[Skip to Content]

West Virginia Medicaid Benefits

Friends sitting and smiling in the mountains

We help make sure you and your family get all your Medicaid benefits. Plus, UniCare members get extra benefits at no cost!

Choose usRenew

What you get with UniCare

Our benefits and services are designed to make a difference in your life.

There are no copays for behavioral health and emergency care services. Your Medicaid benefits include:

  • Primary care provider (PCP) visits
  • Immunizations and wellness visits
  • EPSDT (Early and Periodic Screening, Diagnosis and Treatment) services for members under 21
  • Specialist visits
  • Urgent and emergency care
  • Hospital care
  • Lab and X-ray services
  • Pregnancy services 
  • Family planning
  • Chiropractic services
  • Physical and occupational therapy
  • Speech and hearing services
  • Behavioral health care (mental and substance abuse services)
  • Home health care services
  • Disease management for asthma, diabetes and more

Some members will pay low copays for some care. See your member handbook for a full list of benefits. 

Find a Doctor

Registered nurses are available anytime, day or night. They can:

  • Advise you on where to go when you need care.
  • Help you with any health questions you have.

Call the 24-hour nurse help line 24 hours a day, seven days a week 1-888-850-1108 (TTY 711)

Dental care for children and emergency dental services for adults are provided through SKYGEN USA Dental.

Members under 21 years

  • Diagnostic, preventive, restorative and surgical benefits
  • Routine dental care
  • Oral exams
  • Cleanings
  • X-rays
  • Orthodontic services
  • Flouride Varnish Program

Members age 21 and older

  • Treatment of jaw fractures
  • Biopsy
  • Removal of tumors
  • Emergency extractions
  • Medically necessary emergency procedures from a dentist or oral surgeon
Find a Dentist

Vision benefits are provided by Vision Service Plan (VSP). Vision services include:

Members under 21 years of age

  • Preventive screenings
  • Eye exam once a year
  • Glasses (frames and lenses) once a year
  • Repairs to glasses
  • Contact lenses (if medically necessary)
  • Eye surgery (not cosmetic)

Members 21 years of age and older

  • Medically necessary services needed to diagnose and treat eye conditions
  • Dilated eye exam for diabetic members
  • One pair of eyeglasses after cataract surgery
  • Some contact lenses

To learn more about your vision benefits, call VSP at 1-844-526-0198 (TTY 1-800-428-4833).

Find a provider

Your pharmacy benefits are covered under the state Medicaid program and managed by DXC Technology. If you have questions about your benefits, call the DXC Technology Help Desk at 1-888-483-0797.

You can get no-cost rides to your medical appointments. You or your provider should call to schedule your ride at least five business days before your appointment.

To schedule a ride

Call LogistiCare at 1-844-549-8353 (TTY 1-866-288-3133).

Learn more
  • WW® meeting for eligible members (online included)
  • Fitness Coach Program — eligible members can receive one gym membership to participating gyms such as Anytime Fitness and YMCAs; or home fitness kits option. Benefits for members 18 and older
  • Youth club memberships to participating clubs like Boys & Girls Clubs and YMCA for ages 6-18 (not summer camps)
  • Cellphone with monthly minutes, texts and data for eligible members 18 and older
  • Digital bathroom scale for members with congestive heart failure
  • Oral Care Essentials box with items like electric toothbrush, toothpaste and floss 
  • Hypoallergenic bedding — members with an asthma diagnosis get up to $100 for hypoallergenic bedding, like pillow cases and mattress covers
  • No-cost laptop to help with educational pursuits for graduating high school students with a GPA of 3.5 or higher or students that have completed the GED/TASC
  • Up to $75 in lifestyle aids from a catalog of healthy lifestyle products
  • Personal hygiene box with up to $50 worth of hygiene products or a voucher to purchase personal hygiene products
  • Feminine care collection for females 10-18; up to $75 worth of feminine care products
  • A $100 gas card for members ($25 every 3 months per household) to help members and their families with transportation needs; limit 1 per household
  • Healthy Rewards Program
  • Family Coupon Book filled with special discounts for local retailers, restaurants, and entertainment
  • Summer Camp Sponsorship to Camp KnoKoma and Camp Catch Your Breath for eligible members
  • Online Well-Being program — online platform promoting behavioral health and wellness through instruction, games, goal setting and monitoring for eligible members 13 and older
  • SUD Recovery Support Program that provides daily motivations/check in, peer support through discussion groups and peer to peer messages, and more for eligible members
  • Community Resource Link to locate available local community-based programs, benefits, and services
  • Pregnant members can get:
    • Portable crib or convertible car seat for members with 6 prenatal visits 
    • Pregnancy and childbirth classes to help you have a healthy pregnancy
    • Fresh fruits and veggies program with up to $100 in fresh produce. All pregnant members are eligible. From 1st trimester up to 60 days post-partum.
    • Electric Breast Pump Accessory Kit with disposable nursing pads and extra milk storage bags and bottles
    • Preventive Dental Care which includes coverage for 2 dental visits per pregnancy
    • Mail order diapers for babies of eligible members for going to prenatal visits
    • Safe sleep kit with items like a swaddle sleep sack, pacifier, and infant sleep guidelines for members with a baby under one year of age

You can redeem some benefits online through your secure account. View the extra benefits you’re eligible for on the Benefit Reward Hub or call the Customer Care Center at 1-800-782-0095 (TTY 711) Monday through Friday, 8 a.m. to 6 p.m. Eastern time.

Limitations and restrictions apply. Benefits may change.

Log in to get started today!

Log in

Whether you’re thinking about having a baby, pregnant, already a new mom, or you’re not planning to have a baby, we can help you take steps to stay healthy at every stage.

