The following chart includes a list of all your benefits plus some helpful details about certain benefits. If you have questions about your Medicaid or WV CHIP benefits through Highmark Health Options, look in the latest Member Handbook or call Member Services at 1-833-957-0020 (TTY: 711), Monday–Friday, 8 a.m.–5 p.m.
Read more about maternity care.
For eligible members up to age 12 with autism, ADHD, or other similar diagnosis.
Covers professional development, mentorship, and employment assistance for high school juniors and seniors (age 16–18) and members transitioning out of treatment or incarceration. Includes opportunities that can lead to getting a job and continuing education.
Age 18 and older: For eligible members diagnosed with both prediabetes and high BMI.
Covers one water faucet filter system plus two extra filters per household per year. Note: One filter lasts about 4 months.
A 12-week online program provides eligible members with personalized help and access to affordable healthy food options.
Provides the chance to earn rewards of $5–$25 for activities like wellness visits and screenings. Rewards are put on a debit card.
Read more about the Healthy Rewards Program.
Provides free meal delivery to the home for eligible members who had a hospital stay.
Age 18 and older: Helps eligible members eat healthier, move more, and lose weight.
For eligible members diagnosed with asthma.
Ages 13–17: Earn a $5 gift card by attending quarterly virtual meetings to offer feedback and express concerns about their health and well-being.
Covers one box per eligible member.
Ages 5–18: Covers cost for 4-H clubs, health camps, and other supervised activities, including an ATV safety course.
Age 18 and older: Covers the cost of one Class X Hunting/Fishing/Trapping license per year upon receiving annual flu shot.
If you got your flu shot this year and want to claim your Healthy Reward for your free Class X Hunting/Fishing/Trapping license, call the Healthy Rewards helpline at xxx-xxx-xxxx (TTY: 711), Monday – Friday, 8 a.m. to 5 p.m.
Age 18 and older: Helps members live happier, healthier lives with social groups in their own neighborhood.
Includes services given at member’s residence. This does not include a hospital nursing facility, ICF/IDD, or state institutions. Some suppliers have service limits.
Includes nursing care, physician services, medical social services, short-term care, durable medical equipment, drugs, biologicals, home health aide, and homemaker. Requires physician certification. For adults ages twenty-one (21) and older, rights are waived to other treatment services related to the terminal illness.
Includes eye exams, treatment, lenses, frames, and repairs for children under twenty-one (21) years of age. Includes medical treatment, one pair of glasses after cataract surgery, and contact lenses (for certain diagnosis) for adults twenty-one (21) years of age and older. Does not cover prescription sunglasses or designer frames.
Includes drugs or devices to prevent implantation of fertilized ovum and medical procedures for termination of ectopic pregnancy. Physician certification required. Compliance with all applicable Federal and State laws is required for this benefit.
Includes services and supports provided through the West Virginia Birth to Three program for children under age three (3) who have a delay in their development, or may be at risk of having a delay, and for their families.
Includes physician and nursing services, dental, vision, hearing, lab, dietary, recreational, social services, psychological, habilitation, and active treatment for intellectual/developmental disabilities. Requires physician or psychiatrist certification.
Includes multi-passenger van services and common carriers (example: public railways, buses, cabs, airlines, ambulance as appropriate and private vehicle transportation). Prior authorization is required. To get transportation, call ModivCare at 1-844-889-1941 (TTY: 1-866-288-3133).
Includes nursing, social services, and therapy.
Generally safe, effective, medically necessary transplants covered when no alternative is available. Cannot be used for investigational/ research nature or for end-stage diseases. Must be used to manage disease.
Includes personal hygiene, dressing, feeding, nutrition, environmental support, and health-related functions. Room and board services require physician certification. May not exceed sixty (60) hours per month without prior authorization.
Includes assistance with daily living in a community living arrangement, grooming, hygiene, nutrition, physical assistance, and environmental for individuals in the Aged and Disabled Waiver. Limited on per unit per month basis. Requires physician order and nursing plan of care.
Includes dispensed on an ambulatory basis by a pharmacy, family planning supplies, diabetic supplies, vitamins for children, and prenatal vitamins. Hemophilia blood factor, Hepatitis-C, weight gain, cosmetic, hair growth, fertility, less than effective and experimental drugs are not covered. Drugs dispensed by a physician at no cost are not covered.
Service limitations are listed in the FFS Medicaid policy manual. Services not covered by WVCHIP.
Physician-supervised opioid agonist medication and counseling services provided to those with severe opioid use disorder.
Family planning service for individuals of childbearing age to permanently prevent pregnancy. Service requires informed consent and medical necessity.
You can get many services through Highmark Health Options. For most benefits, you will need to go through your doctor or primary care physician (PCP). There are some services that do not require a referral from your PCP. This means that you do not need approval from your PCP. Look in the Provider Directory for the list of providers who offer these services. You can schedule the appointment yourself.
Your covered services must be medically necessary. You should get these services from providers in the Highmark Health Options network. Your PCP should provide covered services or refer you to another provider to do so. These include medical, behavioral, dental, and vision services. You can get the services listed above by using your Highmark Health Options member ID card.
Some services are not available through Highmark Health Options, Medicaid, or CHIP. If you choose to get these services, you may have to pay the entire cost of the service. Highmark Health Options is not responsible for paying for these services and others:
This is not a complete list of the services that are not covered by Medicaid. If you have a question about whether a service is covered, call Member Services at 1-833-957-0020 (TTY: 711).