Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 20 - Division of County Operations
Rule 016.20.18-003 - AR Works Program Updates

1. Individuals under the age of 18 receiving coverage through ARKids A orNewborn

2. Pregnant women

3. Individuals residing in a nursing or ICF/IID {Intermediate Care Facilities/Individuals with Intellectual Disabilities) facility who are approved for vendorpayment

4. Emergency services

5. Health Maintenance Organization (HMO) enrollees

6. Services provided to individuals receiving hospice care

7. Adult Expansion Group enrollees with household income up to and including 100% of the FPL for their household size are not required to pay co-pays or other cost-sharing.

A-115 Cost Sharing for Workers with Disabilities

MS Manual 08/15/14

1. Physician's visits - $10.00 per visit;

2. Prescription drugs - $10.00 for generic, $15.00 for brand name;

3. Inpatient Hospital - 25% of the first day's Medicaid per diem rate;

4. Orthotic appliances, prosthetic devices and augmentative communication devices -10% of the Medicaid maximum allowable amount,

5. Durable medical equipment -20% of Medicaid maximum allowable amount peritem;

6. Occupational, physical and speech therapy, & private duty nursing - $10.00 per visit, with a cap of $10.00 per day.

After certification, any increases in income that will cause the individual to exceed 100% of the FPL and possibly cause revision to the individual's cost sharing amount wilt not be processed until the next reevaluation. If the individual reports a decrease in income that puts him under

A-330 Adult Expansion Group Identification Cards

MS Manual 05/01/18

For those individuals who are enrolled in a Qualified Health Plan through auto assignment or by their own selection, an Identification card will be mailed directly to the individual by the insurance carrier. For those individuals who are enrolled in Medicaid through the Adult Expansion Group tMS-C-150). a Medicaid card will be mailed within 5 business days of the individual being found eligible for traditional Medicaid.

A-340 Reissuance of Identification Cards

MS Manual 05/01/13

1. Review recipient's case information in the system to verify that correct information [e.g., name, date of birth, mailing address, etc.) has been updated.

2. Select the ID button on the Budget Summary and then check the "Replace" box by the member(s) who needs the replacement card and then click the Save button.

If the recipient is SSI eligible, locate the SSI case number in the system. If there is no record of the case, or the SSI recipient is not receiving a check, refer him or her directly to the local SSA Office. If the SSI recipient has been approved for 30 days or less, inform him or her that it is too early to have received a Medicaid card. It takes Social Security 30 days or more from the date of approval to forward the eligibility date through SDX.

If the SSI case record is located on WA5M, but information on the record is incorrect (e.g., wrong address), the caseworker should contact System Support or Client Assistance for correction(s) to the case.

Note: Adult Expansion Group recipients enrolled in a Qualified Health Plan will contact their insurance provider for answers to plan questions. Contact information will be printed on the insurance card and on the carrier information included with the card.

The purpose of this group is to provide pre-natal care to the unborn child who is expected to be born in the United States. As this coverage is intended to benefit unborn children who will be U.S. citizens at birth, the pregnant woman will not qualify for this coverage if she intends to leave the U.S. before *he baby is born.

This group is also different from the other Pregnant Women groups in that it receives an enhanced federal match rate under the Children's Health Insurance Program (CHIP). The CHIP enhanced funding coverage is available only to pregnant women who have no other insurance that covers pregnancy related services.

The non-citizen pregnant woman will receive postpartum coverage. Postpartum coverage is through the end of the month in which the 60th day from the date of delivery falls.

B-260 Former Foster Care Adults

MS Manual 06/08/16

This group consists of adults up to age 26 who aged out of foster care in Arkansas. There is no income or resource test. Other than the general Medicaid eligibility requirements that all Medicaid eligibles must meet (MS D-100), the requirements for eligibility in this group are that the adult was in foster care in Arkansas, was enrolled in Medicaid when aging out of foster care at age 18-21 depending on the individual circumstances and is currently underage 26.

Individuals in this group receive the full range of Medicaid benefits.

B-270 Adult Expansion Group (Arkansas Works Program)

MS Manual 05/01/18

The Health Care Independence Program was amended to become the Arkansas Works Program starting January 1,2017. Throughout this policy manual the Arkansas Works Program will be referred to as the Adult Expansion Group.

This group consists of adults who are 19 through 64 years of age with household income equal to or below 133% {138% with 5% disregard applied) of the applicable federal poverty level (MS E-110} and are not eligible in either the Parents/Caretaker Relatives group (MSB-230) or Former Foster Care group (MS B-260). Adults who are blind or who have a disability may be covered in this group unless they are determined eligible for coverage in another group on the basis of the need for long term care services (facility or waiver) or other disability related services.

