016.20.00 Ark. Code R. 013

Current through Register Vol. 49, No. 10, October, 2024

Rule 016.20.00-013 - ARKids First - Revised to change the look back period for dropping Health Insurance from 1 year to 6 months

'Standard of Need: In determining ARKids First eligibility, parents will be included irrthe need standard with their natural or adoptive children. -¹ Normally, all'of the full siblings in the household will be included in the budget with their natural or adoptive parents. However, a parent or other relative may choose to exclude a child and that child's income from a case budget if inclusion of that child- and the child's income would cause ineligibility for the other children. Children may be excluded for other reasons, and the parent or relative who applies need not state the reason. An unborn child of a PW will not be counted in the standard of need.

9.Resources: No resource test exists for the ARKids First category.

10.* Health Insurance: Children who are covered, or who have been covered by primary comprehensive health insurance (as defined in item c. below), other than Medicaid, within the 6 months preceding the date of application will not be eligible for services in the ARKids First category unless one of the conditions below is met:

a) The'health insurance is a non-group or non-employer sponsored plan.

b) The health insurance was lost through termination of employment for any reason or through no fault of the applicant. For example, health insurance is lost through no fault of the applicant if the employer ceases to provide employer sponsored health insurance.

c) The health insurance is not primary comprehensive. Primary comprehensive health insurance is defined as insurance that covers both physician and hospital charges.

d) The 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 the state and covers the child on his of her HMO which the child cannot access due to distance). This determination will be made on a case-by-case basis by the ARKids First worker based on information provided by the applicant.

If a parent or guardian voluntarily terminates insurance for a reason other than listed above within the 6 months preceding application, his or her children will be ineligible.

The Central Office Eligibility Unit will accept the applicant's declaration regarding his or her health insurance coverage, unless they are claiming one of the above exceptions or the worker has contradictory information or the applicant's circumstances make the declaration questionable (e.g., the applicant reports earnings from an employer who customarily provides group health insurance).

2340Application Process

2341Right to Apply

All individuals who wish to apply will be given the opportunity to do so without delay. No application or inquiry will be ignored. The Agency has the responsibility to follow up on any request for medical assistance and to make arrangements for completion of the application.

016.20.00 Ark. Code R. 013

5/22/2000