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11.26.19

9 Important Things to Know about Arkansas Medicaid

Arkansas Medicaid is confusing but we are here to help

1. What is Medicaid?

Medicaid, as defined by the United States Government, is a healthcare program for millions. Specifically, it “[Medicaid] provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by the states and the federal government.”

If you live in Arkansas, where Finnegan Health Services is based and serves state-wide, you may be familiar with Arkansas Medicaid as health insurance. For the quarter of July through September, 2017, 935,505 Arkansans were enrolled in Medicaid.

Medicaid covers routine visits to the doctor for adults and children, as well as long term care coverage for elderly and the disabled. Pregnancy care is also covered by Medicaid.

If you have disabling conditions or chronic illnesses, your Medicaid will cover long term care services. Medicaid will also cover some medical supplies for various medical conditions. If you are pregnant, Medicaid will cover your care and your unborn child’s care. As Medicaid is a federally funded state program, coverage policies vary from state to state and over time. 

If you think you are eligible for Medicaid, do not hesitate to enroll. Enrollment can take weeks if not longer, and there are waitlists for the various levels of need. According to the government site, a Medicaid enrollee may incur some copays or expenses related to their Medicaid.

“Out of pocket costs cannot be imposed for emergency services, family planning services, pregnancy-related services, or preventive services for children. Generally, out of pocket costs apply to all Medicaid enrollees except those specifically exempted by law and most are limited to nominal amounts. Exempted groups include children, terminally ill individuals, and individuals residing in an institution. Because Medicaid covers particularly low-income and often very sick patients, services cannot be withheld for failure to pay, but enrollees may be held liable for unpaid copayments.”

You can learn more about Medicaid on a national level here.

2. How to Qualify for Medicaid

Qualifying for Medicaid varies some depending on your state. Medicaid must follow certain national guidelines but specifics may vary. In Arkansas, Eligibility is determined based on income, resources, Arkansas residency, and a few other requirements. All individuals of all ages are eligible for Medicaid if they also meet income restrictions.

Men and women aged 65 and older who meet income, resource and other requirements are eligible for full Medicaid coverage. Individuals who are determined blind or disabled, per the Social Security Administration criteria, who meet income, resource and other requirements are eligible for full Medicaid coverage.

Pregnant women who meet income and other requirements are eligible for full Medicaid coverage. Pregnant women with income up to 200% of Federal Poverty Level may be eligible for limited coverage if they meet certain income and other criteria, including prenatal, delivery, postpartum, and conditions which may complicate the pregnancy, such as gestational diabetes. Coverage continues through the pregnancy and until the end of the month that the 60th day postpartum falls.

Needy children, under age 19, who meet income, and other requirements, are potentially eligible for full Medicaid coverage under the ARKids First program. ARKids First Part B is NOT full coverage. It is limited, for instance they cannot do diapers or nutritional items and have a $125 limit. ARKids Part A is full coverage. A parent or other caretaker, or relative, of children under age 18, who meet income and other requirements, are eligible for full Medicaid coverage. 

Home-Based Care and Long Term Care are both covered on Arkansas Medicaid with certain restrictions. You can find out more about extended care coverage here.
There are many forms available to you on the DHS (Department of Human Services) website here. These forms include income sheets, long term care applications, reference forms, and change of information forms. They are all available in English and Spanish.

3. Understand Medicaid Share of Cost

The Medicaid program has financial limits and conditions on eligibility. In some instances, you must pay, or meet an income guideline, in order to qualify and receive Medicaid. Your “share of cost” is the total amount of medical bills that you must reach before Medicaid can pay any of your other incurred medical bills for you. Your “share of cost” is like a deductible on a health insurance policy. Your “share of cost” is based on your family’s monthly income. There are several Medicaid income guidelines available for you to see here and here.

There are also annual income guidelines for Medicaid eligibility. In Arkansas, those are based on how many people are in the household, including children, and what the annual household income is for all of those people. For example, in Arkansas, Medicaid requires a household of 1 person to have a maximum income of $16,612 per year to qualify. Learn more at the benefits link above. All benefit and income information may change with legislation. 

