Paul Sanchez
If you're looking to pick your insurance with Arkansas Medicaid, there are a few things you should know. Firstly, Arkansas is one of the few states that has implemented Medicaid expansion, but it uses a non-standard approach through a waiver system. This allows the state to use Medicaid funds to cover the cost of private health insurance plans. Secondly, eligibility for Arkansas Medicaid depends on your income, assets, and age. The program provides health insurance to people with low incomes, covering medically necessary services such as dental and routine medical care. If you have both Medicare and Medicaid, Medicare pays first, and Medicaid pays for the remaining costs. It's important to note that Medicaid does not pay co-payments to other insurance providers, and your doctor must bill your other insurance before billing Medicaid. Finally, Arkansas offers programs like ConnectCare to help Medicaid and ARKids First families find a primary care provider and dental care.
| Characteristics | Values |
|---|---|
| Medicaid eligibility in Arkansas | Low-income populations, including children and pregnant women |
| Arkansas' approach to Medicaid expansion | Using Medicaid funds to cover private QHPs instead of fee-for-service or managed care |
| Work requirement for Medicaid enrollees | Implemented in 2018 but overturned by a judge in 2019 |
| Arkansas Works waiver | Valid until the end of 2021 |
| ARKids First | Health insurance program for children under 19 in Arkansas, covering physical exams, eye exams, and dental checkups |
| Medicaid Spend-Down program | For people who need temporary help but make too much money to qualify for full Medicaid benefits |
| Medicare Advantage plans | Private insurance plans offering benefits like fitness classes and meal delivery |
| Medicaid coverage for dental care | Routine dental care and medically-necessary orthodontic care for those under 21; $500 yearly limit for adults |
| Medicaid coverage for new mothers | Not extended to 12 months postpartum |
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What You'll Learn
Medicaid eligibility and enrollment
Arkansas Medicaid, also known as Health Care, is a state- and federally funded program administered by the state under federally set parameters. The program is designed to provide health care coverage for low-income individuals who need medical services but cannot afford them. The Arkansas Department of Human Services (DHS) manages and administers the program for state residents who qualify.
Eligibility Requirements:
- Income: Arkansas Medicaid has income requirements for eligibility. For a single Nursing Home Medicaid applicant, the income criteria is an income of less than $2,901 per month. For a family of four, the maximum allowable income per year is $39,900.
- Assets: There are also asset limits for eligibility. For a single Nursing Home Medicaid applicant, assets must be under $2,000.
- Other: Arkansas Medicaid also covers specific populations, including children, pregnant women, older adults, and those with developmental disabilities. Coverage for pregnant women is currently provided for 60 days after birth; however, efforts are being made to extend this to 12 months.
Enrollment Process:
- Online: You can enroll in Medicaid online at Access Arkansas. Non-disabled adults under the age of 65 can also begin the process online through Healthcare.gov, which will direct them to Access Arkansas if they are likely eligible.
- Phone: Enrollment can also be done over the phone by calling 1-800-482-8988.
- In-Person: Individuals can visit a Department of Human Services office in their county to enroll in Medicaid.
It is important to note that the enrollment process typically takes three to six months, and delays may occur if proper documentation is not provided promptly. Arkansas briefly implemented a work requirement for some Medicaid enrollees in 2018, but it was soon overturned. As of 2024, Arkansas is the only state utilizing a private option approach, with Medicaid expansion enrollees covered under state-purchased QHPs.
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Medicare Advantage plans
Medicare Part D offers prescription drug coverage to all Medicare enrollees. If you opt not to join a Medicare Prescription Drug Plan when first eligible, and you lack other creditable prescription drug coverage, you will likely have to pay a late enrollment penalty. From October 15 to December 7 each year, you can purchase a Medicare Part D drug plan. If you choose not to enroll and do not have credible coverage under another plan, you will pay a penalty when you do enroll.
You can enroll in Medicare Part B during any month in which you are still covered under your current enrollment, or during the 8-month period beginning with either the date your employment ends or the date your group health plan ends, whichever comes first. To enroll, contact the Social Security Administration at 1-800-772-1213 or fill out an Application for Enrollment in Part B (CMS-40B) and a Request for Employment Information (CMS-L564). These forms can be downloaded through Medicare.gov.
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Medicaid with Medicare
In Arkansas, Medicare and Medicaid are two separate programs, each with its own set of benefits and eligibility requirements. Here is some detailed information about both programs and how they interact in Arkansas.
