016.20.96 Ark. Code R. 021
To apply for a waiver, the representative or distributee must mail a statement to the Office of Chief Counsel, Attention: Decedents' Estates, P. 0. Box 1437, Slot 1033, Little Rock, AR 72203-1437, setting forth the facts which constitute the undue hardship. Tax returns, income statements or other documents which support the position that estate recovery would work an undue hardship on the survivors may be submitted.
A determination that hardship does not exist will be made if the individual created the hardship through estate planning in which assets were divested in order to avoid estate recovery,
A decision on the hardship waiver will be made by a DHS Central Office Committee within 30 days of receipt of the waiver request.
The DHS decision will be sent by certified mail, return receipt requested, to the person who applied for the waiver.
If recovery is not made due to a determination of hardship, DHS may decide to recover at a later time if the conditions which caused the original hardship cease to exist.
The waiver applicant may appeal the DHS decision regarding the hardship waiver by writing to the Office of Appeals and Hearings and requesting an administrative review of the decision. The request must be received no later than 30 days from the date of the notice of negative action.
An inmate of a public institution is not eligible for Medicaid.
Federal regulations at 42 CFR 435.1009 define a public institution as an institution that is the responsibility of a governmental unit or over which a government unit exercises administrative control. This control can exist when a facility is actually an organizational part of a government unit, or when a governmental unit exercises final administrative control. Public institutions include county jails, state and federal penitentiaries, juvenile detention centers, and other correctional or holding facilities. Wilderness camps and_boqt camps are "considered public institutions if a governmental unit has any degree of administrative control.
Federal regulations at 42 CFR 435.1009 define an inmate as an individual living in a public institution.
An individual who is an inmate in a penal or correctional institution is not Medicaid eligible, because the State or other governmental authority, by the act of incarceration, has assumed full responsibility for his/her care. If the inmate must be temporarily transferred to a medical treatment or evaluation facility, or if he/she is given temporary furlough, the individual is still considered an "inmate" under custody of the penal or juvenile justice system and is excluded from the Medicaid program.
Inmate status will continue until the indictment against the individual is dismissed or until he/she is released from custody either as "not guilty" or for some other reason (bail, parole, pardon, suspended sentence, home release program, probation, etc.).
As a condition of eligibility for Medicaid, recipients are required to assign their rights to Medical Support/Third Party Liability payments to the Division of Medical Services. This means that any funds settlements, or other payments made by or on behalf of third parties should be paid directly to the Arkansas Medicaid Program. In Arkansas, Third Party Liability payments are automatically assigned by state law.
The Medical Assistance Program is required by Federal and State Regulations to utilize all Third Party sources and to seek reimbursement for services which have been paid by both a Third Party and Medicaid.
Private insurance and Medicaid are complementary. A recipient's Medicaid eligibility is not affected by having Third Party coverage.
When a recipient has Third Party coverage in addition to Medicaid which can be used for medical expenses, Third Party coverage must be utilized first. Medicaid will pay up to the Medicaid allowable charge. For example: A Medicaid recipient has insurance which paid 80%, or $80 of a $100 medical bill. The Medicaid allowable charge for the bill was only $60.00. A Medicaid payment was not due since the.Medicaid allowable charge was less than the insurance payment. Third Party sources whose payment Medicaid will retrieve include private health insurance, automobile liability insurance where applicable, workmen's compensation, settlements for injuries, etc.
The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) is considered to be a Third Party source. Whenever a CHAMPUS beneficiary is also eligible for Medicaid, CHAMPUS is in ewery instance the primary payor. This applies to all classes of CHAMPUS beneficiaries, i.e., dependents of active duty members, retirees, dependents of retirees, dependents of deceased active duty members, and dependents of deceased retirees.
Third Party resources (if any) will be determined by completing the DCO-662 at the time of application and at each reevaluation when Third Party coverage is reported by the applicant/recipient. Third Party resources will be indicated on the'DCO-56 or DCO-57, whichever is applicable.
Third Party information will be indicated on the TPL field on the DCO-56 or DCO-57 and consists of an alpha code. Refer to forms instructions for the applicable code.
NOTE: For cases involving CHAMPUS, the name and Social Security Number of the service member must be entered on the DCO-662. The CHAMPUS address is P.O. Box 7938, Madison, WI 53707.
