Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.97-021 - ARKids First Waiver

Current through Register Vol. 49, No. 6, June, 2024
2300
ARKids First Waiver
The ARKids First category was established by Act 407 of 1997
				(the ARKids First Program Act), and it was implemented by Arkansas on September
				1, 1997. It is designed to provide Medicaid eligibility for uninsured children
				age 18 and under whose family's gross income is at or below 200% of the federal
				poverty level. Persons who are already eligible for Medicaid under another
				category cannot be eligible concurrently in the ARKids First category.
2310
Extent of
			 Services
Parti cipants in the ARKids First category are
not
eligible for the full range of Medicaid services.
				Copayments and coinsurance will apply, as appropriate, for all services with
				the exception of immunizations, preventive health screenings, family planning,
				and prenatal care. Child Health Services (EPSDT) will not be offered. For a
				list of services provided, please refer to "[LESS THAN]Insert Title of
				Brochure[GREATER THAN]."
2320
Nondiscrimination
No person will be prevented from participation, denied
				benefits, or subjected to discrimination on the basis of race, color, national
				origin, age, religion, disability, sex, veteran status, or political
				affiliation. The Agency will be in compliance with the Civil Rights Act of
				1964, Section 504 of the Rehabilitation Act of 1973, the Americans with
				Disabilities Act of 1990, and regulations issued by the Department of Health
				and Human Services.
The Agency has the rsponsibility for informing applicants and
				recipients that assistance and services are provided on a nondiscriminatory
				basis and that they have a right to file a complaint with the Agency or federal
				government if it is thought that discrimination has occurred on the basis of
				race, color, national origin, age, religion, disability, sex, veteran status,
				or political affiliation.
2330
ARKids First Eligibility
			 Criteria
To be eligible for services in the ARKids First category, the
				following criteria must be met:
1.
Age:
Each individual must be under age 19 (eligibility
			 ends on the 19th birthday) to qualify. Proof of age is required (Re. MS
			 3321).
2.
Relationship
			 and Living with Specified Relative:
An individual must meet these
			 criteria (Re. FA 2252-2253.1), unless the individual has been removed from the
			 custody of his or her parents by court order, has been court ordered to an
			 institution, has b een emancipated, or legal custody has been given to someone
			 else (e.g., a guardian) (Re. MS 6130). Provisions at MS 6270 and 6275 (except
			 that resources are not considered) also apply to participants in the ARKids
			 First category.
3.
Citizenship or Alien Status:
Each individual must be
			 either a U.S. citizen or a qualified alien (Re. MS 3310 #3). Proof of
			 citizenship or alien status is required (Re. MS 3324).
4.
Social Security Enumeration
			 Reouirement:
Each individual whose needs are included in the
			 budget must be enumerated or must apply for enumeration (Re. MS
			 1390).
5.
Mandatory
			 Assignment of Rights to Medical Support/Third Party Liability:
State and federal law make assignment automatic for Medicaid
			 participants (Re. MS 1350). Failure to cooperate in identifying and billing
			 other resources and medical benefits may result in termination of the ARKids
			 First case.
6.
Referral
			 to OCSE:
If a parent of an eligible child is absent, or if both
			 parents are present but paternity has not been established, an OCSE referral
			 must be made (Re. MS 1310). ARKids First participants who are pregnant are not
			 required to cooperate with OCSE for their children, but an absent parent of a
			 pregnant participant must be referred.
7.
Residence:
Each
			 individual must be a resident of Arkansas to qualify (Re.
			 = MS 2200).
8.
Income:
Gross
			 income for participants cannot exceed 200% of the Federal Poverty Income
			 Guidelines for the appropriate number included in the budget (See chart that
			 follows this section). Total gross income will be counted (i.e., no earned
			 income deductions, exclusions, or child care will be allowed). The income
			 disregards at FA 2351, however will apply. Earned income will be verified
			 according to FA 2361, except that a maximum of 4 check stubs will be required.
			 Earned income will be computed according to FA 2362.1 and 2362.2. Any countable
			 and verified unearned income will be added to earned income to derive the total
			 gross income.
If a minor who is pregnant is living with her parent(s), then
				the gross income of the parent(s) will be counted in full to the pregnant
				participant.
In minor parent (MP) households, the income of the parent(s) of
				the minor parent is counted in full in the MP's need determination, but is
				totally disregarded in the need determination of the MP's child.
The income of an alien sponsor is disregarded.
Lump sums are considered income in the month received when
				determining eligibility for each of the three months in the retroactive
				eligibility period up through the date of certification. Lump sums and other
				income changes which occur
after
the date of
				certification will be disregarded.
