Health Insurance For Low-Income
Medicaid is a program that helps pay for medically necessary medical services for needy and low-income persons. It uses state and federal government money. The Department of Human Services (DHS) runs the Medicaid program in Arkansas. Medicaid and Medicare are different programs. Medicare is federal health insurance. Medicare pays for covered medical services for people aged 65 and older, and for some people who have a disability. With the introduction of Obamacare (The Affordable Care Act), Texas opted to expand their Medicaid programs in 2013. If you were denied Medicaid coverage in Texas previous to this expansion, you may now qualify.
Child Health Management Services (CHMS)
Medicaid: ARKids First-A
Medicaid: ARKids First-A is a program for children under age 21 that provides healthcare services for children found to have a health problem or are not developing normally. The purpose is to discover what’s wrong and how to treat it in order to keep it from progressing and affecting the child’s future. To receive these services, you will need to get a referral from your PCP.
The Children's Health Insurance Program (CHIP) was signed into law in 1997 and provides federal matching funds to states to provide health coverage to children in families with incomes too high to qualify for Medicaid, but who can't afford private coverage. All states have expanded children's coverage significantly through their CHIP programs, with nearly every state providing coverage for children up to at least 200% of the Federal Poverty Level (FPL).
ARKids First-B (CHIP Title XXI funded) does not offer the CHMS program but provides health insurance coverage for children whose families make too much money to qualify for Medicaid.
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
Early and Periodic Screening, Diagnosis, and Treatment provides well-child care visits to a doctor that includes shots to prevent diseases and regular check-ups to make sure children are developing normally for individuals under 21 years of age.
ARKids First-B (CHIP Title XXI funded): If your child is enrolled in ARKids First-B, well child visits are referred to as preventive health screenings. These well-care services visits are covered. You will not have to pay a co-pay for these visits.
Medicaid and ARKids First will pay for pelvic exams, pap tests, and mammograms for all ages. You can choose to see your PCP for these services or a gynecologist (a women’s health specialist). No referral is needed for these services. If you’re 21-years-old or older, there are yearly limits on the number of doctor visits Medicaid will pay for each year. If you have ARKids First-B (CHIP Title XXI funded), you may have to pay a co-payment. Medicaid also pays for family planning for women who are able to have children.
Nursing Home Care
Medicaid pays for nursing home care in a Medicaid-certified nursing home. In order to qualify for Medicaid assistance, the placement must be order by a doctor.
There are three Medicare Savings Programs (MSP) that help you pay for your Medicare Part B premiums. They are the Qualified Medicare Beneficiary program (QMB), the Special Low-Income Medicare Beneficiary program (SLMB) and the Additional Low-Income Medicare Beneficiary program (ALMB). A household’s income determines which category they qualify for. All three programs pay Medicare Part B premiums. QMB also pays Medicare co-pays and deductibles on Medicare-covered services. It does not cost anything to apply for or receive benefits from this program.
HIPP (Texas Health Insurance Premium Payment) Program
Waivers are vehicles states can use to test new or existing ways to deliver and pay for healthcare services in Medicaid and the Children’s Health Insurance Program (CHIP).
The autism waiver provides one-on-one, intensive early intervention treatment for individuals ages 18 months through 6 years with a diagnosis of autism. To qualify for this program, the individual must meet both medical and financial criteria. The medical criteria include requiring an ICF/IID level of care and having a diagnosis of autism. The waiver program is provided through the Partners for Inclusive Communities (also known as Partners) under the administrative authority of the Division of Medical Services.
DDS Alternative Community Services (ACS)
ACS services are for individuals with a developmental disability that require special care for all ages. The individual must have a diagnosis of cerebral palsy, epilepsy or autism, or been declared intellectually disabled before age 22-years-old. Care is provided in the individual’s home, foster home or an apartment in a group home. A referral from a doctor may be required. To find out more or apply, call 501- 682-2277 for children. For adults, call 501-682-8678 or 501-683-5687.
Developmental Day Treatment Clinic Services (DDTCS)
DDTCS provides services through a licensed clinic to adults and children with developmental and intellectual disabilities. Services may include the identification of the developmental or intellectual disability and assessment of the severity. For more information, call Developmental Day Treatment Clinic Services at 501-682-8677.