Upon determining that Third Party coverage exists, inform the recipient of the restrictions placed on the coverage by the Medicaid Program, (i.e., recipients are not entitled to any benefits and/or compensation from Third Party sources on services for which Medicaid has made or will make compensation). Instruct recipients who want Medicaid billed for services that they are to assign their TPL resource benefits to the provider before services are rendered.
Recipients are not entitled to any benefits and/or compensation from Third Party sources on services for which Medicaid has made or will make compensation. For this reason, recipients are responsible for assigning the TPL resource benefits to the provider before services are rendered if they want Medicaid billed for the services.
If the provider elects not to accept Medicaid on the recipient, the recipient becomes a "private pay" patient and is responsible for the full cost of services rendered. Assignment is not required for non-Medicaid claims.
It is the responsibility of the provider to be alert to the possibility of Third Party sources, to file a claim for services with Third Party sources, and to report receipt of funds from these sources to the Medical Assistance Section.
Since Medicaid makes payment on a "last pay" basis, the provider has the option of accepting the private insurance payment or that of Medicaid. When both the private insurance and Medicaid make payment, the provider can keep the larger of the two payments but must refund the lesser amount to Medicaid,
Recipients who are not cooperating with the Division of Medical Services Third Party Liability Unit will be subject to termination of Medicaid assistance. The Third Party Liability Unit will notify the County Office when a recipient has been determined uncooperative.
When a notice is received from the Third Party Liability Unit that a recipient is not cooperating, the Service Representative will:
using action reason 003 and close the adult member on WAFM effective the date advance notice expires. Use code 059 to close an adult member.
If the adult has countable income used in determining eligibility, key a "Y" to the Budget Indicator Field.
The recipient who has not cooperated with the Third Party Liability Unit will remain ineligible for Medicaid until that unit determines that the recipient is cooperating. The Third Party Liability Unit will notify the County Office when a case or member can be reopened.
Public Law 99-509, the Omnibus Reconciliation Act of 1986, prohibits a State from denying any individual Medicaid benefits who does not have a fixed or permanent address, but who resides in the state and is otherwise eligible.
If the applicant is considered an Arkansas resident and meets the other requirements for eligibility, the case may be certified using the address of choice for the applicant.
The Medicaid Identification Card is mailed by the Agency Data Processing Unit to eligible recipients of the Medicaid Program. The ID card should be received within two weeks after a case is approved on ACES. The following Information Is imprinted on the card;.
NOTE - The recipient should be instructed to keep, his Medicaid card even after an eligibility period has ended, as he will need it should he become eligible again in the future,
When a Recipient reports non-receipt of a Medicaid card, the County Office will need to secure sufficient background information in order to identify the problem. Probable situations that will be encountered and steps to correct them are as follows:
The County Office will inform the recipient that a Medicaid card will be issued. The recipient will also be informed that if the card is not received within 10 days, he should contact the Client Assistance Unit for further assistance. The recipient may call the Client Assistance Unit at its toll-free number: 1-800-482 -8988 (Voice) or 1-501-682 -8275 (TDD).
The County Office will refer the recipient directly to his local SSA Office.
The County Office has the capability to issue duplicate Medicaid cards if a recipient requests a replacement due to loss, theft, or destruction of the original. The procedures are the same for SSI and non-SSI recipients.
(Refer to DCO Users' Manual for instructions on updating these screens.)
Medicare is a Federal Insurance Program which pays part of hospital and medical costs for persons 65 years of age and over, certain disabled persons, and others determined eligible by the Social Security Administration. Medicare Insurance in " Arkansas is'processed by Arkansas Blue Cross and Blue Shield. Medicare consists " of 2 types of coverage. Part A - Hospital Insurance and Part B - Medical Insurance.
Part A - Hospital Insurance is available to certain eligible Medicare recipients without cost; other individuals, age 65 and over may purchase Part A for a premium. Part A provides hospital insurance coverage for inpatient hospital care, post-hospital extended care and post-hospital home health care. The Agency purchases this coverage for individuals entitled as Qualified Medicare Beneficiaries and Qualified Disabled Working Individuals who must pay the Part A premium (Re. MS 2047 -2047.11 and MS 2048-2048.7).
Part B - Medical Insurance for persons eligible for Medicare and Medicaid (with the exception of Medically Needy Spend Down) and for Specified Low Income Medicare Beneficiaries (Re. MS 2051-2051.6) is purchased by the Agency. Medical Services include physician services, supplies, home health care, outpatient hospital services, therapy, and other services.