Medicaid in Arkansas
Medicaid is a health program managed by the state of Arkansas and funded jointly by the state and federal governments. The Arkansas Department of Human Services (DHS) administers the program, and its local county offices serve as the primary resource for beneficiaries and applicants. Arkansas has implemented Medicaid expansion, but it uses a non-standard approach through a waiver. The state primarily utilizes a private option approach, where Medicaid expansion enrollees obtain coverage through state-purchased QHPs in the exchange rather than directly through Medicaid.
Eligibility for Medicaid in Arkansas is based on income and asset limits. The state has specific guidelines for seniors seeking long-term care through Medicaid, and it offers various pathways to eligibility. Additionally, certain populations, such as children and pregnant women, must be covered for the state to qualify for Medicaid funding.
Medicare in Arkansas
Medicare is a federal insurance program for senior citizens. The Arkansas Insurance Department's Senior Health Insurance Information Program (SHIIP) provides free counseling, education, and information to individuals with Medicare. They can answer questions related to coverage, supplemental insurance, long-term care, and Medicare Advantage Plans.
Combining Medicaid and Medicare in Arkansas
Some individuals may qualify for both Medicaid and Medicare, and there are programs and considerations specific to this situation. The Program of All-Inclusive Care for the Elderly (PACE) combines the benefits of Medicaid and Medicare into a single program, offering long-term care and additional benefits such as dental and eye care.
When navigating Medicare and Medicaid together, beneficiaries may encounter issues such as enrollment in a Medicare Advantage plan without their knowledge, coordination of benefits, and third-party liability. The Attorney General's office and the Centers for Medicare and Medicaid Services are resources to help resolve these issues and provide educational information.
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Medicaid expansion
Medicaid is a joint state-federal operation, with states having autonomy over how they run their programs. Arkansas has been a leader in Medicaid expansion over the past decade, implementing it under Obamacare (the Affordable Care Act) and giving health coverage to hundreds of thousands of low-income Arkansans. The state uses a non-standard approach via a waiver, allowing it to use Medicaid funds to cover the cost of private health insurance plans instead of a fee-for-service or Medicaid managed care approach.
The Affordable Care Act's (ACA) Medicaid expansion extended coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($21,597 for an individual in 2025). Obamacare incentivized states to accept Medicaid expansion by offering a 90% federal matching rate, much higher than the national average of 57%. Arkansas, with its high poverty rate, benefits from this, paying only about 30% of the cost of most Medicaid services.
Arkansas was one of the first Southern states to adopt Medicaid expansion, and as of 2024, it is the only state still utilizing a private option approach. The program has been called "Arkansas Works" and, more recently, "ARHOME". It has successfully reduced the number of uninsured Arkansans and now covers more than 220,000 people.
However, Arkansas's Medicaid expansion is under threat. It is one of nine states with a trigger law that would automatically end Medicaid expansion if the federal match rate drops below a certain level. With Republicans in control of Congress, it seems likely that Medicaid will be restricted in some way. The state's expansion also faces challenges due to its work requirement, which was implemented in 2018 but overturned by a judge in 2019 after thousands lost coverage. In 2023, Arkansas submitted a waiver amendment to CMS seeking to implement a new approach that includes job training and assistance.
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How to apply for Arkansas Medicaid
To apply for Arkansas Medicaid, you can enroll online at Access.Arkansas.gov. You can also submit an application by mail, phone, or in person at your local county office.
If you would like to talk to a counselor about your options, you can call the Choices in Living Resource Center at 1-866-801-3435 or email [email protected]. The Arkansas Department of Human Services also has an intake and referral unit within its Division of Developmental Disabilities that can help you navigate the process for applying for services. You can reach them at 501-683-5687.
Eligibility for Arkansas Medicaid is determined by age, income, and medical needs. For example, children from birth to age 18 with incomes up to a certain percentage of the Federal Poverty Level (FPL) are eligible, as are pregnant women with incomes up to a certain percentage of FPL. It's important to note that Arkansas has specific requirements for its Medicaid program, such as work requirements and limited retroactive eligibility.
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Frequently asked questions
The Arkansas Medicaid Program is a state-federal initiative that provides health insurance to people with low incomes. Arkansas Medicaid covers 27% of the state's population.
Arkansas Medicaid eligibility depends on your income, assets, and age. You may qualify if you meet the income eligibility requirements. People who don't qualify for full benefits may qualify for Medicare Savings Programs or other discounted medical services.
If you have both Medicare and Medicaid, Medicare pays first, and Medicaid pays last. You must use your health insurance before Medicaid will pay. Your doctor must bill your other insurance before billing Medicaid. When showing your Medicaid ID card, you must also tell your doctor the name of your other insurance company and your insurance number.