A woman who is pregnant at the time of application cannot be included in this group until after the postpartum period. She must be enrolled in one of the pregnant women groups or in the parents/caretaker relatives group if eligible. However, a woman who becomes pregnant after enrolling in this adult group may remain in the adult group throughout her pregnancy.

Individuals eligible in this group will participate in the Arkansas Works Program authorized by the Arkansas Works Act of 2016 and its amendment in 2017, The Arkansas Works Program provides Medicaid funding in the form of premium assistance to enable individuals to enroll in private health insurance plans.

Exception: Individuals eligible for the Adult Expansion Group, who have health care needs that make coverage through the Health Insurance Marketplace impractical, overly complex, or would undermine continuity or effectiveness of care, will not enroll in a private Qualified Health Plan (QHP) but will remain in Medicaid [Re.MSA-1001,

NOTE: If an individual in this group has a child(ren) under age 18 living in the home, the child(ren) must be covered in Medicaid or have other health insurance coverage.

Unless exempt, all Arkansas Works enrollees between the ages of 19 through 49 will be required to comply with the work and community engagement requirement for the Arkansas Works Program (Re. MS F-200 and F-201). All Arkansas Works Program recipients will be referred to the Arkansas Division of Workforce Services for free job assistance services to assist them in complying with the work and community engagement requirement.

NOTE: Individuals enrolled in the Arkansas Works Program are required to have a valid email address.

Medical Services Policy Manual, Section D

D-500 Mandatory Assignment of Rights to Medical Support/Third Party Liabilities

MS Manual 05/01/18

As a condition of eligibility for Medicaid, recipients are required to assign their rights to Medical Support/Third Party Liability payments to the Department of Human Services. This means that any funds settlements or other payments made by or on behalf of third parties should be paid directly to the Arkansas Medicaid Program. In Arkansas, Third Party Liability payments are automatically assigned by state law.

The Medical Assistance Program ts required by Federal and State Regulations to utilize all Third Party sources and to seek reimbursement for services which have been paid by both a Third Party and Medicaid.

Private insurance and Medicaid are complementary. A recipient's Medicaid eligibility, except for an ARKids B recipient, is not affected by having Third Party coverage (Re. M5 F-180).

When a recipient has Third Party coverage in addition to Medicaid, which can be used for medical expenses, Third Party coverage must be utilized first. Medicaid will pay up to the Medicaid allowable charge. For example: A Medicaid recipient has insurance which paid 80%, or $80 of a $100 medical bill. The Medicaid allowable charge for the bill was only $60.00. A Medicaid payment was not due since the Medicaid allowable charge was less than the insurance payment. Third Party sources whose payments Medicaid will retrieve include private health insurance, automobile liability insurance where applicable, workmen's compensation, settlements for injuries, etc.

Tri-Care is considered to be a Third Party source. Whenever a Tri-Care beneficiary is also eligible for Medicaid, Tri-Care is in every instance the primary payer. This applies to all classes of Tri-Care beneficiaries, i.e., dependents of active duty members, retirees, dependents of retirees, dependents of deceased active duty members, and dependents of deceased retirees.

V Mote: The Third Party Liability policy does not apply to individuals enrolled in a private Qualified Health Plan through the Adult Expansion Group, however Assignment of Rights to Medical Support does apply.

Medical Services Policy Manual, Section E

E-100 Financial Eligibility

MS Manual 10/26/15

Each individual applying for or receiving Medicaid benefits must have a financial eligibility determination made at application and, if eligible, on an on-going annual basis or when a change affecting eligibility occurs. Financial eligibility consists of an income test and if the-category requires, a resource or asset test.

Most Medicaid eligibility groups have an income limit which an individual's countable income must fall under in order to be eligible for coverage in that group. Income limits and the manner in which countable income is determined vary by eligibility groups. The groups to which an income limit does not apply, and therefore no income determination is made, are the following:

* Newborns (MS B-220):

Former Foster Care Adults (MS B-2E0):

* Workers with Disabilities (MS B-330).

*f NOTE: For the Workers with Disabilities category, before determining eligibility, the applicant must pass a pre-test screening to ensure his/her unearned income does not exceed the SSI individual benefit plus $20. If the applicant meets this criteria, all income is disregarded in the financial eligibility determination. However, both unearned and earned income will be used to determine cost sharing. See MS A-115.

A resource limit applies to most of the eligibility groups that do not use MAGI methodologies for financial eligibility. For these groups, the value of an individual's countable resources must be determined. There is no resource limit, and therefore no resource determination is made, for the following groups:

* Those using MAGI methodologies (MS E-110):

* Newborns (MS B-220J;

* Former Foster Care Adults (MS B-2601;

* Workers with Disabilities (MS B-330).

E-110 Income and Resource Limits for MAGI and Non-MAGI Groups

MS Manual 05/01/18

Below are the income and resource limits for all Medicaid groups. When the income limit is based on a percentage of the federal poverty level (FPl), the countable household income will be compared to the FPL for the applicable household size. Refer to Append ices F and S for the specific income level amounts.