Since Medicaid eligibility is determined by the federal poverty level guidelines, be sure to check the websites before making your family plan. Most Medicaid eligibility and all CHIP eligibility is based on modified adjusted gross income (MAGI). Income eligibility levels are tied to the federal poverty level (FPL). If you see charts that are confusing to you, call your county local DHS office for more information.

4. How Medicaid and Medicare work together

According to the government website, Medicaid.gov, “Medicaid provides health coverage to 7.2 million low-income seniors who are also enrolled in Medicare. Medicaid also provides coverage to 4.8 million people with disabilities who are enrolled in Medicare. In total, 12 million people are “dually eligible” and enrolled in both Medicaid and Medicare, composing more than 15% of all Medicaid enrollees. Individuals who are enrolled in both Medicaid and Medicare, by federal statute, can be covered for both optional and mandatory categories.”

If you have a medical need (chronic illness or disability) for both Medicaid and Medicare, your eligibility for services is different than if you only had Medicaid or only had Medicare. For starters, Medicare has four basic forms of coverage:

  • Part A: Pays for hospitalization 
  • Part B: Pays for physician services, lab and x-ray services, durable medical equipment/DME, and outpatient services
  • Part C: Medicare Advantage Plan (like an HMO or PPO) offered by private companies approved by Medicare
  • Part D: Assists with the cost of prescription/Rx drugs

Medicare enrollees with limited income and/or resources may get help paying for their copays, premiums, and out-of-pocket medical expenses with their Medicaid, depending on the eligibility. This is not guaranteed to all Medicare and MEdicaid dual recipients. Be sure to research. 

Medicaid also covers additional services beyond those of Medicare. This can include nursing facility care beyond the allotted 100-day limit. It can also include stays at skilled nursing facilities that Medicare covers, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid by Medicare with Medicaid filling in the difference, as a copay, up to the state’s payment limit. The state payment limit varies from state to state. You can call your local DHS office for more specifics.

As of 2019, in all of the 48 Continental United States, a monthly income for an individual to qualify is $1,061. For a couple, the monthly income limit is $1,430 to qualify for Medicaid and Medicare. The amount is slightly higher in Hawaii and Alaska. The monthly income limit goes up as the recipient’s Social Security monthly amount comes into play.

Medicaid and Medicare are tricky subjects and there is a ton of information out there. Focus on your state and exactly what you are eligible for. For questions, call your local county DHS office. They can help you with Medicaid enrollment, or Medicaid enrollment for disability. The power of your government health insurance is in your hands. If you have questions about your Medicare and Medicaid eligibility in Arkansas, Finnegan Health Services has the answers. Call us today at 501-663-6600 or email wecare@finneganhealth.com.

5. Medicaid & Medicare differ in Arkansas

The two major branches of federal health insurance are Medicare and Medicaid. Medicaid is a partially government funded program and partially state funded program run by the state. Arkansas has Medicaid available. Medicare is an insurance company designed for children and adults with long-term or lifelong disabilities and senior citizens. 

Arkansas Medicaid is run under the Department of Human Services (DHS) in each county of the state. Medicaid is a form of government run health insurance for individuals, including children, of low-incomes. There are many ways someone can be eligible for Medicaid under various rules. 

Children of families with low incomes have several options for healthcare. CHIP (Children’s Health Insurance Program) is for children whose family makes too much to qualify for Medicaid, but not enough to purchase private health insurance. There are nearly 8 million children on CHIP currently. CHIP covers all routine health care coverage including routine wellness visits, x-rays and lab work, immunizations, dental and vision care, and more. CHIP serves children until their 19th birthday.

For adults who are low-income, Medicaid offers coverage. This includes pregnant women, children, parents, seniors, and those with disabilities. Currently the annual income limit for Medicaid is approximately $16,000 per year for a single person household. The amount is approximately $22,000 for a two person household. If you make the limit or under the limit, you can qualify for Arkansas Medicaid. 

In order to qualify for Medicare in Arkansas, you must have a life-long disability such as quadriplegia, or have a permanent feeding tube, for example, or be a senior citizen aged 65 or older. There are some other guidelines for qualifying for Medicare, but most people qualify at 65. If you are not 65, but have Lou Gherig’s Disease, have permanent kidney failure, or have received Social Security benefits for 24 consecutive months, you automatically qualify for Medicare. 