Limitations for recipients with joint Medlcare/Medicaid coverage:
The Division of Medical Services pays Medicare Part B premiums for eligible Medlcare-Medlcaid recipients on the basis of their Medicare claim number supplied by the County Office on Form DCO-57. For recipients who report that the premium is still being deducted from their monthly Social Security check, the County Office will complete Form DCO-53, Report of Buy-In Problem Cases and mail to the Medical Assistance Section, Attention: Buy-In Coordinator.
To meet the Social Security enumeration requirement, each person included in the Medical Assistance Unit must either:
A person who does not meet the SSN requirement may not be included in the Assistance Unit until application to SSA has been made,
Only those eligible in the Newborn Infant Categories and aliens eligible under emergency provisions are exempt from the enumeration requirement.
For persons who have a SSN, the County Office Worker will request the card for photocopy. If the client does not have the card with him at the time of the interview but the number is known, the enumeration requirement has been met and assistance cannot be denied or delayed,
The County Office Worker may verify the SSN by any of the following.
The County Office Worker will also advise the individual to seek a replacement card from Social Security.
The card should be viewed and photo-copied whenever possible to help ensure the accuracy of the number and to help resolve any mismatches,
For individuals age 18 or over, the County Office Worker will issue an SS-5 and a DCO-12 along with the identifying information and pseudo-SSN to the applicant to apply in person at the local Social Security Administration Office. The County Office Worker will not forward any evidence to SSA for the applicant unless SSA specifically requests such evidence. A photocopy of the SS-5 and DCO-12 will be retained in the county office until the DCO-12 is returned by SSA showing that a complete SSN application has been received.
If the DCO-12 is returned by SSA showing that a complete SSN application has not been received, the County Office Worker will send a DCO-700 advising the applicant that he must submit a complete SSN application to SSA within 10 days or the Medicaid application will be processed without that person's needs being included in the unit.
For each person under age 18 who must apply for a SSN, the County Office Worker must complete the SS-5 and DCO-12. The County Office Worker will gather acceptable types of evidence to verify date of birth, identity and U.S. citizenship. NOTE: Form DCO-645 is not acceptable evidence. The original copies of this evidence along with the SS-5 and DCO-12 will be submitted to the local Social Security Administration Office. A photocopy of the SS-5 and DCO-12 should.be retained in the county office until the DCO-12 is returned by the SSA office indicating that a complete SSN application has been received.
If the DCO-12 is returned by SSA indicating that additional information or evidence is required, the County Office Worker will obtain the additional evidence, if available to the County Officer Worker, and resubmit the entire SSN application and DCO-12. If additional evidence is not available to the worker, a DC0-700 will be sent to the applicant requesting the information and advising that if not provided within 10 days the application will be processed without the person's needs included in the unit.
Each month, all Social Security numbers that have been entered to ACES by the county office with enumeration code "V" are submitted to the Social Security Administration to verify SSN, name and date of birth. If all match data agrees with SSA records, the enumeration code is changed to "S" by the system and the SSN is no longer keyable by the county.
If one or more of the match items does not agree with SSA records, the enumeration code "V" will be changed to one of the following mismatched codes:
If the name shown on the card is incorrect, according to the client, proof of the correct name should be obtained and ACES corrected. An SS-5 with the documents verifying the correct name will then be sent to SSA to correct their records. A DC0-I2 will be sent with the SS-5.
Effective January 1, 1994, the Medicaid Program has a twelve month filing deadline from date of service for all Medicaid claims, (e.g., claims with a 7/1/95 date of service must be received by the Claims Processor on or before 7/1/96 if payment is to be made). Claims which are not received within the twelve month period will be routinely denied. Recipients are not liable for payment of any claim denied due to the timely filing policy.
In situations when the recipient's Medicaid card is not issued until after the service has been rendered, the provider must still submit the claim within twelve months from the date of service. If the claim denies for recipient ineligibility, the provider may resubmit the claim once eligibility is determined. If the initial claim for payment was submitted within the filing deadline, the claim win be considered timely filed, regardless of when the el igibil ity determination is finalized for the date of service.