E 200 Determining Financial Eligibility Under the MAGI Methodology used to determine the monthly income. If the most recent tax data is not available or does not reflect current income, the individual's income will be determined by other means as determined appropriate by the caseworker, such as sales receipts, business records, etc.

Costs directly related to producing the income are subtracted from the self-employment annual gross before the monthly earnings are included in the budget. See Schedule C in Appendix Q for all allowable costs associated with self-employment income.

After allowable deductions from annual income, the remainder is then divided by 12 to determine the monthly income.

E-267 Comparing Income to Income Standard for Appropriate Household Size

MS Manual 01/01/14

After the Medicaid household composition, size and countable current income have been established, the Medicaid household's countable income will be compared to the household size income standard for the appropriate eligibility group to determine whether an individual is income eligible. Income eligibility wilt first be determined in the eligibility group the individual falls into with the lowest income standard, e.g., eligibility for a parent would first be determined in the Parent/Caretaker Relative group before a group with a higher income standard.

E-268 The 5% Gross Income Disregard

MS Manual 05/01/18

Each individual will be allowed a general gross income disregard in the amount of 5% of the Federal Poverty Level for the household size.

The five percent (5%) disregard will be applied only to the Families and Individuals category that has the highest income level in which an individual could be eligible. For example, if an individual is not income eligible in the lowest income level group (eg., Parents/Caretaker Relatives), the five (5%) disregard will be applied to the higher income group (e.g., Adult Expansion Group). However, if the individual is eligible in the higher income group without applying the five percent (5%) disregard, the disregard will not be applied.

When applied, the 5% disregard effectively raises the income limits for the applicable eligibility group by five (5) percentage points. For example, the income limit for the Adult Expansion Group rs 133% (MSE-110). To apply the 5% disregard, add 5% to 133% to raise the income limit to 138% of FPL. The eligibility groups with dollar amounts for income limits are not the highest income limit groups for the individuals that fall into them. Therefore, the 5% disregard will never be applied to the dollar amount income limits.

Application of the 5% Disregard in the ARKids First eroups

The 5% disregard is applied to the ARKids A income limit only if the child who would otherwise be ineligible without the disregard is covered by a health insurance plan. Since eligibility tn ARKids B is not available to a child with health insurance, ARKids A is the eligibility group with the highest income limit available to an insured child and therefore, the 5% disregard can be allowed.

The 5% disregard is not applied to the ARKids A income limit if the child is uninsured and ineligible for ARKids A without application of the disregard. ARKids B is the eligibility group with the highest income limit for uninsured children and therefore, the 5% disregard ts applied only if needed to achieve ARKids B eligibility.

Refer to MS F-180 for exceptions to health insurance coverage for ARKids B eligibles.

E-269 Who Is Eligible-Example Scenario MS Manual 05/01/18

Continuing the example of Bertha, Audrey and Chloe to show whose income will be counted and who is eligible for Medicaid.

Bertha and Audrey's household are the same which includes Bertha, Audrey & Chloe.

[GREATER THAN] Bertha earns $8,000.00 per month, which equals $96,000 annually.

[GREATER THAN] Audrey earns $314.22 per month, which equals $3,770.64 annually.

[GREATER THAN] Audrey is the child and tax dependent of Bertha. Audrey is not required to file taxes; therefore, her income does not count. Bertha's income is counted.

[GREATER THAN] Bertha's household size is 3.

[GREATER THAN] Compare the $8,000 00 monthly income to the 133% + 5% = 138% standard for a household size of 3, $1,345.96.

[GREATER THAN] Bertha and Audrey are not eligible for Medicaid; therefore, the agency will electronically transfer their account to the FFM for possible eligibility for Advanced Premium Tax Credits and cost sharing reductions.

Chloe's household includes Chloe and her mother, Audrey.

[GREATER THAN] Audrey earns $314.22 per month, which equals $3,770.64 annually. Audrey's income will be counted because neither her mother, nor father is included in this household. Chloe's child support income is disregarded.

[GREATER THAN] Chloe's household size is 2.

[GREATER THAN] Compare the $314.22 monthly income to the ARKids A standard of 142% for 2, $1,948.24. Note: The 5% disregard was not needed for ARKids A eligibility and therefore was not applied.

[GREATER THAN] Chloe is eligible for ARKids A.