Monthly Standards (9/1/97)
Number in Standard
200%
1
1315.00
2
1768.34
3
2221.66
4
2675.00
5
3128.34
6
3581.66
7
4035.00
8
4488.34
9
4941.68
10
5395.02
For each additional person, add $453.34.
Standard of Need:
In determining
				ARKids First eligibility, parents will be included in the need standard with
				their natural or adoptive children. Normally, all of the full siblings in the
				household will be included in the budget with their natural or adoptive
				parents. However, a parent or other relative may choose to exclude a child and
				that child's income from a case budget if inclusion of that child and the
				child's income would cause ineligibility for the other children. Children may
				be excluded for other reasons, and the parent or relative who applies need not
				state the reason. An unborn child of a PW will not be counted in the standard
				of need.
9.
Resources:
No resource test exists for the
			 ARKids First category.
10.
_
Health Insurance Through an Employer:
Children
			 who have been covered by
primary comprehensive health insurance, other than
				Medicaid, within the 12 months preceding the date of application will not be
				eligible for services in the ARKids First category (unless insurance was lost
				through no fault of the applicant). Primary comprehensive health insurance is
				defined as insurance that covers both physician and hospital
				charges.
An applicant who has lost insurance through an employer
				is considered not at fault if his or her employment terminates for any reason.
				If an applicant loses insurance for any other involuntary reason (e.g., the
				employer ceases to provide group health insurance), he or she also is
				considered not at fault. If a parent or guardian
voluntarily
terminates insurance for any reason within
				the 12 months preceding application, his or her children will be deemed
				ineligible.
The Central Office Eligibility Unit will accept the
				applicant's declaration regarding his or her health insurance coverage, unless
				the worker has contradictory information or the applicant's circumstances make
				the declaration questionable (e.g., the applicant reports earnings from an
				employer who customarily provides group health insurance).
2340
Application Process
2341
Right to
			 Apply
All individuals who wish to apply will be given the
				opportunity to do so without delay. No application or inquiry will be ignored.
				The Agency has the responsibility to follow up on any request for medical
				assistance and to make arrangements for completion of the
				application.
2342
Distinction Between Application and
			 Inquiry
The distinction between an application and an inquiry is
				as follows:
1.
An
			 application is a written and signed request for assistance by an individual or
			 his or her authorized representative.
2.
An inquiry is a request for
			 information by an individual or his or her authorized representative.
2343
Completion of the Application
The application process will require the completion of a
				DCO-995 by the individual, adult relative, custodian, guardian, or
				representative of an institution if the individual is court ordered. If
				emancipated, the minor must sign the application. If a child has been court
				ordered to an institution, a representative or designee of the institution must
				sign the application.
The DCO-995 will be available at DHS county offices,
				local health units, or by mail, if requested. To request an application by
				mail, an individual may call 1-888-474 -8275. Application forms will also be
				given to churches, licensed day care centers, hospitals and institutions,
				selected physicians* offices, clinics, public schools, community neighborhood
				centers, and pharmacies, if they request a supply of forms.
After completion, the DCO-995 (along with proof of Social
				Security enumeration, age, and income), will be mailed by the applicant or by a
				DHS county office, if requested by the applicant, to the ARKids First Central
				Office Unit, Post Office Box 5701, North Little Rock, AR 72219-5701, for
				processing.
2343.1
Referrals to the ARKids Unit from County
			 Offices
If all children of a Medicaid applicant are determined
				ineligible by the county office, and it appears that they may be eligible for
				ARKids First, the county office will deny the Medicaid application (if
				appropriate), make copies of the relevant parts of the record for their files,
				fax the first page of the application, and mail the remainder of the original
				case record to the Central Office Eligibility Unit at Pulaski County-North
				(60-2) for processing. Upon receipt of the appliction's first page, the central
				office worker will reregister the DCO-95 in category 01, using the original
				date of application.
If one or more children of a Medicaid applicant are
				determined ineligible by the county office (but other children appear eligible
				for Medicaid in another category), and the ineligible children appear eligible
				for ARKids First, the county office will fax the first page of the application
				and mail a copy of the relevant parts of the record to the Central Office
				Eligibility Unit at Pulaski County-North (60-2) for processing. The county will
				include a cover memo with the copy of the case record that indicates which
				children are ineligible for Medicaid. Upon receipt of the appliction's first
				page, the central office worker will reregister the DCO-95 in category 01,
				using the original date of application.
