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Arkansas Medicaid, ARKids First,

&You

Arkansas Medicaid Client Handbook

A GUIDE TO YOUR RIGHTS AND RESPONSIBILITIES

REVISED 2021

Arkansas Medicaid, ARKids First, & You

First Connections Program.. . . . . . . . . . . . . . . . 45 Children with Chronic Health Conditions (CHC) Program (Title V Children and Youth with Special Health Care Needs).45

Your Guide to Arkansas Medicaid and ARKids First

How to use this handbook:

〈Read through this entire handbook as soon as you can to learn about Medicaid and ARKids First.

〈Keep it as a reference to look up things you need to know.

〈Mark the parts that you do not understand and make a note of your questions.

〈When you get answers to your questions, write them in your handbook for future reference.

This handbook cannot tell you everything.

〈Laws and rules can change, so some things might have changed since this handbook was printed.

〈This handbook is not a legal document. That means it is just a guide, not a contract.

〈The Department of Human Services (DHS) is not responsible for information in this handbook that is no longer correct.

〈Call Medicaid at 1-800-482-8988 if you have questions.

DHS is here to help you!

Call or visit your county office when you have questions or concerns.

You can find the closest county office to you at https://

humanservices.arkansas.gov.

What is Medicaid?

Medicaid is a program that helps you by paying for covered medical care you need. The term “Medicaid” in this handbook refers to many types of health care coverage like:

〈Traditional Medicaid – coverage for people with household incomes less than 100 percent of the Federal Poverty Level

〈Arkansas Works – health care coverage for people with household incomes that are more than 100 percent and up to 138 percent of the Federal Poverty Level

〈Dental care coverage for eligible children and adults

〈Pregnancy & Newborn Medicaid - coverage for women who are pregnant or who have recently given birth as well as their newborns;

〈ARKids First - coverage for children up to age 19

〈First Connections - coverage to support infants and toddlers with developmental delays

〈TEFRA - a category of Medicaid that provides care to children with a disability in their homes rather than in institutions

〈Community Employment Support Waiver – coverage for people who have a developmental disability and need special care

〈Autism Waiver - treatment for clients from ages 18 months through 7 years with a diagnosis of autism spectrum disorder

〈Long-term Care - coverage for people who need long-term disability services, in-home personal assistance, assisted living, or nursing home services

〈Many other categories of Medicaid

You don’t have to remember all of these program names. After you apply, you will get a letter to let you know if you or your child is eligible for one or more of these programs. Learn more about these programs under Covered Services starting on page 37.

About Medicaid and ARKids First

Medicaid

〈Medicaid is a program that helps you by paying for covered medical care you need. Read page 5 to find out who can get Medicaid.

〈Medicaid uses state and federal money to pay these bills. In Arkansas, DHS runs the Medicaid program.

〈Medicaid is not the same thing as Medicare. Medicare pays for covered medical services for people age 65 and older and for some people who have a disability.

ARKids First

〈ARKids First is health care insurance for children.

〈ARKids First has two programs: ARKids A and ARKids B.

〈ARKids A is Medicaid for children.

〈ARKids B is for children whose parents make too much money to get regular Medicaid, but do not have health insurance for their children.

〈When you fill out the ARKids First application, you can apply for both programs. DHS will decide whether you qualify for either program.

Do Medicaid and ARKids First pay you or your doctor?

〈Medicaid and ARKids First will not make payments to you.

〈Medicaid and ARKids First pay doctors, hospitals, and other health care providers who are enrolled in the Medicaid program.

〈Your doctor or other health care providers should bill Medicaid or ARKids First for your medical services; however, billing Medicaid or ARKids First is not mandatory. Please see page 4 for more information about how Medicaid pays for services.

Some important points about Medicaid and ARKids First:

〈Medicaid and ARKids First can help pay some of your medical bills but not all medical bills are covered.

〈Doctors do not have to bill Medicaid or ARKids First, even if they are Medicaid or ARKids First providers.

〈Before you get a service or treatment for you or your child, ask if it will be billed to Medicaid or ARKids First.

〈If Medicaid will not be billed for a service, the doctor must tell you.

〈If you still want the treatment, you may have to pay for it yourself

or you can find another doctor who will bill Medicaid or ARKids First.

〈Most people must choose a primary care physician, also called a PCP.

〈Your PCP is the doctor who is in charge of your health care.

〈You will be given a card to show your doctor or health care provider for the coverage you get.

〈Take care of your card, and keep it with you at all times. Your card makes it easier to get the care you need.

〈If you have ARKids B, or if you’re an adult on Medicaid, you will have to pay for part of your medical care.

〈Do not let others use your card. If you do, you are breaking the law. This means you could lose your Medicaid eligibility and even serve time in jail.