Medical Services Policy manual, Section F

F-200 Work and Community Engagement Requirement for the Adult Expansion Group

MS Manual 05/01/18

1. Enrollees age 50 or older-Work and community engagement requirement does not apply for this age group;

2. Enrollees age 19-49 that are employed or self-employed at least 80 hours per month on an ongoing basis - Exempt from the work and community engagement requirement;

3. Enrollees age 19-49 that are employed or self-employed on a one-time, not ongoing monthly basis - Complying with the work and community engagement requirement;

4. Enrollees age 19-49 that are not employed or self-employed at least 80 hours per month but meet an exemption to the work and community engagement requirement. Exemptions are:

5. Enrollees age 19-49 that are not employed or self-employed at least 80 hours per month but participate in any one or a combination of work activities for at least 80 hours per month to meet the work and community engagement requirement (See MS G-190) Work activities include:

1. being employed at least 80 hours per month; or

2. qualifying for an exemption to the work and community engagement requirement; or

3. completing a combination of sufficient work and work activities.

Employment: Individuals who earn the equivalent of Arkansas minimum wage for at least 80 hours per month through ongoing employment or self-employment will be considered exempt from reporting work activities on a monthly basis. The employment information will be verified by using the individual's reported income at application/renewal/change report to determine if the individual's reported earnings are equal to 80 hours monthly times the current minimum wage.

Individuals who earn the equivalent of Arkansas minimum wage for at least 80 hours monthly, on a one-time not ongoing basis will be considered compliant with the work and community engagement requirement and must report their work activities on a monthly basis.

Individuals who are employed less than the equivalent of Arkansas minimum wage for at least 80 hours monthly must combine their employment or self-employment with other allowed work activities for a combined total of 80 hours monthly to be considered compliant with the work and community engagement requirement and must report their work activities on a monthly basis.

Example l: Joe is employed by a local grocery store and earns $800 monthly on an ongoing basis. $800 monthly wages divided by $8.50 (current Arkansas minimum wage) = 94 monthly hours. Joe is exempt from reporting monthly work activities until he has a change in circumstance reducing his employment below 80 hours monthly.

Example 2: Amy was paid $680 in June by a family friend to paint their home. Amy did this as a one*time job and is not employed or self-employed on an ongoing basis. $680 one-time wages divided by $8.50 (current Arkansas minimum wage) = 80 hours. Amy is compliant with the work and community engagement requirement for the month of June and must report again in July which work activities she completes to be compliant.

Example 3: Sue works at a local restaurant as a cook and earns $400 monthly on an ongoing basis. $400 monthly wages divided by $8.50 (current Arkansas minimum wage) = 47 hours. Sue must complete 33 additional hours in an allowed work activity to be considered compliant each month.

Exemptions: Exemptions are determined at application/renewal/change report. Initial exemptions will be determined at application based on information the applicant provides in the application. All other exemptions will be reported and validated by the individual through an online portal. Clients who log in to the portal and report an exemption after the initial determination will receive a notice informing them when the exemption will need to be revalidated. If it is determined that a recipient no longer meets the exemption, the individual must complete a combination of sufficient work and work activities in order to meet the work and community engagement requirement.

The following table lists exemptions and their validation schedule.

Work Activities: Work activities can be performed alone or in combination to comply with the work and community engagement requirement. Total monthly work activity hours must equal 80 at a minimum. A combination of employment hours and work activities may be used to meet the work and community engagement requirement. If the individual uses a combination of sufficient employment hours and work activities to meet the required 80 hours, monthly demonstration of compliance is required for each.

The following table lists approved work activities and their validation schedule.

Recipients who are required to report employment hours, exemptions, or work activity, must report no later than the 5th of each month for the previous month's work activities or exemptions. If the recipient does not report by the deadline, a notice will be sent informing the recipient that a month of non-compliance has accrued. If the recipient accrues a second month of non-compliance, a notice wilt be sent informing the recipient of the second month of noncompliance and that their case will be closed at the end of the third month of non-compliance. This notice will serve as the notice of adverse action. If the recipient satisfactorily complies with reporting work activities by the 5lh of the month following the third month of non-compliance, their case will be reinstated.

* Recipients cannot provide electronic demonstration of compliance retroactively after the 5 of the following month. For example, a recipient cannot provide electronic demonstration of compliance on April 7th for meeting the work and community engagement requirement in March.

* Recipients cannot provide electronic demonstration of compliance proactively for future months. For example, a recipient cannot provide electronic demonstration of compliance on April 25 for meeting the work and community engagement requirement in May.

* Demonstration of an exemption or work activity must be done electronically, except when information regarding a work activity or exemption is provided on an application.

* If the recipient provides false or incomplete information or fails to report a change, the individual will be subject to possible consequences such as repayment, disqualification, and/prosecution for fraud (MS M-210).

* Quality Assurance reviews will be conducted on a periodic basis. When a case is selected for a Quality Assurance review, additional verification may be required to be provided by the recipient.

Medical Servers -Appendix X. Referrals for IndependentChoices

05/01/18

1. Are 18 years of age or older and currently receive Medicaid in a category that covers personal care, or

2. Are in the ARChoices in Homecare waiver program; and