2343.2
Referrals to County
			 Offices from the ARKids Unit
If any or all children of an ARKids First applicant
				appear eligible for Medicaid in another category, the central office worker
				will contact the applicant and ask if he or she would like to file an
				application with the DHS county office. If so, the central office worker will
				fax a copy of the DC0-995's first page and mail copies of relevant verification
				and documentation to the DHS county office in the applicant's county of
				residence. Upon receipt of the application's first page, the county office
				worker will reregister the DC0-995 in the appropriate category, using the
				original date of application. Also, the central office worker will mail page
				three of a DCO-95, along with a DC0-700, informing the applicant that the
				Medicaid application will be denied unless he or she completes page three and
				returns it to the DHS county office within 10
				days.
2344
Completion of Forms During Eligibility
			 Determination
In determining eligibility, the central office
				eligibility worker will complete Forms DCO-86, DCO-96, DCO-608, and the DCO-662
				(when applicable). The SS-5 will be completed and mailed to the applicant for a
				signature if the applicant has not been previously enumerated. Each person to
				be included in the need standard must be enumerated. If necessary, the worker
				also will complete a DCO-002, listing specifically the information that is
				needed to determine eligibility and providing 15 days in which all required
				verification must be returned.
2345
Entry of Application
			 on WIMA
On the date the application is received by the Central
				Office Eligibility Unit, it will be entered on WIMA. The worker will enter the
				register number on Form DCO-995. The category entered on WIMA will be ARKids
				First (category 01).
2346
Time Limit for
			 Disposition of Application
The Central Office Eligibility Unit will have up to 45
				days from the date of application to make disposition by one of the following
				actions: approval, denial, or withdrawal.
2347
Delayed Action on
			 Application
2347.1
Agency Delay
When action on an application will be delayed beyond 45
				days by the Central Office Eligibility Unit, the applicant will be notified by
				DCO-700 of the reason for delay and of his or her right to
				appeal.
2347.2
Applicant Delay
When the applicant has been instructed by DCO-002 to
				provide information and has not done so by the end of a 15-day period, the
				application will be denied. If the applicant has difficulty in providing the
				information and requests additional time, the central office eligibility worker
				will send a second DCO-002 that clearly specifies what information is needed by
				the end of an extended 10-day time period, and, if requested, will assist the
				applicant in obtaining the information. If the information has not been
				provided by the end of the 10-day extension, the application will be
				denied.
2348
Disposition of the
			 Application
2348.1
Approval
When
approving an application, the
				central office eligibility worker will:
1.
Record pertinent information on the
			 DCO-96;
2.
Complete
			 the DCO-608;
3.
Complete, sign, and key the DCO-56 to authorize eligibility;
			 and
4.
Notify the
			 applicant by DCO-55 or DCO-700.
The worker will certify eligible individuals as ARKids
				First (category 01) on the DCO-56. The head of household (parent, guardian,
				etc.) will be shown as "Payee," and each eligible child will be entered. When
				the head of household is also eligible, he or she is listed as both "Payee" and
				as an eligible. The eligible head of household under 19 must be given a child's
				suffix (201, etc.).
When the head of household over 18 has been included in
				the budget, he or she will be entered as a closed status adult member, with an
				"M" in the budget indicator.
If an ARKids First participant has been court ordered to
				an institution, the institution or its designee will be entered on the DCO-56
				as "Guardian/Authorized Representative," and the child will be listed as "Payee
				and as an eligible participant.
Eligibility will begin on the date of application or up
				to three months prior to the date of application, if the individual alleges
				incurred medical expenses in for the retroactive period and all other
				eligibility factors are met. Retroactive eligibility for ARKids First will not
				begin prior to September 1, 1997.
After certification, the Central Office Eligibility Unit
				will produce and mail the ARKids First Identification Card to the
				participant.
2348.2
Denial
When denying an application, the central office
				eligibility worker will:
1.
Record all pertinent information on the DCO-96. It is not necessary to
			 verify any eligibility factor other than the one upon which the application is
			 being denied. However, verification already obtained will be retained in the
			 case record for future reference;
2.
Complete denial information and key
			 the DCO-995; and
3.
Notify the applicant by DCO-55 or DCO-700.
2348.3
Withdrawal
When an applicant or representative requests that the
				application be withdrawn, the central office eligibility worker
				will:
1.
Notify the
			 applicant or representative by DCO-700 that the application will be denied in
			 10 days at the applicant's or representative's request. If a signed written
			 statement requesting the withdrawal is received, the application may be denied
			 upon request of the statement;
2.
Record pertinent information on the
			 DCO-96;
3.
Upon
			 receipt of a written request, or at the end of the 10-day notice, if a verbal
			 request was received, whichever is appropriate, key the denial information on
			 the DCO-995.
4.
Notify
			 the applicant or representative by DCO-55 or DCO-700 that the application has
			 been denied.
