Gizmo Warehouseby Joe Eichenbaum | 17A

Medicaid work requirements · West Virginia

Medicaid work requirements in West Virginia: who is subject and who loses coverage (2027)

Data snapshot 2026-06-03 · part of These 5 Million People Are About to Lose Their Medicaid — But They Don't Have To

West Virginia expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 159,195 of them (15.5% of an expansion pool of 170,182) will have to prove 80 hours a month of work, school, or service, or an exemption, to keep coverage.

This model's bottom-up estimate is that 51,586 people in West Virginia lose coverage by 2034: 46,810 of them still eligible but lost to paperwork and reporting failures, and 4,776 not meeting the requirement. Nationally the same model gives 5,461,400, against CBO's 5,200,000.

Whether those eligible people keep coverage depends on the state's ability to renew them automatically (ex parte) from data it already holds. West Virginia scores 60 of 100 on this model's ex parte capability index, a mid band; its eligibility system is RAPIDS.

Key figures

Model v2-2026-06-03. "Strict" counts adults whose ACS record shows them subject with no observable exemption; "permissive" allows the broader exemption reading.
MeasureWest Virginia
Expansion stateYes
Subject to the requirement via waiverNo
Expansion pool (adults 19 to 64)170,182
Adults subject, strict definition159,195
Adults subject, permissive definition156,011
Share of expansion pool subject15.5%
Projected coverage loss by 203451,586
Hardship exception statusAdopting
Early implementerNo
Ex parte capability score (0 to 100)60 (mid)

Who is subject in West Virginia

Of the 159,195 subject adults, 33% already work 80 or more hours a month and 63% are not working. 36% have a child under 14 at home. Among those not working, 51% report a disability and 16% are caregivers.

ACS PUMS 5-year 2020 to 2024, subject adults only.
CharacteristicShare of subject adults
Age 19-2412%
Age 25-3422%
Age 35-4423%
Age 45-5419%
Age 55-6424%
Not working63%
1 to 19 hours a month1%
20 to 79 hours a month4%
80 or more hours a month (meets the bar)33%
Not working: Disabled51%
Not working: Caregiver16%
Not working: Postpartum0%
Not working: Student2%
Not working: Other30%

Why eligible people lose coverage

Of the 51,586 projected to lose coverage in West Virginia, 46,810 meet the requirement or qualify for an exemption but fail to document it. 13,054 of those are working people who cannot prove their hours through data the state can see, and 33,756 qualify for an exemption the state does not detect automatically.

Bottom-up model v8.0-2026-05-30; documentation-failure buckets compound over the 14 six-month renewal cycles through 2034.
GroupProjected to lose coverage
Multiple part-time jobs (aggregation failure)4,157
Variable shifts / on-call work3,724
Self-employed (other)1,698
Volunteering / job training969
Full-time students not auto-verified869
Seasonal: agriculture, hospitality, food service749
Cash-paid construction & trades665
Gig / courier (DoorDash, Uber, Lyft, Instacart)222
Medically frail without auto-match10,676
Caregivers of a disabled adult8,220
Parent caregivers of children ≤13 without auto-match7,818
Kinship caregivers (non-parent) of children ≤132,799
SUD treatment not flagged in claims data1,253
Recent incarceration (data-match gap)1,069
American Indian / Alaska Native (tribal exemption)999
Other categorical exemptions (foster, AYA cancer, SNAP/TANF)822
Pregnancy / postpartum data lag100

Can the state renew people automatically?

The ex parte capability index blends the state's observed automatic-renewal rate (59% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. West Virginia's composite score is 60 (mid band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.

ComponentScore
Composite60
Observed ex parte59
Core capability62
Data sources65
Historical churn50

How subjects overlap across exemption categories

Each subject adult sits in exactly one cell. Categories: Working ≥ qualifying hours / income; Parent caregiver of child ≤13; Medically frail; Full-time student.
CombinationAdultsShare
None of the four60,88738.3%
Medically frail26,81816.9%
Working ≥ qualifying hours / income23,27914.6%
Working ≥ qualifying hours / income + Parent caregiver of child ≤1322,76114.3%
Parent caregiver of child ≤1312,4437.8%
Full-time student3,4712.2%
Working ≥ qualifying hours / income + Full-time student2,8971.8%
Parent caregiver of child ≤13 + Medically frail2,0091.3%

Counties in West Virginia

Subject adults concentrate: Kanawha County (15,404), Monongalia County (11,325), and Berkeley County (10,454) account for 23% of the state's subject population.

All 55 counties in West Virginia with subject adults, sorted by count. County figures are model allocations of the state estimate by ACS tract characteristics.
CountyAdults subjectSubject rateProjected lossPoverty rateWorking-age population
Kanawha County15,40415.3%4,99216.0%100,730
Monongalia County11,32515.8%3,67021.0%71,900
Berkeley County10,45413.3%3,38711.0%78,498
Cabell County8,53115.7%2,76420.0%54,294
Wood County7,29415.5%2,36415.0%47,153
Raleigh County6,27315.4%2,03322.0%40,741
Harrison County5,58114.9%1,80914.0%37,358
Marion County5,27816.1%1,71015.0%32,708
Putnam County5,14115.6%1,66611.0%32,952
Mercer County5,03215.6%1,63119.0%32,276
Jefferson County5,03114.1%1,6309.0%35,698
Ohio County3,78916.2%1,22815.0%23,392
Fayette County3,42215.5%1,10922.0%22,130
Wayne County3,24315.1%1,05117.0%21,523
Greenbrier County2,87616.0%93220.0%17,954
Preston County2,87013.8%93014.0%20,822
Marshall County2,76616.4%89615.0%16,826
Logan County2,65515.1%86024.0%17,556
Hancock County2,62916.5%85213.0%15,956
Randolph County2,42415.2%78515.0%15,912
Jackson County2,42215.5%78520.0%15,598
Mineral County2,39615.9%77714.0%15,065
Nicholas County2,28217.3%73917.0%13,157
Upshur County2,27717.1%73818.0%13,324
Hampshire County2,18916.4%70917.0%13,342
Mason County2,17315.5%70416.0%14,047
Brooke County2,16517.6%70211.0%12,278
Boone County1,89816.0%61517.0%11,863
Mingo County1,89415.4%61429.0%12,312
Wyoming County1,88516.3%61124.0%11,592
Lincoln County1,74815.9%56619.0%11,023
Morgan County1,64516.7%53311.0%9,879
Lewis County1,56816.6%50817.0%9,422
Taylor County1,47615.7%47817.0%9,406
Barbour County1,41416.1%45822.0%8,788
McDowell County1,41213.4%45833.0%10,579
Hardy County1,31516.4%42617.0%7,996
Wetzel County1,27316.4%41317.0%7,754
Roane County1,24716.4%40421.0%7,626
Braxton County1,18017.3%38218.0%6,812
Monroe County1,13417.5%36713.0%6,493
Grant County1,06417.9%34512.0%5,940
Summers County1,05015.9%34021.0%6,601
Ritchie County76516.5%24820.0%4,625
Webster County76117.3%24718.0%4,400
Tyler County74716.7%24212.0%4,480
Clay County74017.7%24025.0%4,188
Pleasants County71815.8%2338.0%4,548
Pocahontas County70216.8%22820.0%4,172
Doddridge County69914.6%22614.0%4,792
Tucker County63717.0%20610.0%3,739
Pendleton County62520.6%20216.0%3,033
Gilmer County62013.2%20111.0%4,692
Calhoun County56417.3%18334.0%3,252
Wirt County49317.8%16020.0%2,772

State brief and methodology

Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.

Sources

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