Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.17-004 - Medical Services Policy B-270, E-110, E-268, E-269, F-200, F-201, G-190, I-600, I-610 and Appendix F

Current through Register Vol. 49, No. 6, June, 2024
B-270
			 Adult Expansion Group (Arkansas Works Program)
MS Manual 01/01/17
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 95% (100% with 5% disregard
				applied) of the applicable federal poverty level
(MS
				E-110
) and are not eligible in either the Parents/Caretaker
				Relatives group
(MS B-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.
MS
				A-100)
.
T
NOTE:
If an individual in this group
				has a child(ren) under age IS 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 requirement for the
				Arkansas Works Program (Re.
MS F-200 and F-2011
. 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 Requirement.
T
NOTE:
Individuals enrolled in the
				Arkansas Works Program are required to have a valid email address.
E-110
Income and Resource
			 Limits for MAGI and Non-MAGI Groups
MS Manual 01/01/18
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
Appendices F and S
for the specific income level amounts.
Category
Income Limit
Resource Limit
ARKids A
142% of FPL *
No Resource Test
ARKids B
211% of
FPL
*
No Resource Test
Newborns
No Income Test
Eligibility is based on mother's
Medicaid eligibility at child's birth
No Resource Test
Pregnant Women:
Full Medicaid Pregnant Woman
1 person: $124.00
2 person: $220.00
3 person: $276.00
4 person: $334.00
5 person: $388.00
See Appendix F for household sizes over 5.
No Resource Test
Limited Medicaid Pregnant Woman
209% of FPL *
Unborn Child
209% of FPL *
Parents and Caretaker Relatives
1 person: $124.00
2 person: $220.00
3 person: $276.00
4 person: $334.00
5 person: $388.00
See Appendix F for household sizes over 5.
No Resource Test
Adult Expansion Group
95% of FPL*
No Resource Test
Medically Needy:
Exceptional (EC)
EC - may not exceed the monthly
1 person: $2,000
income limit
2 person: $3,000
Spend Down (SD)
SD - may exceed the quarterly income limit
See MS O-710 for the monthly and
3 person: $3,100
quarterly income limit
TEFRA
3 times the SSI Payment Standard
Appendix S
$2000
Autism
3 times the SSI Payment Standard Appendix S
$2000
Long-Term Services & Supports: Nursing Facility,
						  DDS, ARChoices, Assisted Living and PACE
3 times the SSI Payment Standard Appendix S
Individual $2000 Couple $3000
Medicare Savings:
ARSeniors
QMB
SMB
Ql-l
QDWI
Equal to or below 80% FPL
100% FPL
Between 100% & 120% FPL
120% but less than 135% FPL
200% FPL
Appendix F
ARSeniors, QMB, SMB & Ql-l: Individual $7,390
						  Couple $11,090
QDWI:
Individual $4000 Couple $6000
Workers with Disabilities
Unearned income may not exceed SSI individual benefit
						  plus $20
No resource test
PICKLE
Under the current SSI/SPA level Appendix S
Individual $2000
Widows & Widowers with a Disability (COBRA and OBRA
						  '87)
Under the current SSI/SPA level Appendix S
Individual $2000
Widows & Widowers with a Disability and Surviving
						  Divorced Spouses with a Disability (OBRA '90)
Under the current SSI/SPA level Appendix S
Individual $2000
Disabled Adult Child (DAC)
Under the current SSI/SPA level Appendix S
Individual $2000
*Mav be eligible
for
an additional 5%
						  disregard, MS E-268.
E-268
			 The 5% Gross Income Disregard
MS Manual 01/01/18
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 (e.g., 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 is 95% (
MS
				E-110
). To apply the 5% disregard, add 5 to 95 to raise the income
				limit to 100% 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
				groups
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 in 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 is 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 01/01/18
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 95%
				+ 5% = 100% standard for a household size of 3, $1,701.67.
[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.
[GREATER THAN] 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, $1,835.35.
Note:
The 5%
				disregard was not needed for ARKids A eligibility and therefore was not
				applied.
[GREATER THAN] Chloe is eligible for ARKids A.
F-200
Work Requirement for
			 the Adult Expansion Group
MS Manual 01/01/18
The Arkansas Works Program requires certain recipients of the
				Adult Expansion Group to meet the requirement of working 80 hours or more per
				month. Unless exempt, Adult Expansion Group recipients are ineligible to
				receive Medicaid benefits if, during any 3 months of the calendar year, they
				failed to meet the work requirement. Adult Expansion Group recipients will fall
				in one of four categories for the work requirement:
1. Enrollees age 50 or older - Work
			 requirement does not apply for this age group;
2. Enrollees age 19-49 that are employed at
			 least 80 hours per month - Complying with the work requirement;
3. Enrollees age 19-49 that are not employed
			 at least 80 hours per month but meet an exemption to the work requirement.
			 Exemptions are:
a. Currently receiving an
			 exemption to the SNAP Requirement to Work;
b. Receiving TEA Cash assistance;
c. Receiving unemployment benefits;
d. Has been determined medically
			 frail;
e. Caring for an
			 incapacitated person;
f. Living in
			 home with a dependent minor;
g.
			 Being pregnant;
h. Experiencing a
			 short-term incapacitation;
i.
			 Participating in an alcohol or drug treatment program;
j. Enrolled in full-time education, job
			 training or vocational training; or k. Membership in a recognized American
			 Indian/Alaska Native tribe.
4. Enrollees age 19-49 that are not 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 requirement. (See
MS G-190)
Work activities include:
a. Currently meeting SNAP Requirement to
			 Work;
b. Enrolled in education
			 (less than full time);
c.
			 Participating in job training (less than full time);
d. Participating in vocational training (less
			 than full time);
e. Participating
			 in a health education class;
f.
			 Volunteering; or g. Conducting an independent job search and/or participating
			 in job search training.
T
NOTE
: A combination of employment
				hours and work activities may be used to meet the work requirement.
Enrollees age 19-49 that are not employed at least 80 hours per
				month and do not meet an exemption or comply with work activities will lose
				Medicaid coverage for the remainder of the year after 3 consecutive or
				non-consecutive months of non-compliance with the work requirement within the
				calendar year. Those Adult Expansion Group recipients who lose coverage for
				non-compliance with the work requirement but meet an exemption later in the
				calendar year will not be allowed to regain coverage in Arkansas Works until
				the following calendar year. However, those Adult Expansion Group recipients
				who have lost coverage for non-compliance and turn 50 years old within the same
				calendar year will be allowed to apply to regain coverage the month the
				recipient's turns 50. Those individuals who have lost Arkansas Works coverage
				due to non-compliance may be determined eligible for coverage in other Medicaid
				categories during the period of Arkansas Works ineligibility.
T
NOTE
: Months of non-compliance with
				the work requirement will not carry over into the next calendar
				year.