Medicare was designed for the elderly who didn’t have health insurance at 65. Medicaid was designed to provide health insurance to low income persons. These two forms of government health insurance can be used simultaneously if you are disabled or 65 and have low income. If you have questions about what medical supplies your insurance will cover, contact Finnegan Health Services today at 501-663-6600.

6. Arkansas Medicaid Long Term Care

In Arkansas, the Medicaid state plan will cover the cost of living in a nursing home facility. It will also cover limited personal care in the home and community. Care in the home depends on the patient’s level of functionally. The applicants must require nursing home level care, but be willing to live at home, in assisted living, or in adult foster care instead.

Long term care facilities (LTCFs) include skilled nursing facilities, intermediate care facilities, adult day care, post-acute head injury retraining residential facilities, and assisted living facilities. They provide a wide range of medical and personal care services for those who cannot manage on their own within the community. But who still want and deserve to live in a community home setting. 

LTC is also known as Long-Term Services and Supports (LTSS).

A growing number of home and community-based programs are available as alternatives to nursing facilities. While a nursing facility is the right option for some people, others may find help is available to keep them at home. Keeping a patient in their home setting or in any home-styled setting, can be beneficial to the patient, and so, their care. 

One of your options for Long Term care is ARChoices in Homecare. The ARChoices in Homecare program provides home and community-based care for individuals aged 21 and over as an alternative to institutionalization. Individuals aged 21-64 must have a physical disability. You can also be a senior citizen, aged 65 and older.  

ARChoices in Homecare services can offer help doing everyday activities that you may no longer be able to do for yourself. Activities like bathing, dressing, getting around your home, preparing meals, or doing household chores are performed safely with assistance in a home environment.

Assisted Living Facilities are another option. They provide assistance in a residential setting, with activities of daily living for individuals that are aged, blind, or who have a physical disability. 

DDS (Division of Developmental Disabilities Services) is another in home service. It provides both home and community waiver services for individuals with developmental disabilities, who would otherwise require care in an institution. An individual applying for waiver services must be financially eligible and meet the level of care required for admission. 

Nursing facilities are another option. They are institutions that provide medically necessary care 24 hours per day for residents who require skilled nursing care, rehabilitation services or health-related care, and services above the level of room and board. These are primarily not for the care and treatment of mental diseases.  Recipients must receive the full range of Medicaid benefits to be eligible. Medicaid also pays all, or a portion, of monthly facility vendor payment depending on the patient’s monthly income. 

Financial Restrictions under Medicaid Long Term Care

“Arkansas is an income cap state, which means in order to be eligible for Medicaid Long Term Care benefits, there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at the time of application.” 

“The income limit for all of the LTSS programs is three times the current SSI Standard Payment Amount (SPA) for an individual.  The income limit for 2018 is $2,250.00. The income limit usually increases at the first of each calendar year. Only the income of the applicant is counted toward this limit.  For residents of Nursing Facilities, Assisted Living Facilities, and Adult Family Homes, if there is a non-resident spouse, the spouse may be eligible to keep all or a portion of the income of the spouse living in the facility.”

For people in need of home-based or community-based services, Long Term Care is an effective resource for Medicaid populations. You can receive treatment at your home or at a “homey” environment which provides comfort and care to the patient. 

You can learn more about Arkansas Medicaid on our website and by calling 01-663-6600.

7. How Arkansas Medicaid works for Nursing Homes

If you have Arkansas Medicaid, and you need to live in a nursing home facility, Medicaid will cover three types of services including skilled nursing, rehabilitation, and long term care. 

  • Skilled nursing or medical care and related services
  • Rehabilitation needed due to injury, disability, or illness
  • Long term care —health-related care and services (above the level of room and board) not available in the community, needed regularly due to a mental or physical condition

A nursing home may provide some or all of the covered services, or none of them if they do not accept Medicaid. You will have to reach out to the specific nursing facility you are interested in to see if they accept Medicaid as payment. Many facilities that accept Medicaid only have a set number of bedrooms for Medicaid patients. Your local county DHS can help you find a skilled nursing facility that will accept your health insurance. 