2350
Continuing
			 Eligibility
2351
Reevaluations
ARKids First category cases will be scheduled for
				completion of a reevaluation every 12 months. The system will generate and mail
				a DCO-975 to every casehead on the sixth workday before the end of the 10th
				calendar month of eligibility. This form should be returned to the Central
				Office Eligibility Unit by the 10th day of the 11th calendar month of
				eligibility. The casehead must report and send verification of gross earnings
				received, and note any other changes that may affect eligibility.
Upon receipt of a complete DCO-975, the worker will
				redetermine eligibility, and, if still eligible, complete a narration on the
				DCO-96, complete a DCO-608, and key a reevaluation date and budget information
				on the DCO-56. If the participant is no longer eligible for the program, the
				worker will send a 10-day notice of adverse action, advising the participant
				that his or her case will be closed effective the last day of the certification
				period (i.e., after one full year of coverage).
If the casehead fails to return a DCO-975 by the 10th day
				of the 11th calendar month of eligibility, the central office eligibility
				worker will mail a DCO-700 and a manual DCO-975 to the casehead, advising him
				or her that a completed DCO-975 and proof of current income must be received by
				the Central Office Eligibility Unit within 15 days or the case will close
				effective the last day of the certification period.
If the casehead fails to return a
complete
DCO-975 by the 10th day of the 11th calendar
				month of eligibility, the central office eligibility worker will mail a DCO-700
				to the casehead, specifying the information needed to redetermine eligibility,
				and advising him or her that the information must be received by the Central
				Office Eligibility Unit within 15 days or the case will close effective the
				last day of the certification period.
Example: A case is certified for eligibility beginning
				September 3 (the first day of the certification period). The system-generated
				DCO-975 will be mailed to the casehead on June 23 (the sixth workday before the
				end of the 10th calendar month), to be returned by July 10 (the 10th day of the
				11th calendar month of eligibility). If the participants are no longer eligible
				after completing the reevaluation, or if the casehead fails to complete the
				reevaluation, the case will close effective September 2 (the last day of one
				full year of coverage).
If sufficient information to determine eligibility is
				received by the worker prior to the effective date of closure and the
				participant remains eligible, the reevaluation is complete and the case will
				remain open.
If sufficient information to determine eligibility is
				received by the worker after the case has been closed with a future end date,
				or if the information received prior to the end of the certification period
				could not be processed by the effective date of closure, the case will be
				reinstated.
If the requested information is received after the
				effective date of closure, a new application will be
				required.
2352
Changes
Changes in cases (e.g., adding or dropping an individual
				or change of address) will be made by the Central Office Eligibility Unit on
				Form DCO-56 for data entry. All changes will be documented in the case record.
				Participants are not required to report changes in income until the
				reevaluation.
2352.1
Facility Transfers of Court Ordered
			 Juveniles
Arkansas Code Ann. §
												9-27-332(b) and
				9-27-334(c) state
				that a facility cannot be specified by name when a juvenile is court ordered to
				an inpatient psychiatric facility. Therefore, a case will not be closed solely
				because the court ordered ARKids First participant moves from one facility to
				another.
After a child is returned to parental custody, a new
				court order is required to disregard parental income even if the child later
				returns to the same facility.
2353
Change Notification to
			 Participant (Advance Notice)
The central office eligibility worker will notify the
				participant 10 days prior to case closure or to dropping an individual from the
				case by Form DCO-700 or DCO-55.
Advance notice is not required when:
1.
The Agency has factual information
			 confirming the death of a participant.
2.
The Agency receives a clear written
			 statement signed by the participant that her or she no longer wishes assistance
			 or that gives information which requires termination, and the participant has
			 indicated in writing that he or she understands the consequences of supplying
			 such information.
3.
The participant has been admitted or committed to a tax supported
			 insitution (e.g., state penal institution) and is not. eligible for continued
			 Medicaid assistance. (NOTE: Eligible children may continue to qualify while
			 receiving inpatient psychiatric care from the Arkansas State Hospital, Little
			 Rock (Re. MS 2070).
4.
The participant's whereabouts are unknown and Agency mail directed to him
			 or her has been returned by the Post Office indicating no forwarding
			 address.
5.
A
			 participant has been accepted for assistance in another state, and that fact
			 has been established by the Central Office Eligibilty
			 Unit.
2354
Case Closures
To close an ARKids First case, the central office
				eligibilty worker will:
1.
Record pertinent information in the case narrative;
2.
Give 10 days advance notice to the
			 participant by DCO-700 or DCO-55; and
3.
Complete DCO-56 for data
			 entry.
2355
Maintenance of Case Records
ARKids First case records will be maintained by the
				Central Office Eligibility Unit.