Claims with a date of service prior to January 1, 1994 have a 185 day filing deadline, (e.g., claims with a 12/1/93 date of service had to have been received by the Claims Processor on or before 6/1/94 for payment to be made). An exception to the 185 day deadline occurs when eligibility is not authorized until after the service has been rendered. In this situation, the 185 day filing period begins with the date Medicaid is authorized instead of the date of service.
Medicare determines covered services and allowed charges on all joint Medicare/ Medicaid claims. Medicaid is only responsible for the deductible and/or coinsurance on the allowed charges. For dually eligible recipients, a claim filed with Medicare will serve as the claim for Medicaid payment of the deductible/coinsurance amounts. The provider must submit the claim to Medicare within twelve months from the date of service in order to meet the Medicaid filing deadline. If the provider submits the claim to Medicare within twelve . months from the date of service, the claim will be considered timely filed, regardless of when Medicare crosses the claim to Medicaid for payment of the deductible/coinsurance.
In cases where the recipient is reporting problems regarding Medicaid payment of claims to a provider, refer him to Recipient Inquiries, Medical Assistance Section at 582-8317.
The U-18 Category is a Medical Assistance Only category intended to provide services to needy individuals under 18 years of age who meet the AFDC income and resource requirements.
Historically, it has been optional for states to provide Medicaid to children under age 18, using the AFDC guidelines. Arkansas previously elected to cover this group and will continue to do so, as described below.
States are now mandated by Section 1902(a)(A)(i)(III) and Section 1905 (n) of the Social Security Act to provide services to "qualified" children. A "qualified" child is one who was born after September 30, 1983, who is under age 19, and who meets the AFDC income and resource requirements. Until all of these children have reached age 19 (October 1, 2002), Arkansas will continue to cover children under age 18 born prior to October 1, 1983, on an optional basis in the U-18 program.
The services specified in the pamphlet, "Your Guide to Medicaid Services in Arkansas", are available to eligibles under the U-18 category. Child Health Services (FPSDT), WIC, and Family Planning Services will be offered to U-18 eligibles.
To be eligible for services in the U-18 category, an individual or family member must be under age 18 (eligibility may continue throughout the month of the ,18th birthday) and meet the eligibility criteria of the U-18 category.
Persons who are already eligible for Medicaid under another category cannot concurrently be eligible in the U-18 category.
No person will be prevented from participation, denied benefits, or subjected to discrimination on the basis of race, color, national origin, age, religion, disability, sex, veteran status or political affiliation. The Agency will be in compliance with the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, and Regulations issued by the Department of Health and Human Services.
The Agency has the responsibility for informing applicants and recipients that assistance and services are provided on a nondiscriminatory basis and that they have a right to file a complaint with the Agency or Federal Government if it is thought that discrimination has occurred on the basis of race, color, national origin, age, religion, disability, sex, veteran status, or political affiliation.
The eligibility criteria of the State's AFDC program form the basis of the eligibility criteria for the U-18 Category. The following AFDC requirements apply to the U-18 category.
Standard of Need - In determining U-18 eligibility, parents will be included in the need standard with their natural/adoptive children. Normally, all of the full siblings in the household will be included in the budget with their natural/adoptive parents. However, a parent may choose to exclude a child and that child's income or resources from a case budget if inclusion of that child and the child's income or resources would cause ineligibility for the other children. Children may also be excluded for other reasons, and the parent who applies need not state the reason.
. The AFDC pretest is not applicable (Re. FA 2364).
The $30 plus 1/3 earned income exclusion is not allowed (Re. FA 2365.2).
stepparent income is disregarded in determination of need for his/her stepchild(ren) (Re. FA 2377.1), but is deemed to the spouse who is the parent of the child(ren) if that spouse is under 18 and requests assistance.
In minor parent households, the income of the parent(s) of the minor parent is counted in full in the minor parent's need determination, but totally disregarded in the need determination of the minor parent's child.
Lump sums are considered income in the month received and, if retained, a resource in the month(s) following.
The income of an alien sponsor is disregarded (Re. FA 2377.4).
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.
The distinction between an application and an inquiry is as follows:
Applications for U-18 will be taken in the county-office of the applicant's county of residence. When the applicant is an unemancipated individual under age 18, application will be made by a responsible adult relative, legal custodian, or legal guardian. The authorized representative of these individuals may also apply on behalf of the child if he/she has been designated as the authorized representative in writing by the adult relative, custodian or guardian.
