Guide to the Arkansas Medicaid Program
Medicaid is a state and federal program that provides health insurance to people with low incomes. Arkansas Medicaid covers 27 percent of the state’s population. Use this guide to find out if you qualify and how to apply.
Click on the links below to learn more about Arkansas Medicaid.
- Arkansas Medicaid Program Coverage
- Arkansas Medicaid Eligibility Requirements
- Health Insurance for Kids (ARKids)
- Arkansas Medicaid Application
- What is ConnectCare?
- Dental Managed Care
- Arkansas Works
- Arkansas Medicaid Prescription Drug Coverage
- Tax Equity and Fiscal Responsibility Act (TEFRA)
- Qualifying for Medicare and Arkansas Medicaid
Arkansas Medicaid Program Coverage
The Medicaid program in Arkansas covers medically-necessary services that include but aren’t limited to:
- Ambulance transportation
- Chiropractic care
- Dental care
- Diagnostic testing & preventive services
- Doctor’s services
- Emergency room care
- Home health care
- Hospice care
- Hospital services
- Long-term care
- Medical equipment & supplies
- Mental health
- Prescription drugs
- Rehabilitation services
- Therapy (physical, occupational, or speech)
- Vision care
- Women’s health services
Arkansas Medicaid Eligibility Requirements
Household Size: Maximum Annual Income:
According to Arkansas Medicaid, many people who qualify fall into one of the following categories:
- Age 65 and older
- Age 19 and younger
- Parents or relatives who are caretakers of children with absent, disabled, or unemployed parents
- Nursing home residents
- People in foster care younger than 21
- People who have medical needs for certain home- and community-based services
- Women who have breast or cervical cancer
Partial Medicaid Benefits
People who don’t qualify for full Medicaid benefits may qualify for Medicare Savings Programs and other ways to receive discounted medical services such as ARKids First-B and Medicaid Spend-Down.
ARKids First-B is for children under 19 years old who don’t receive medical insurance through a parent’s employer and who live in households that qualify based on income. The child’s household income must be greater than the full ARKids First amount, but still low enough to qualify for ARKids First B.
The Medicaid Spend-Down program is for people who need temporary help but make too much money to qualify for full Medicaid benefits. You may qualify for Medicaid Spend-Down if you have extremely large medical bills. You must re-enroll in Medicaid Spend-Down once every three months with your local DHS office.
Health Insurance for Kids (ARKids First)
ARKids First is a health insurance program that covers more than 70 thousand children under 19 in Arkansas. The insurance covers services such as physical exams and wellness visits, eye exams, and dental checkups. The program is based on family income and it can pay for up to 100 percent of covered services. The program uses the following income eligibility requirements:
Family Size: ARKids A: ARKids B:
1 $17,738.64 $26,358.12
2 $24,009.36 $36,675.88
3 $30,297.12 $45,018.96
4 $36,567.84 $55,336.72
5 $42,838.56 $63,654.48
6 $49,126.32 $72,997.56
7 $55,397.04 $82,315.32
8 $61,667.76 $91,633.08
Add $6,270.72 for each additional family member for ARKids A, and $9,317.76 for ARKids B.
Arkansas Medicaid Application
If you qualify for Medicaid or your family qualifies for ARKids First, you’ll need to select a primary care provider. ConnectCare is a program that helps Medicaid and ARKids First beneficiaries find a primary care physician and dental care.
What is ConnectCare?
If you think you may qualify for the Arkansas Medicaid program or ARKids First, click here. The application website covers information such as how to apply for Arkansas Medicaid online, how to apply in-person, answers to frequently asked questions, and contact information for your local DHS office.
Dental Managed Care
The Medicaid program in Arkansas covers different services for people “under age 21” and adults:
- Services for people under 21: Medicaid in Arkansas covers routine dental care such as cleanings and exams. The program also includes coverage for medically-necessary orthodontic care such as braces.
- Services for adults: Medicaid pays up to “$500 a year for most dental care,” which includes one exam, one cleaning, one set of X-rays, and one fluoride treatment.
Medicaid will also pay for the following services if they’re medically necessary:
- Simple tooth pulling
- Surgical tooth pulling
- One set of dentures
Dentures do not count toward Medicaid’s $500 limit. You can only receive one full or partial set of dentures per lifetime.
Some Arkansas Works beneficiaries owe a monthly premium and copays when they visit the doctor. The amount of your premium and/or copay depends on your income.
The Arkansas Works program also helps people find work, earn a GED, or develop new skills.
Arkansas Medicaid Prescription Drug Coverage
The Medicaid program in Arkansas uses a list of covered drugs called a formulary. Click here to download the Arkansas Medicaid program’s list of “preferred” drugs. You can appeal Medicaid’s decision regarding “non-preferred” drugs if your doctor says nothing else can treat your condition.
Tax Equity and Fiscal Responsibility Act (TEFRA)
The Tax Equity and Fiscal Responsibility Act (TEFRA) helps children under 19 years old with disabilities receive care at home, rather than in an institution. TEFRA can help pay for services for eligible children.
In order to qualify, a child must meet the Social Security Administration’s (SSA) definition of being disabled. If SSA has not determined the child to be disabled, a medical review team can assess your child’s medical records to determine disability.
Even though the child’s care would take place at home, the eligible child must have a condition that would otherwise require placement in an institution like a hospital, skilled nursing facility, or a facility for people with intellectual disabilities.
TEFRA eligibility depends on the child’s income, which cannot exceed three times the SSI limit, which can change every year. The child’s “countable resources” cannot be more than $2,000. Countable resources include cash, money in bank accounts, and vehicles. Parental income and assets do not factor into the child’s eligibility.
Qualifying for Medicare and Arkansas Medicaid
If you are 65 or older, have ALS, ESRD, or you’ve received SSDI for at least 25 months, you may qualify for Medicare. People who have both Medicare and Medicaid may qualify for a type of Medicare Advantage plan called a Dual Special Needs Plan (DSNP).
Many DSNPS have low or $0 monthly premiums, which means that you may be able to receive all of the supplemental benefits Medicare Advantage plans can offer at little or no additional cost to you.
Many people have to wait until the Annual Enrollment Period (AEP), which is from October 15 to December 7, to make changes to their coverage. However, you qualify for a Special Enrollment Period (SEP) if you have a DSNP.
Your DSNP SEP allows you to make one change per quarter from January to September. You can still make a change during the fourth quarter, but you can only make a change during AEP. The change you make during AEP will take effect on January 1 the following year.
A licensed agent with Medicare Plan Finder can help you find out if you qualify for a DSNP and help you enroll. To learn more about Dual Special Needs Plans call 1-844-431-1832 or contact us here today.