Medicaid is required to provide coverage at these nursing facilities for adults in need who are 21 years old and older. Coverage is available on a state by state, and case by case basis, for those under 21 years old. 

Medicaid can not deny you service in a nursing facility, or make one subject to waiting lists, as they may for home and community based services. Because of this, a skilled nursing facility may be open immediately to your needs as opposed to waiting for in-home services. It is also the goal of the nursing facility to transition you out of a skilled nursing facility and back into the community as soon as possible. 

Medicaid is required to cover dietary needs, medical services, specialty treatments, prescription drugs and pharmaceutical services, personal hygiene equipment, and emergency dental services. Private rooms, special dietary foods prepared outside of the facility’s ability, personal comfort items, and any personal items are not covered by Medicaid and may cost extra. 

There is “no exhaustive list of services a nursing facility must provide,” as long as the patient’s care is not compromised, to “reach the highest practicable level of well-being.”

8. Can Arkansas Medicaid be used out of state?

If you are moving, one cannot transfer Medicaid from state to state. If you plan carefully, you can gain eligibility in their new state without a lapse in benefits. Working with your county DHS BEFORE you move will make this process easier. 

If you are needing to use your Arkansas Medicaid health insurance in another state, for medical purposes, you will have to work with your doctor, DHS, and the clinic in another state, BEFORE you see that other doctor in another state. 

Your Medicaid health insurance coverage may not provide a full set of benefits if you need care out of state. For example, some states only cover out-of -state emergency room visits to stabilize emergency conditions. If you must be admitted to a hospital in another state, or if you must receive essential, regular psychiatric care or medications from an out-of-state provider, the home state will not pay for the services through Medicaid. In these situations, a caregiver often must sign an agreement to pay for the services before the person with special needs can receive care.

Domiciliary care is room and board for people who have to be away from home while they are getting medical treatment. Medicaid and ARKids First-A will pay for room and board when you live too far away to drive back and forth every day. This is for in-state treatment only. There is no limit to the number of days you can stay while you are being treated. Medicaid will also pay for a ride from your home to the place you will stay. The domiciliary care provider will give you a ride to the clinic or medical center where you will be treated. You must speak with your DHS case manager in all of these instances BEFORE you use them for best results. 

ARKids First-B, for children under 19, does not cover domiciliary care.

9. The Importance of EPSDT Well Child Exam

For all children, a well child exam is crucial for the pediatrician to follow the child as they grow and develop. These exams are a way for doctors and parents to discuss any issues the child may be having during their developmental stages. These exams are covered by your child’s Arkansas Medicaid.

If you think you can skip your child’s EPSDT, or well child exam, you are wrong. Medicaid requires that Finnegan Health Services, or any other DME, have a record of your child’s wellness exam in order to provide your child with their medical supplies. 

If your child receives medical supplies on Medicaid, you must keep up with their EPSDT exams or Medicaid will deny the medical supplies. 

Medicaid requires these exams in order to ensure that your child still does need the medical supplies, how many medical supplies they need, and to ensure proper usage of the medical supplies. The pediatrician and the parent must work together to get these Medicaid insured children to the doctor’s office when the EPSDTs are required. 

EPSDTs Are Required at Ages:

  • 1 month
  • 2 months
  • 4 months
  • 6 months
  • 9 months
  • 1 year
  • 15 months
  • 18 months

And for the ages between 2 and 21 years old, a well child exam is required annually except for the child’s 7th year and except for the child’s 9th year. 

These exams help Medicaid track your child’s physical and mental development. It is also a way for the pediatrician to help ensure the patient gets the care and medical supplies they need.

If your child uses medical supplies, PLEASE NEVER SKIP A WELL CHILD EXAM. Skipping these exams WILL delay the delivery of your child’s prescribed medical supplies. This delay is not the fault of the DME provider like Finnegan Health Services, nor is it the doctor’s fault. Your child must attend every required EPSDT check in order to receive their medical supplies in a timely manner. 

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