If a parent voluntarily places his/her child in an institution, the parent will apply for the child in the parent's current county of residence. That county will be considered the child's residence county.
If an individual under age 18 has been court ordered to an institution, the county in which the institution is located will be considered the county of residence and a representative of the institution or designee will make the application in that county.
If a court ordered U-18 enters an out-of-state institution, the out-of-state institution, or designee, will apply for U-18 in the county office of the child's last residence county or the county considered the "home" county.
Parents should not apply on behalf of their child who has been court ordered to an institution.
An emancipated individual under age 18 will be allowed to file an application on his/her own behalf for U-18. Judicial and common law emancipation will be recognized.
A judicially emancipated minor is one who has been given the right by a court to manage his own affairs.
A common law emancipated minor is one who has been given the right to manage his own affairs by voluntary or implied agreement between parent(s) and child, A common law emancipated minor must be demonstrating that he/she is responsible for the management of his/her own affairs by establishing an independent household or by sharing equally in payment of household expenses if 1iving with parent(s)/family.
When the applicant cannot be seen in the county office due to incapacity, confinement, etc., and he/she has no authorized representative, arrangements will be made to see the applicant at a place convenient to him/her.
Applications from Division of County Operations employees or their relatives will be made in their county of residence. The applications will be processed in the normal manner unless the appli cati on i s made at the employee's pi ace of employment. When the application is made at the individual's place of employment, it will be processed by the next level supervisor.
The adult relative, custodian, guardian, or emancipated U-18 will be allowed to have an individual or individuals of his choice accompany, assist, and represent him in the application process or a reevaluation of eligibility.
When the adult relative, custodian, guardian, or emancipated U-18 is not present during the application or reevaluation process, a written authorization designating the authorized representative will be required, unless the applicant/ recipient is incapable of completing one.
Upon receipt of the photocopy, the county will register the application on the WIMA screen. The date of application will be the actual date the application was taken at ACH.
The system assigned register number will be entered on the photocopy DCO-95, and the photocopy will then be mailed back to ACH.
Upon receipt of the photocopy, ACH personnel will enter the register number on the original DCO-95 and destroy the photocopy.
If ACH personnel have not received the photocopy DCO-95 back within 10 days of the date it was mailed to the county, they will follow up on the application by calling the county.
ACH will complete an eligibility determination for each application. Upon completion, ACH will forward the application/case record to the appropriate County Office for review and authorization.
The county office will review each application, submit a DCO-56 to data entry, and send a DCO-700 or DCO-55 to the applicant. A copy of the DCO-700 (or memorandum, if a system notice was generated) will be mailed to ACH, P.O. Box 34114, Little Rock, AR 72203, Attn: Financial Counselor, to notify ACH of approval or denial.
Upon disposition of the application, the county office will mail a copy of the DCO-700 (or memorandum, if a system notice was generated) to Medicaid Office, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 729, Little Rock, AR 72205, Attn: Admissions Office, Mail Slot # 729, to notify UAMS of approval or denial.
Application for U-18 will be made on the DCO-95 and must be signed by the responsible adult relative, legal custodian, legal guardian, or the authorized representative of these individuals. If emancipated, the U-18 must sign the application. If the U-18 has been court ordered to an institution, a representative or designee of the institution will sign the application.
Individuals who may be eligible under more than one category have the option.of -applying under more than one category. The county office has the responsibility to discuss the alternatives so that the applicant can make an informed decision. When more than one application is entered on WIMA, each application will be disposed of separately. An individual will be certified in one category only. When an individual applies under more than one category, all documents will be maintained in a single case record.
NOTE: Normally, only one (1) U-18 related case can be certified per household. There may be more than one case per household if there is more than one family in the home, or if there is a stepparent, minor parent, grandparent, etc. in the home. However, the natural/adoptive parent(s) will always be included in the Need Standard with his/her eligible children. A parent may exclude children from a case budget, and the parent who applies need not state the reason. For exceptions to budgeting only one case per household, refer to MS 7611.
Reapplications for U-18 are made in the same manner as initial applications. Previous case records (if any) will be obtained and/or reviewed.
The tasks to be completed during the application interview include:
During the application interview the county office worker will complete Forms DCO-7, DCO-86, DCO-87 (if used by the county), DCO-96, DCO-662, and the DHS-3300 (when applicable). The SS-5 will be completed if the applicant has not been previously enumerated (Re. MS 1390). Each person to be included in the need standard must be enumerated. The DCO-95 will be completed and signed by the U-18 representative (Re. MS 6130) or by the U-18 individual, if emancipated.
