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. 6, June, 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:
1. Persons age 65 or older who are:
a. Entitled to monthly Social Security
			 benefits on the basis of covered work under the Social Security Act; or
			 qualified Railroad Retirement beneficiaries; or
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
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