WV MEDICAID MARKET
West Virginia
monitoring
No current verified market signal.
Last verified: unavailable
Last verified: unavailable · no state-specific item
No current verified signal
Precapture is monitoring this market. No state-specific public intelligence item is currently published.
Plans in this market
Parent, plan, and program come from the plan graph. Enrollment and share use the latest CMS reported count. Operations counts are CMS MCPAR. A dollar amount is not on this page.
Plans in this market 18
| Parent | Plan | Programs | Latest CMS enrollment | Share | MCPAR operations |
|---|---|---|---|---|---|
| CVS/Aetna | Aetna Better Health of WV | not reported | 122,563 (2018) | 30.1% calculated | not reported |
| CVS/Aetna | Aetna Better Health of WV | not reported | 28,068 (2024) | 100.0% calculated | not reported |
| CVS/Aetna | Aetna Better Health of WV (formerly CoventryCares) | not reported | 127,795 (2017) | 30.1% calculated | not reported |
| CVS/Aetna | Aetna Better Health of West Virginia | not reported | 137,463 (2019) | 35.5% calculated | 5 sanctions, 719 appeals resolved |
| Elevance | UniCare | not reported | 154,644 (2019) | 39.9% calculated | not reported |
show all 18
| Parent | Plan | Programs | Latest CMS enrollment | Share | MCPAR operations |
|---|---|---|---|---|---|
| Elevance | Unicare | not reported | 139,509 (2018) | 34.3% calculated | not reported |
| Elevance | Unicare of WV | not reported | 162,513 (2020) | 39.7% calculated | not reported |
| Elevance | Unicare of WV | not reported | 192,434 (2022) | 39.2% calculated | 918 appeals resolved |
| Elevance | Wellpoint West Virginia | not reported | 145,177 (2024) | 38.3% calculated | 492 appeals resolved |
| not reported | Modivcare | not reported | 456,099 (2024) | 100.0% calculated | not reported |
| not reported | The Health Plan | not reported | 95,269 (2019) | 24.6% calculated | not reported |
| not reported | The Health Plan of WV | not reported | 97,594 (2024) | 25.7% calculated | 83 appeals resolved |
| Highmark | WV Family Health | not reported | 69,911 (2017) | 16.5% calculated | not reported |
| Highmark | West Virginia Family Health | not reported | 64,396 (2018) | 15.8% calculated | not reported |
| not reported | CoventryCares of WV | not reported | 123,656 (2016) | 31.7% calculated | not reported |
| not reported | The Health Plan | not reported | 72,947 (2016) | 18.7% calculated | not reported |
| not reported | UniCare | not reported | 132,088 (2016) | 33.9% calculated | not reported |
| not reported | WV Family Health | not reported | 61,392 (2016) | 15.7% calculated | not reported |
CMS reported enrollment
CMS reporting years in this file run from 2016 through 2024. Retrieved 2026-11-01. The latest reporting year is 2024, which is behind the retrieval date. Enrollment figures are the CMS cell for that reporting year. Share is calculated from CMS reported total enrollment for that state, program, and year. Precapture does not combine rows. A year missing from a trend was not reported. A plan and region with more than one CMS row in a year has no trend and no year-over-year change. The dataset says a reported 0 may not truly represent 0 when a state suppressed a small count. CMS reported.
Mountain Health Promise (Comprehensive MCO)
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Aetna Better Health of WV | CVS/Caremark | CVS/Aetna | State-wide enrollment | not reported | not reported | not reported | not reported | 2020: 20,276 |
| Aetna Better Health of WV | CVS/Caremark | CVS/Aetna | Statewide | CMS reported 28,068 (2024) | 100.0% | +2,557 (+10.0%) | 0.0 pts | 2021: 25,533; 2022: 29,588; 2023: 25,511; 2024: 28,068 |
Mountain Health Trust (Comprehensive MCO)
Mountain Health Trust (Comprehensive MCO) 13
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Aetna Better Health of WV (formerly CoventryCares) | Aetna | CVS/Aetna | statewide | not reported | not reported | not reported | not reported | 2017: 127,795 |
| Aetna Better Health of WV | CVS/Caremark | CVS/Aetna | Statewide | CMS reported 136,477 (2024) | 36.0% | -27,214 (-16.6%) | +0.3 pts | 2018: 122,563; 2020: 146,458; 2021: 164,655; 2022: 173,985; 2023: 163,691; 2024: 136,477 |
| Aetna Better Health of West Virginia | Aetna | CVS/Aetna | Statewide | not reported | not reported | not reported | not reported | 2019: 137,463 |
| The Health Plan of WV | The Health Plan of WV | The Health Plan of WV | Statewide | CMS reported 97,594 (2024) | 25.7% | -20,133 (-17.1%) | +0.1 pts | 2020: 100,089; 2021: 115,228; 2022: 125,010; 2023: 117,727; 2024: 97,594 |
| The Health Plan | The Health Plan | The Health Plan | Statewide | not reported | not reported | not reported | not reported | 2018: 80,725; 2019: 95,269 |
show all 13
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| The Health Plan | The Health Plan | The Health Plan | statewide | not reported | not reported | not reported | not reported | 2017: 84,064 |
| UniCare | Anthem | Elevance | Statewide | not reported | not reported | not reported | not reported | 2019: 154,644 |
| UniCare | Anthem | Elevance | statewide | not reported | not reported | not reported | not reported | 2017: 142,892 |