Before termination of the interview, the county worker will also complete a DCO-002, listing specifically the information that is needed to determine eligibility and giving a time frame in which all required verification must be returned.
On the date the application is received by the county office, it will be entered on WIMA. The county office will enter the register number on Form DCO-95. The category entered on WIMA will be U-18 (Cat.51).
The county will have up to 45 days from the date of application to make disposition by one of the following actions: approval, denial, or withdrawal.
When action on an application will be delayed beyond 45 days by the county office, the applicant will be notified by Form DCO-700 of the reason for delay and of his/her right to appeal.
When the applicant has been instructed by DCO-002 to provide information and fails to do so by the end of the specified time, the application will be denied. If the applicant has difficulty in providing the information and requests additional time, the county office worker will send a second DCO-002 that clearly specifies what information is needed by the end of the extended time period and, if requested, will assist the applicant in obtaining the information. If the information has not been provided by the end of the extended time period, the application will be denied.
The county office will secure all social and financial information necessary to determine eligibility. The applicant or representative will be the primary source of information. The county office worker will assist in obtaining necessary information if the applicant or representative is unable to do so.
When necessary, the applicant or representative will sign Form DHS-81, Consent for Release of Information, to secure information from a collateral source. Collateral information is evidence provided by persons other than the applicant or by written documents. The rights of the applicant will be protected during collateral interviews by giving only the information necessary to enable the collateral to understand the need for the information.
When an original, photocopy, or certified copy of a document used as evidence is not a permanent part of the case record, the narrative must contain the following:
Conflicting evidence will be resolved.
The county officer worker will document each task covered in the interview and record in the narrative and/or on forms all necessary social and financial information.
The income and resources of a spouse or parent must be considered as available to the individual whether or not they are actually contributed, if they live in or are considered to be living in the same household.
The following living arrangements will be considered living in the same household:
Temporary residency in public or private institutions for education, treatment, observation, or emergency care (e.g.. State schools for the Blind and Deaf, Arkansas Human Development Center, private boarding school, vocational school, college, etc.), provided the individual spends vacations and/or weekends in the household.
A child placed in a residential or treatment facility by the voluntary action of his parents (i.e., not by court order) will be considered as living with parents.
When an individual under age 18 is removed from his normal family setting by court order and placed with a third party (whether the parent(s) retain legal custody or not), the individual will not be considered living with the parent(s).
When a child is placed in a residential treatment facility by the voluntary action of his parent(s), and the voluntary placement is followed by a court order, parental Income and resources will be disregarded beginning on the effective date of the court order (Re. MS 5275). Prior to the effective date of the court order, the child will be considered to be living with the parent(s), and the parent(s)' Income and resources will be counted in full.
If a child Is court ordered to a facility, but continues to reside with his/her parent(s) because the facility will not admit until Medicaid is approved, eligibility will be determined with parental Income and resources counted in full.
If a court order states that the child "will be voluntarily placed by the parent(s)" in a facility, this will be considered a court ordered placement with parental income and resources disregarded.
When the individual is not considered to be living in the same household with the parent(s), only the income and resources of the parents that are actually contributed will be considered. The child's own income will be included in the budget whether given to the child or not.
Children incarcerated under the juvenile justice system who have been charged with or found guilty of a criminal offense are not eligible for Medicaid. This Includes children who are detained In juvenile detention centers or other alternative placements such as wilderness or boot camps.
A juvenile (U-18) who is court ordered directly to a treatment facility (rather than to a juvenile holding or correctional institution) on probation, parole, suspended sentence, etc. may be considered for Medicaid assistance, even if he/she has been charged with criminal acts and/or labeled a "juvenile delinquent".
For purposes of this policy, a court order placing a juvenile Into a residential treatment facility becomes effective when the judge's decision is made, that is, when the judge decides the issue of the juvenile's placement. Thus, the effective date of the order will often precede the date the judge signs the written order, but may not precede the date the judge considered and determined the issues. The disregard of parental income and resources begins when the court order is effective.
A court order may state that it has been entered "nunc pro tunc". This means that the order was effective when the judge made the decision, even though the order was signed and filed at a later date. A statement that the order was entered "nunc pro tunc" cannot make the order effective before the judge's decision was actually made.
