Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.17-008 - Medical Services Policy Manual Sections A-180, C-120, C-130, C-150, E-265 and E-270

Current through Register Vol. 49, No. 6, June, 2024
Medical Services Policy Manual, Section A
A-180
Medicaid/Health Insurance
			 Marketplace Interactions
MS Manual 02/01/18
The Patient Protection and Affordable Care Act of 2010 and the
				Health Care and Education Reconciliation Act of 2010 (collectively referred to
				as the Affordable Care Act) allow individuals under the age of 65 to obtain
				affordable health insurance coverage through a Health Insurance Marketplace
				established in each state. A Health Insurance Marketplace is an online
				marketplace where individuals can shop for a health insurance plan that is both
				affordable and meets the individual's specific health care needs. In addition,
				an individual can apply through the Health Insurance Marketplace for assistance
				in meeting the cost of health insurance through an insurance affordability
				program. In Arkansas, the Health Insurance Marketplace is a State Partnership
				with the Federal government and is referred to as the Federally Facilitated
				Health Insurance Marketplace (FFM).
The term "Insurance affordability program" includes the
				Medicaid program, premium tax credits including advance payment of the credit,
				and cost-sharing reductions. Only individuals who are determined ineligible for
				an appropriate Medicaid coverage group are potentially eligible for the premium
				tax credit and cost-sharing reductions. The upper income limit for any amount
				of premium assistance is 400% of the federal poverty level for the individual's
				household size.
When an individual applies for an insurance affordability
				program through the FFM and appears to be Medicaid eligible, the FFM will send
				a file to DHS and DHS will process it. If found eligible, the applicant will be
				approved in the appropriate category based on the eligibility determination.
				The applicant will not be required to submit a separate Medicaid application to
				DHS. DHS will notify the individual of the next steps to complete the
				enrollment process. See
MS C-150.
For any individual determined ineligible for Medicaid, the FFM
				will then continue to determine eligibility for the premium tax credit and
				cost-sharing reductions. Once eligibility and the amount of the tax credit and
				cost-sharing reduction is determined, the individual will be given insurance
				plan options from which to select the plan that best suits the individual and
				family. Enrollment in the selected plan will then occur through the FFM.
Since Medicaid is one of the insurance affordability programs
				under the Affordable Care Act, an individual may apply directly to DHS for
				Medicaid eligibility. To coordinate and streamline the application process for
				the insurance affordability programs, DHS uses the same Single Streamlined
				Application used by the FFM. Although DHS will not make a determination of
				eligibility for the premium tax credit or cost-sharing reductions for
				individuals determined Medicaid ineligible, DHS will send the individual's
				electronic account to the FFM which will include the needed application data
				for the FFM to make those determinations.
In addition to the interactions resulting from the application
				process, the Affordable Care Act mandates that the Medicaid agency and the FFM
				coordinate enrollment activities for the individual when changes occur that
				result in either Medicaid ineligibility or eligibility. For example, the parent
				in a family who was Medicaid eligible starts a new job which results in the
				loss of Medicaid eligibility. In this situation, DHS will send the electronic
				account to the FFM and notify the individual to go to the FFM to have
				eligibility for the premium tax credit and cost-sharing made and then select
				and enroll in a Qualified Health Plan (QHP). The loss of Medicaid eligibility
				triggers a 60 day Special Enrollment Period at the FFM.
Medical Services Policy Manual, Section C
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				document.
C-120
Submitting an Application
MS Manual 02/01/18
An application may be completed and submitted electronically
				via
Access Arkansas
or through the Federally
				Facilitated Health Insurance Marketplace (FFM). An application may also be
				completed in writing on an approved DHS application form and submitted to the
				Agency via mail, fax, email, telephone or in person to a designated DHS
				Agency.
NOTE;
See
Appendix
				I
for a listing of which application forms are needed to apply for
				a specific coverage category.
An application may be submitted by the individual, the
				individual's spouse or Authorized Representative, emancipated minor or if the
				applicant is a minor who is not living with a parent, a caretaker acting
				responsibly for the minor.
Although an application will be accepted and processed with
				only the minimal information listed below, the applicant should complete as
				much information as possible in order to avoid delays in determining
				eligibility and processing the application.
An application must include at a minimum the following
				information:
1. Applicant's
			 name,
2. Applicant's address (or
			 other means of contacting the applicant if homeless), and
3. Applicant's signature (written, telephonic
			 or electronic).
When an individual applies for health insurance coverage
				through the FFM, the FFM will send a file to DHS and DHS will process it. If
				the applicant is found to be eligible for Medicaid, the applicant will be
				approved in the appropriate category based on the eligibility determination.
				The applicant will not be required to submit a separate Medicaid application to
				DHS.