First Connections Program
The First Connections Program is for children, from birth to age 3, and their families whose children child have delays in development and require special care. The program works with each family to locate and coordinate services to assist the child learning and to help the family care for the child. To find out more, call 1-800-642-8258.
Tax Equity and Fiscal Responsibility Act (TEFRA) Program
TEFRA is a Medicaid program that provides care to children (under the age of 19) with a disability in their home rather than in an institution. This program excludes parental income and resources in the eligibility criteria. The income and resources of the child are the only resources included in the eligibility criteria. Appropriate medical services must be available to provide care for the child in the home. The estimated cost of care in the home cannot exceed the estimated cost of care for the child in an institution. If the family currently has health insurance, they must keep it. To find out more about TEFRA, contact the DHS office in your county.
IndependentChoices is available to Medicaid recipients willing to accept the responsibilities for ensuring their in-home personal assistance needs are met. The beneficiary or their representative becomes the employer responsible for hiring, training, and supervising their personal care worker using Medicaid funds controlled by the beneficiary or the beneficiary’s representative. Medicaid provides a budget to pay a worker and purchase goods and services that lessen human dependency. This program covers individuals that are age 65 and older, or who are at least 18 and have a disability.
ARChoices in Home Care
ARChoices provides services for home and community-based adults ages 21 through 64 with a physical disability and seniors age 65 or older that choose services to remain at home or other community setting rather than care in a nursing home.
LivingChoices Assisted Living
LivingChoices is an assisted living option through the Medicaid program that pays for apartment-style housing for people needing some extra care and supervision. It is for people that are at risk of nursing home placement or who already live in a nursing home and want more independence. A portion of the resident’s monthly income pays for room and board. To qualify for LivingChoices assisted living, a person must have a diagnosis making a have proof of medical necessity and a financial burden.
Program of All-Inclusive Care for the Elderly (PACE)
PACE is a program for individuals age 55 and older that meet state specific criteria for nursing home care placement. PACE allows them to live as independently as possible. PACE provides needed services to the individuals enrolled in this program in all healthcare settings, 24-hours-a-day
School-Based Mental Health Services (SBMH)
School-Based Mental Health Services provides mental health services to children under age 21 that are in school and have a mental health problem. Medicaid will pay for these services, provided the child meets the specified criteria.
Arkansas Medicaid FAQs
- What is Medicaid?
Medicaid is a state funded insurance that that provides coverage to low income families, pregnant women, newborns, and children that may not be able to afford to purchase their own care.
- Who is eligible for Medicaid?
The following individuals are eligible for Arkansas Medicaid:
- Children from 0 - 18 yrs of age, with income up to 211% of Federal Poverty Limit (FPL)
- Pregnant women with incomes up to 209% of FPL
- Parents with incomes up to 133% of FPL
- Non-elderly adults with incomes up to 133% of FPL
- Qualified elderly and disabled adults
- How do I find out if I am eligible for Medicaid?
To find out if you are eligible for Medicaid, you must fill out an application for Medicaid or CHIP. You may fill out an application at any time of the year. See more on Medicaid.
- Will Medicaid cover my children?
Your household income level will determine if your child or children can be covered by Medicaid.
- What is CHIP?
CHIP is a program that supports children in families that cannot afford private health insurance, but whose household income is too high to qualify for Medicaid.
- Does Medicaid satisfy the health insurance requirement?
Yes, Medicaid will satisfy the Affordable Care Act (Obamacare) health insurance requirement for the covered individuals.
- What information and documents should I have when I'm signing up for Medicaid?
Depending on the Medicaid program being applied for, you will need the following: Identity, Social Security, proof you live in Arkansas, proof of income, proof of medical costs, and bank account information.
- How does Obamacare work with Medicaid?
Because of Arkansas' Medicaid eligibility requirements, Obamacare does not impact people who qualify for Medicaid and vice versa. As such, tax credits are only available for people who are not eligible for other plans.
- What is ARKids First?
ARKids First is the Medicaid option for children offered in Arkansas that offers a range of benefits and services. This is the program that provides a large portion of the coverage for our Arkansas kids that qualify for Medicaid.