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West Virginia Income Maintenance Manual Chapter 22

West Virginia Income Maintenance Manual Page 1 Chapter 22 West Virginia Children’s Health Insurance Program (WVCHIP)

22.1 INTRODUCTION The West Virginia Children’s Health Insurance Program (WVCHIP) is administered through the Children’s Health Insurance Agency within the Department of Human Services (DOHS, the Department). WVCHIP is a means-tested health insurance program for children from birth to age 19 and pregnant women. See 22.17 for WVCHIP Pregnancy. Applications are received through the Federally Facilitated Marketplace (FFM), the DOHS, or any entity approved to take applications on behalf of the DOHS. Eligibility determination by the FFM or the Department are equally valid. Eligible clients are assigned to one of the following WVCHIP enrollment groups based on the countable income of the Income Group (IG): • WVCHIP Children Gold – up to 150% of the federal poverty level federal poverty level (FPL) with limited co-payments • WVCHIP Children Blue – over 150% of the FPL and up to 211% of the FPL with full co- payments • WVCHIP Pregnancy Blue – over 185% of the FPL and up to 211% of the FPL with full co-payments • WVCHIP Children and Pregnancy Premium – over 211% of the FPL and up to 300% of the FPL with monthly premiums and full co-payments • Exempt – Federal regulations exempt Native Americans/Alaska Natives from cost sharing Even though some policies and procedures for WVCHIP are the same as those for Medicaid, medical coverage under WVCHIP is not Medicaid. WVCHIP policies and procedures have been placed in this chapter to differentiate WVCHIP from Medicaid. Where policies and procedures duplicate those for Medicaid, reference is made to the appropriate Income Maintenance Manual (IMM) chapter.