Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.18-004 - Exceptions to the 90 day waiting period for ARKids-B applicants with additional health insurance coverage.

Current through Register Vol. 49, No. 6, June, 2024
F-180
			 Other Health Insurance Coverage
MS Manual 09/01/18
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.
Adult Expansion
				Group
An individual who is eligible for or enrolled in Medicare
				is not eligible for the Adult Expansion Group.
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 premium paid by the family for coverage of the child under the group
			 health plan exceeded 5 percent of household income.
*t
NOTE: A group health plan means an
				employee welfare benefit plan that provides medical care to employees or their
				dependents directly or through insurance, reimbursement, or
				otherwise.
b.
The child's parent is determined eligible for advance payment of the premium
			 tax credit for enrollment in a Qualified Health Plan (QHP) through the Exchange
			 because the Employer-Sponsored Insurance (ESI) in which the family was enrolled
			 is determined unaffordable in accordance with
			 26 CFR
			 1.36B-2(c)(3)(v).
c.
The cost of family coverage that
			 includes the child exceeds 9.5 percent of the household
			 income.
d.
The
			 employer stopped offering coverage of dependents (or any coverage) under an
			 employer-sponsored health insurance plan.
e.
A change in employment, including
			 involuntary separation, resulted in the child's loss of employer-sponsored
			 insurance (other than through full payment of the premium by the parent under
			 COBRA).
f. The child has
			 special health care needs. Special health care needs are defined as the health
			 care and related needs of children who have chronic physical, developmental,
			 behavioral or emotional conditions. Such needs are of a type or amount beyond
			 that required by children generally
g. The child lost coverage due to the death
			 or divorce of a parent.
h. 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.