West Virginians don’t need to be taught the value of work

By Ellen Allen

This commentary was originally published September 24, 2026 by West Virginia Watch

 

West Virginians know what it means to get up early, drive a long way to a job, work a second shift, care for a child or aging parent, go to school, volunteer in their community or keep working when they don’t feel their best because the bills still have to be paid. 

For many West Virginians, work isn’t an abstract political talking point. It is how they survive. That is why the new Medicaid work reporting requirements coming Jan. 1, 2027, deserve more than a debate about whether people should work. 

Under the new federal requirements, certain adults ages 19 to 64 enrolled in Medicaid expansion will generally need to complete 80 hours a month of work, education, job training or community service. 

Perhaps the U.S. House of Representatives needs work requirements. But I digress. 

On paper, 80 hours may sound straightforward. Real life isn’t. The people affected by these requirements are not numbers on a spreadsheet. They are people whose lives are already complicated. 

That’s something we’ve heard repeatedly through our work at West Virginians for Affordable Health Care and through our Echoes of Resilience storytelling project. When people talk about getting health care, they don’t talk about policy in isolation. They talk about the drive to the doctor’s office, missed hours at work, the cost of gas, who will watch the kids, whether they can afford to miss a shift and what happens when their health makes all those decisions harder. 

We learned during the Medicaid unwinding that paperwork matters. People can lose coverage not because they are ineligible, but because they don’t receive a notice, don’t understand what is being requested or simply can’t get the paperwork completed in time. We should not pretend that won’t happen again. 

If you or someone you love has Medicaid through the Adult Expansion Group, now is the time to understand what is coming. 

First, make sure your contact and household information are current with the state. Report changes in income, employment, household members, education, pregnancy or other circumstances through WV PATH. 

Second, know whether you qualify for an exclusion or exception. The rules are not one-size-fits-all. Certain pregnant people, parents and caregivers, people with significant health conditions or disabilities, some people in treatment or recovery, certain veterans, former foster youth and others may be excluded or exempt. 

If the requirement does apply to you, understand what can count. Paid work is not the only option. Education, job training, volunteer or community service, and certain unpaid or in-kind work can count. You may also meet the requirement through a combination of activities. For some people an income of at least $580 a month can satisfy the requirement, and seasonal workers may qualify based on their six-month average income. 

Keep records when appropriate, particularly if you are relying on unpaid or in-kind work or community service. Pay attention to your mail and WV PATH account. If the Department of Human Services asks for information, don’t ignore it. You generally have 30 days to respond. 

Most importantly, ask questions if you’re unsure. The West Virginia Medicaid Help website and Medicaid helpline at 1-877-716-1212 are available to help. 

The stories we’ve heard through Echoes of Resilience have reinforced something policymakers too often forget: people experience health policy in the context of their entire lives, not in the neat categories of a statute. =

Those stories don’t tell us that West Virginians don’t want to work. They tell us that work is only one part of a much bigger picture. A person can be working and still struggling. They can be working fewer hours because there simply aren’t more hours available. They can be providing unpaid care that never appears on a paycheck. 

And all of them can need health care. 

A mother working 60 hours one month and 90 the next is still working. A seasonal worker whose income fluctuates is still working. A caregiver whose labor doesn’t come with a paycheck is still contributing. A person dealing with a serious health condition may be fighting every day just to remain stable. 

And a person who misses a notice or cannot complete a form on time should not suddenly become less deserving of health care. Medicaid is not a reward for working. It is health coverage. 

Health care should be a foundation people can stand on — not another obstacle they have to overcome.