If the order is for facility psychiatric evaluation only, the child will be considered to be living with the parents,
If the order to a facility is for evaluation and "treatment, if necessary", the child will not be considered to be living with the parents if it can be verified that the child has, in fact, been kept in the facility for treatment.
Orders declaring that a child is a member of a "family in need of services" (FINS) or is a "juvenile in need of services" (JINS), or is a "family of one" have no effect on the manner in which eligibility is determined. Unless the court orders the child to a treatment facility, the child will be considered to be living with the parents.
Even if a child Is court ordered to a facility and is determined eligible by the county office, Medicaid will not pay for inpatient psychiatric services if medical necessity is not established. The county office does not determine medical necessity. It is the responsibility of the admitting facility to obtain the certificate of need.
The AFDC resource limit applies to the U-18 No Grant category. If countable resources for the individual or family unit are $1000 or less, the applicant(s) is(are) resource eligible.
The Reduced Standard of Need will be computed on the DCO-7 using AFDC criteria and taking into consideration stepparent/grandparent budgeting exceptions (MS 6040) and living arrangements (MS 6270). All adjusted monthly income received by or considered available to the individual will be entered in Section C of the
" DC0-7-:
For any individual under age 18 in an institution, include special needs only (Re. FA 2385.1).
The county office worker will complete the following steps:
NOTE: The income and resources of an individual who is a recipient of AFDC or SSI will not be considered available in U-18 determinations.
When approving an application, the county office worker will:
The county office will certify eligible individuals as U-18 (Cat. 51) on the DCO-56. The head of household (parent, guardian, etc.) will be shown as "Payee", and each eligible child will be entered. When the head of household is also eligible, he/she is listed both as "Payee" and as an eligible. The eligible head of household under 18 must be given a child's suffix (201, etc.).
When the head of household over 18 has been included in the budget, he/she will be entered as a closed status adult member, with a "Y" in the budget indicator.
If a U-18 eligible has been court ordered to an institution, the institution or its designee will be entered on the DCO-56 as "Guardian/Authorized Representative" and the child will be listed as "Payee" and as an eligible recipient.
Eligibility will begin the month of application (i.e. current eligibility) or up to 3 months prior to the month of application (i.e. retroactive eligibility) if there are incurred medical expenses for the period and all other eligibility factors are met. The AFDC Needs Standard also applies to retroactive el igibility.
The Reduced Needs Standard will be completed for the first month in which retroactive coverage is needed. When there is a deficit, eligibility will be authorized for that month and for any subsequent month(s) in which there is a deficit. The Reduced Needs Standard will be completed for each month in succession until eligibility is established. Eligibility may be authorized for any one or all of the months during the retroactive period, and each month must be shown in the "Retro. Med," section of the DCO-56.
When denying an applicant, the county office worker will:
- I - -/ -"
When an applicant or representative requests that the application be withdrawn, the county office worker will:
When an applicant moves out of the county in which the application was taken, the county office worker in the initial county will:
Upon receipt of a transferred application, the receiving county will:
U-18 Category cases will be scheduled for completion of reevaluation ewery 12 months. The Information Systems Section will notify the county office by DCO-75 (Case Reevaluation Notice) that case reevaluation is due. Reevaluations will be conducted in the same manner as initial determinations (i.e. all eligibility criteria will be reverified). Forms needed for reevaluation will be those required for initial certification.
Changes in cases (e.g., adding or dropping an individual or change of address) will be made on Form DCO-56 for data entry. All changes will be documented in the case record.
Ark. Code Ann. § 9-27-332(b) and 9-27-334(c) state that a facility cannot be specified by name when a juvenile is court ordered to an inpatient.psychiatric facility. Therefore, a case will not be closed solely because the court-ordered U-18 moves from one facility to another.
If the child transfers to a facility in another county, the case will remain open and will be transferred to the county where the new facility is located. If the child is transferred to an out-of-state facility, the case record will be transferred, if necessary, to the child's home county office.
After a child is returned to parental custody, a new court order is required to disregard parental income and resources even if the child later returns to the same facility.
The county office worker will notify the recipient 10 days prior to case closure or to closing an individual from the case by Form DCO-700 or DCO-55.
Advance notice is not required when:
To close a U-18 case, the county office worker will:
016.20.96 Ark. Code R. 021