Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 20 - Division of County Operations
Rule 016.20.16-003 - MS B-315, MS F-180, Appendix P & PUB-405
Current through Register Vol. 49, No. 9, September, 2024
B-300 Aid to the Aged, Blind and Disabled (AABD) Eligibility Groups
Note: Recipients of Medicaid in the Workers with Disabilities group will be able to access services under ARChoices provided the functional need criteria for ARChoices have been met as well as the financial criteria of the Workers with Disabilities group.
B-315 TEFRA
MS Manual 10/01/16
This group consists of children 18 years of age or younger with disabilities that must meet the medical necessity requirement for institutional placement in a hospital, a skilled nursing facility, Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) or be at risk for future institutional placement. Medical services must be available to provide care to the child in the home, and it must be appropriate to provide such care outside an institution.
The income limit is three (3) times the SSI/SPA. Only the child's income is considered. Parental income is not considered in the eligibility determination, but is considered for the purpose of calculating the month premium. For information regarding TEFRA premiums and calculation, see MS F 170-173. The resource limit is $2000. Only the child's resources are considered. Parent resources are disregarded. Recipients of TEFRA Waiver receive the full range of Medicaid benefits and services.
B-316 Autism
MS Manual 08/15/14
This group consists of children ages 18 months through six (6) years who have a diagnosis of autism. In addition to the autism diagnosis, the waiver participant must have a disability determination and meet the ICF/IID level of care. The income limit for the child is three (3) times the SSI/SPA and the resource limit is $2000. Parental income and resources are disregarded. Autism recipients will receive the full range of Medicaid benefits and services in addition to intensive early intervention treatment.
B-317 Division of Developmental Disabilities Services (DDS) Alternative Community Services Waiver Program
MS Manual 08/15/14
This group consists of individuals of any age who have developmental disabilities as determined by the Division of Developmental Disabilities Services (DDS). DDS waiver services are provided to individuals who meet the ICF/IID level of care. The income cannot exceed three (3) times the SSI/SPA. If the waiver applicant is living in the home of his/her parents, the parental income and
Medical Services Policy Manual, Section F
F-100 Non-Financial Eligibility Requirements
been made, the case will be closed. (Refer to C-231 for re-application when TEFRA case is closed due to non-payment of premiums.)
F-180 Other Health Insurance Coverage
MS Manual 10/01/16
For most eligibility groups, an individual may be covered by other health insurance without affecting his or her eligibility for Medicaid. There are two exceptions to this which are described below.
Health Care Independence Program
An individual who is eligible for or enrolled in Medicare is not eligible for the Health Care Independence Program.
ARKids B
Children who have health insurance or who have been covered by health insurance other than Medicaid in the 90 days preceding the date of application will not be eligible for ARKids B unless one of the following conditions is met:
a. The health insurance is a non-group or non-employer sponsored plan.
b. The health insurance was lost through termination of employment for any reason.
c. The health insurance was lost through no fault of the applicant. For example, health insurance is lost through no fault of the applicant if the employer ceases to provide employer-sponsored health insurance.
d. The health insurance is/was not primary comprehensive. Primary comprehensive health insurance is defined as insurance that covers both physician and hospital charges.
e. Health insurance coverage is available to a child through a person other than the child's custodial adult and is determined to be inaccessible (e.g., the absent parent lives out of state and covers the child on his or her HMO, which the child cannot access due to distance). This determination will be made on a case-by-case basis by the caseworker based on information provided by the applicant.
If a parent or guardian voluntarily terminates insurance within the 90 days preceding application for a reason other than those listed above, the children will not be eligible for ARKids B.
The applicant's declaration regarding the child's health insurance coverage will be accepted.
This is a special requirement for ARKids B only and does not apply to ARKids A or other Medicaid categories.
F-190 Medicare Entitlement Requirements for MSP Eligibility Groups
MS Manual 01/01/14
Medicare entitlement is an eligibility requirement for all Medicare Savings Programs (except ARSeniors), even though the requirement differs somewhat between the five groups. Medicare entitlement means that the individual has applied for, is eligible for, and is enrolled in Medicare Part A. Conditionally eligible means that an individual can be enrolled (entitled) for Part A Medicare only on the condition that he/she is eligible for QMB, and thus eligible for the state Medicaid agency to pay the Part A premium as part of the QMB benefits. The Medicare entitlements requirement is as follows:
* ARSeniors-lndividuals do not have to be entitled to Medicare (e.g., Qualified Aliens who have not worked enough quarters to Qualify for Medicare can still be eligible for ARSeniors). However, individuals who are entitled to Medicare and choose not to enroll in Medicare are not eligible for the ARSeniors program.
* QMB-lndividuals must be entitled to or conditionally eligible for Medicare Part A.
* SMB-lndividuals must be entitled to Medicare Part A.
* Ql-l-lndividuals must be entitled to Medicare Part A.
* QDWI-lndividuals who lost Medicare Part A & SSA-DIB benefits due to SGA. The individual must be eligible to reenroll in Medicare Part A (Re MS F-192).
F-191 Medicare Part A Entitlement
MS Manual 01/30/15
Medicare Part A beneficiaries include the following groups:
APPENDIX P TEFRA
Premium Schedule How to determine TEFRA Premium Range
Stepl Look at the chart below. If the family has income after allowable deductions at or below the amount listed for the household size, a premium will not be assessed.
If the household has income that is greater than the amount listed below for the household size, continue to Step 2.
|
Family Size |
150% FPL |
|
1 |
$17,820.00 |
|
2 |
$24,030.00 |
|
3 |
$30,240.00 |
|
4 |
$36,450.00 |
|
5 |
$42,660.00 |
|
6 |
$48,870.00 |
|
7 |
$55,095.00 |
|
8 |
$61,335.00 |
|
For each additional member add: |
$6,240.00 |
Step 2 Find the income here to determine the TEFRA Premium Range
|
Annual Income |
Monthly Premiums |
|||
|
From |
To |
Percent % |
From |
To |
|
$0 |
$25,000 |
0.0% |
$0 |
$0 |
|
$25,001 |
$50,000 |
1.00% |
$20 |
$41 |
|
| $50,001 |
$75,000 |
1.25% |
$52 |
$78 |
|
$75,001 |
$100,000 |
1.50% |
$93 |
$125 |
|
| $100,001 |
$125,000 |
1.75% |
$145 |
$182 |
|
$125,001 |
$150,000 |
2.00% |
$208 |
$250 |
|
$150,001 |
$175,000 |
2.25% |
$281 |
$328 |
|
$175,001 |
$200,000 |
2.50% |
$364 |
$416 |
|
$200,001 |
Unlimited |
2.75% |
$458 |
$458 |
