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Acceptable Ways to Apply Applications can be mailed Hand delivered to your local county office Faxed Apply online for ARKids:

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Presentation on theme: "Acceptable Ways to Apply Applications can be mailed Hand delivered to your local county office Faxed Apply online for ARKids:"— Presentation transcript:

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2 Acceptable Ways to Apply Applications can be mailed Hand delivered to your local county office Faxed Apply online for ARKids:

3 Documentation Needed to Apply Self-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.

4 Time Limit for Disposition of Application The 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.

5 ARKids A Full range of Medicaid Must select PCP before most benefits will be paid Income limits 133% of the FPL for children under 6 Income limits 100% of FPL for children 6 and older Income deductions: $90 from earned income, Child care deductions, and $50 deductions for child support No resource limits May have insurance and still be eligible. Insurance pays before ARKids A. Age must be under 19

6 ARKids B Benefits – limited coverage with co-pays Must select PCP before application can be certified Income limits 200% of FPL Income deductions - $50 for child support No resource limits Not 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

7 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.

8 Additional Coverage: ARKids A & TEFRA Audiology, 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.

9 Screenings (through Child Health Services) ARKids A & TEFRA If the child receives periodic Child Health Services checkups, benefits are unlimited for covered services that are medially necessary.

10 Co-payments: ARKids B ARKids 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 1 st 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 30 th. The annual cost-sharing maximum will be recalculated and the cumulative cost- sharing counter will be reset each July 1.

11 TEFRA Eligibility Requirements Age: Must be under 19 Disability: 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 Necessity Appropriateness of Care Cost Effectiveness

12 TEFRA con’t Payment 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.

13 Questions?


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