| Unicare of WV | Elevance | Elevance | Statewide | not reported | not reported | not reported | not reported | 2020: 162,513; 2021: 182,632; 2022: 192,434 |
| Unicare | Anthem Insurance Companies, Inc. | Elevance | Statewide | not reported | not reported | not reported | not reported | 2018: 139,509 |
| WV Family Health | WV Family Health/Highmark | WV Family Health/Highmark | statewide | not reported | not reported | not reported | not reported | 2017: 69,911 |
| Wellpoint West Virginia | Elevance | Elevance | Statewide | CMS reported 145,177 (2024) | 38.3% | -32,169 (-18.1%) | -0.4 pts | 2023: 177,346; 2024: 145,177 |
| West Virginia Family Health | West Virginia Family Health/Highmark | West Virginia Family Health/Highmark | Statewide | not reported | not reported | not reported | not reported | 2018: 64,396 |
Non-Emergency Medical Transportation (NEMT)
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Modivcare | Modivcare, Inc. | Modivcare | Statewide | CMS reported 456,099 (2024) | 100.0% | -88,643 (-16.3%) | 0.0 pts | 2022: 588,280; 2023: 544,742; 2024: 456,099 |
WV Mountain Health Trust (Comprehensive MCO)
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| CoventryCares of WV | not reported | unmatched | Statewide | not reported | not reported | not reported | not reported | 2016: 123,656 |
| The Health Plan | not reported | unmatched | Statewide | not reported | not reported | not reported | not reported | 2016: 72,947 |
| UniCare | not reported | unmatched | Statewide | not reported | not reported | not reported | not reported | 2016: 132,088 |
| WV Family Health | not reported | unmatched | Statewide | not reported | not reported | not reported | not reported | 2016: 61,392 |
Plan operations (CMS MCPAR)
Counts, rates, dates, and status are the CMS MCPAR cells for that plan, program, and reporting year. The appeal rate is calculated from CMS reported appeals resolved in favor of the enrollee divided by CMS reported appeals resolved. It is not a CMS-published rate. A plan links when the name matches one enrollment plan in that same state and program. Unmatched is shown and is not guessed. A sanction amount is not on this page. Retrieved 2026-11-02. CMS MCPAR.
National plan operations · Federal compliance deadlines
Appeals, grievances, and enrollment share (2024)
| Plan | Parent | Program | Appeals resolved | In favor of enrollee | Appeal rate | Grievances resolved | Medicaid enrollment share | Managed care enrollment share |
|---|---|---|---|---|---|---|---|---|
| Aetna Better Health of West Virginia | CVS/Aetna | Mountain Health Promise | 20 | not reported | not reported | 122 | 4.9% | 5.7% |
| Aetna Better Health of West Virginia | CVS/Aetna | Mountain Health Trust | 304 | not reported | not reported | 931 | 25.8% | 29.4% |
| The Health Plan of West Virginia, Inc. | The Health Plan of WV | Mountain Health Trust | 42 | 15 | 35.7% calculated | 69 | 19.5% | 22.3% |
| Wellpoint West Virginia, Inc. | Elevance | Mountain Health Trust | 492 | 106 | 21.5% calculated | 1,386 | 29.3% | 33.5% |
Sanctions (2024)
| Plan | Parent | Topic | Date | Corrective action plan | Remediation status |
|---|---|---|---|---|---|
| Aetna Better Health of West Virginia | CVS/Aetna | Financial issues (N/A) | 2024-06-28 | Yes | Yes, remediated |
| Aetna Better Health of West Virginia | CVS/Aetna | Other, specify (Deficiencies in the Dental Provider Network) | 2024-06-28 | Yes | Yes, remediated |
Award history
- Mountain Health Trust (Request for Application for qualified MCOs) MHT RFA (no number captured): awarded. Mountain Health Trust (Request for Application for qualified MCOs) (MHT RFA (no number captured)). Status recorded from the retrieved documents: awarded. Named awardees in confirmed excerpts: Highmark Health Options West Virginia. Award date 2024-01-16. Contract start 2024-07-01.
Retrieved 2026-11-03. Sources and scores
Early procurement signals
No official early-procurement document has been retrieved for this state. This is not a finding that no signal exists. Early signals
Contract amendments
No official Medicaid managed-care contract amendment has been retrieved for this state. This is not a finding that no amendment exists. Contract amendments
Medicaid policy
Indiana rows are official policy instruments. Other states show only Federal Register notices of hearings on SPA disapprovals, which are a narrow slice and not waiver or SPA coverage.
Federal Register notices of hearings on SPA disapprovals are read from the Federal Register JSON API. That covers no approved SPAs, waivers, or section 1115 demonstrations.
Coverage not_collected.
No official Medicaid managed-care policy instrument has been retrieved for this state. This is not a finding that no waiver, state plan amendment, or rule exists. Medicaid policy
Federal Register SPA disapproval hearing notices (2015 or later): 0
Plan financials
No official Medicaid plan financial filing has been retrieved for this state. This is not a finding that no filing exists, and it is not a zero. Plan financials. Coverage: not_collected.
Federal compliance deadlines
Cited federal Medicaid managed care deadlines, with the Federal Register citation, the effective date, the compliance date, and the plan obligation.