acceptable ways to apply applications can be mailed hand delivered to your local county office faxed...

Acceptable Ways to Apply

Applications can be mailedHand delivered to your local county officeFaxedApply online for ARKids:

http://access.arkansas.gov/welcome.aspx

Documentation Needed to ApplySelf-declaration for all eligibility factors will

be accepted with the exception of citizenship, alien status for non-citizens, and age.

You may be contacted either by phone or mail, if the county has verification of income through other programs (e.g. SNAP, or WESD) and there appears a discrepancy that could make a difference in eligibility.

Time Limit for Disposition of ApplicationThe caseworker will have up to 45 days from

the date of application (ARKids) to make disposition by one of the following actions: approval, denial, or withdrawal.

The date of application is the date the application was received in the county office.

If applying for TEFRA, the application can take longer (up to 90 days) if disability must be established.

ARKids AFull range of MedicaidMust select PCP before most benefits will be paidIncome limits 133% of the FPL for children under 6Income limits 100% of FPL for children 6 and olderIncome deductions: $90 from earned income, Child

care deductions, and $50 deductions for child support

No resource limitsMay have insurance and still be eligible. Insurance

pays before ARKids A.Age must be under 19

ARKids BBenefits – limited coverage with co-paysMust select PCP before application can be

certifiedIncome limits 200% of FPLIncome deductions - $50 for child supportNo resource limitsNot eligible if child has comprehensive group

or employer-based insurance. If dropped, 6 month waiting period except where insurance was terminated involuntarily

Age must be under 19

Basic Coverage – ARKids A & B (TEFRA)Physician, prescription drugs, hospital,

ambulance (emergency only), dental, medical equipment, medical supplies, emergency department services, eye glasses, family planning, health screens, home health services, laboratory and x-ray, mental health – outpatient only, podiatry, speech therapy and vision, chiropractor, immunizations, nurse midwife and nurse practitioner.

Additional Coverage: ARKids A & TEFRAAudiology, child health management services,

developmental day treatment clinic services, domiciliary care, end stage renal disease services, hearing aids, hospice, hyperalimentation, inpatient psychiatric, nursing facilities, orthotics, personal care, transportation (non-emergency), private duty nursing, prosthetics, therapy (occupational and physical), ventilator services, and targeted case management.

Screenings (through Child Health Services) ARKids A & TEFRAIf the child receives periodic Child Health

Services checkups, benefits are unlimited for covered services that are medially necessary.

Co-payments: ARKids BARKids B requires a co-pay as follows: $5.00 per

prescription drug, $10.00 per medical visit, $10.00 per emergency ambulance trip, 20% of the 1st day of inpatient hospitalization 20% of Medicaid allowed amount for each item of durable medial equipment. A co-payment is not required for preventative health screens, family planning services and dental checkups. ARKids B families will have an annual cumulative cost-sharing (co-payments & coinsurance) maximum of 5% of the family’s gross annual income. The annual period is the state fiscal year (SFY) of July 1 through June 30th. The annual cost-sharing maximum will be recalculated and the cumulative cost-sharing counter will be reset each July 1.

TEFRA Eligibility RequirementsAge: Must be under 19Disability: Must be disabled according to the SSI

definition of disability. If not established by SSA, it must be determined by Medical Review Team

Income: The child’s gross countable income must be less than $2,022 (2009 long term care limit) (parent’s income not considered)

Resources: The child’s countable resources cannot exceed $2000. (parent’s resources not considered)

Medical NecessityAppropriateness of CareCost Effectiveness

TEFRA con’tPayment of Premiums: Annual income over

$25,000 will be required to pay monthly premiums.

Dropped Health Insurance: Can receive TEFRA & retain health insurance coverage. For applicants, if insurance voluntarily dropped in the 6 months prior to application, the child will be ineligible for TEFRA benefits for 6 months. For recipients, if coverage was voluntarily dropped after the case was approved, the case will be closed for 6 months beginning with the month following the month of discovery.

Questions?