Learn more

Healthy Rewards is a no-cost, optional program for eligible members enrolled in our health plan. The program encourages you to get the care you need to create a healthy lifestyle.

You can redeem these Healthy Rewards through the Benefit Reward Hub:

  • $10 for a new member health screener
  • $25 for childhood wellness visits
  • $50 for HPV vaccinations
  • $25 for adolescent wellness visits
  • $50 for breast cancer screenings
  • $50 for cervical cancer screenings
  • $25 for childhood dental visits 
  • $80 for following up with your doctor after being hospitalized for a behavioral health condition
  • $40 for ADHD medication management
  • $10 for a sexually transmitted infections screening 
  • $50 for a diabetic retinal eye exam
  • $50 for a diabetic A1c and nephropathy screening
  • $5 for completing a What do you know about diabetes? quiz

Requesting benefits

You can redeem some benefits through your secure account. Log in to see what you may be eligible for. You can request other rewards by calling the Customer Care Center at 1-800-782-0095 (TTY 711) Monday through Friday from 8 a.m. to 6 p.m. Eastern time.

Log in

You can redeem these Taking Care of Baby and Me® Healthy Rewards through the Benefit Reward Hub:

  • $25 for prenatal visit in the first trimester or within 42 days of enrollment into UniCare
  • $25 for attending at least six prenatal visits
  • $25 for attending postpartum visit 21 to 56 days after delivery
  • $25 for baby’s two-week checkup
  • $25 for attending at least six well-child checkups by 15 months of age

Requesting benefits
You can redeem some benefits through your secure online account. Log in to see what you may be eligible for. You can request other rewards by calling the Customer Care Center at 1-800-782-0095 (TTY 711) Monday through Friday from 8 a.m. to 6 p.m. Eastern time.

Log in

Referrals

A referral is when your primary care provider (PCP) sends you to some other provider for care. You’ll need to see your PCP for a referral before you see a specialist.

Self-referral

Some types of services are known as self-referral services. That means you can get these services without a referral from your PCP. You don’t need your PCP’s OK for a self-referral if the provider works with us.

  • Family planning
  • OB/GYN care from providers who work with UniCare
  • Pregnancy care
  • Emergency care
  • Vision care
  • Dental care
  • Behavioral health care

We’ll also pay for related lab work and most medicines you get at the same place as the self-referral service.

Preapprovals (also called prior authorization)

For some services, your provider will need to get approval, or an OK, from us before you get them. Your PCP will work with us to get preapproval.

You do not need an approval from your PCP for these types of care:

  • Family planning
  • OB/GYN services from plan providers
  • Emergency care
  • Vision care
  • Behavioral health services

Getting a second opinion

You might have questions about a diagnosis or the care your primary care provider (PCP) says you need. You may want to get a second opinion from another provider. You should speak to your PCP if you want a second opinion. You or your PCP may also ask us for help. You must get services from a provider in our plan. If there is no provider in our plan that fits the care you need, we’ll let you get a second opinion from a provider outside our plan. There is no cost to you for a second opinion.

For information about second opinions or services that need preapproval, please see your member handbook.

Some members will have a small copay, or fee, for some services.

There are no copays for:

  • Family planning services
  • Emergency services
  • Behavioral health services
  • Members under age 21
  • Pregnant women (including up to 60 days after pregnancy)
  • American Indians and Alaska Natives
  • Members getting hospice care
  • Other members or services not under the State Plan authority
  • Members who have met their household maximum limit for copays per calendar quarter
  • Members with primary insurance other than Medicaid
  • Approved home infusion supplies
  • Vaccines administered by a pharmacist

Copays apply for the following:
The amount you pay depends on the service and your income compared to the Federal Poverty Level (FPL).
 

Service Up to 50.00% FPL 50.01 – 100.00% FPL 100.01% FPL and Above
Inpatient Hospital (Acute Care) $0 $35 $75
Office Visits (Physicians and Nurse Practitioners) $0 $2 $4
Outpatient Surgical Services in a Physician’s Office; Ambulatory Surgical Center; or Outpatient Hospital (excluding emergency rooms) $0 $2 $4
Non-Emergency Use of Emergency Room $8 $8 $8
 

You have to pay the copays listed above until you and all family members in your household enrolled in the plan get to the household copay maximum. Your household copay maximum is based on your household income. You’re assigned to a tier based on your household size and income for the quarter.

Tier Gross quarterly income range Copay maximum
Tier 1 $0 - $1,966 $8
Tier 2 $1,967 - $3,932 $71
Tier 3 $3,933 and above $143

 

You will have no copays for the rest of the quarter once your household meets its copay maximum. You also may self-attest (report to us) that you have met the copay maximum. Call our Customer Care Center when you meet your copay maximum. Keep all your household copay receipts to show you have met the copay maximum.

You will start each quarter with $0 in copays and build toward your copay maximum. For more information on copay amounts, please call the Customer Care Center at 1-800-782-0095 (TTY 711).

We put tools and technologies in your hands to make it easier to access care and services. Your Care Plan is a tool for UniCare Case Management members to help you:

  • Stay connected with your care coordinator
  • Get your care coordinator’s phone number and email address
  • Send secure messages about diagnoses, goals, medicines, services and more
  • View your goals and objectives
  • Check due dates and statuses of goals and objectives
Go to Your Care Plan

Get the most from your benefits

New to UniCare?

As a new member, we know you have questions. We also know you’re short on time! Learn the basics about your health plan in these videos.

View videos

UniCare member handbook

Complete benefit information can be found in your member handbook.
 

Get help for addiction

If you are in need of substance use disorder (SUD) services, UniCare can help.

Learn about SUD services

Not a member yet? Choose UniCare.

You have a choice in your health care. Choose UniCare for the health care you need plus extra benefits to help you live a healthier life.

How to enroll