$38,720 |
4 |
$2,650 |
$31,800 |
$3,534 |
$42,400 |
$3,887 |
$46,640 |
5 |
$3,100 |
$37,200 |
$4,134 |
$49,600 |
$4,547 |
$54,560 |
6 |
$3,550 |
$42,600 |
$4,734 |
$56,800 |
$5,207 |
$62,480 |
7 |
$4,000 |
$48,000 |
$5,334 |
$64,000 |
$5,867 |
$70,400 |
8 |
$4,450 |
$53,400 |
$5,934 |
$71,200 |
$6,527 |
$78,320 |
*Add $3,400
(annually) for each additional
member over 8
Click here for information about
co-payments.
Can my family qualify
for WVCHIP if our income is over
the amount listed on the income
chart?
There are several income disregards
that may help you qualify for
the program if your income is
above the maximum limit for your
family size. Income disregards
are subtracted from each applicant’s
gross income. Listed below are
the types of disregards that are
available to applicants:
- $90 monthly deduction for
each parent working full-time
or part-time
- $50 monthly deduction on
total child support income
- Up to $175 monthly deduction
for child care expenses for
each child over age 2
- Up to $200 monthly deduction
for child care expenses for
each child under age 2
- Up to $175 monthly deduction
for dependent adult care expenses
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:
Access WV
West
Virginia Primary Care Association
Free
Health Clinics
Health
Insurance Paid Premium
Hill-Burton
Act
OUCH
CAP
