DYS Adjudicated Juveniles and Medicaid

1. Press Start to begin DYS Adjudicated Juveniles and Medicaid

2. A few things about Medicaid

3. ARKids First provides health insurance coverage for Arkansas children from birth to age 19 There are two categories of coverage in ARKids First A and B

4. ARKids A ARKids A provides the full range of Medicaid services.

5. ARKids B ARKids B provides a more limited range of services with limited co-pays for some services. Medicaid recipients are responsible for paying a co-insurance amount equal to 10% of the Per diem charge for the first Medicaid covered day per inpatient hospital admission Medicaid recipients are also responsible for paying a copayment amount per prescription based on a graduated payment scale, not to exceed $3 per prescription

6. Incarcerated individuals are NOT eligible to Medicaid When placed in a Medicaid approved facility (hospital, therapeutic group home, sex offender treatment) the juvenile becomes eligible to Medicaid, if they meet all the other eligibility requirements.

7. Income Relationship and living with a specified relative Residency Age Citizenship To be eligible for Medicaid each juvenile applying MUST meet these 5 criteria

8. AGE: the juvenile must be under 18 Citizenship: the juvenile must be a U.S. citizen or legal alien

9. The juvenile must be a resident of the state of Arkansas. An institutionalized juvenile is considered a resident of the State of his parents or legal guardian.

10. In order to be eligible for ARKids A or B, a child must be living with a relative who is within 5 degrees of kinship; unless he has been removed from the custody of his parent/relative/guardian by court order, has been court ordered to an institution, has been emancipated, or has reached age 18.

11. M - Modified A - Adjusted G - Gross I - Income The Medicaid household size is the number of people who will be counted to determine the appropriate Federal Poverty Level or other income standard for the household. Medicaid household means the household members whose income will be considered when determining eligibility and/or who will be included in the household size. Under the MAGI methodology, the Medicaid household composition is based on the federal income tax filing status. It is used to determine whose income will be considered in determining eligibility.

12. The eligibility effective date is the first day of the month of application, unless retroactive coverage is approved. Retro active coverage can be approved for up to three full months prior to the date of application if: The applicant received medical services in the retroactive period; and The applicant was eligible in the month the medical services were received. Application Received today

13. Every morning you will receive an updated Daily Insurance report. This report tells you how many juveniles in DYS custody have Medicaid, SSI Medicaid, other insurance, or no known medical coverage at all.

14. As of the date of this email message; there were a total of 327 juveniles in DYS custody. 228 of the juveniles have Medicaid. 99 are totally un-insured. 23 are Foster Care Medicaid and 50 have SSI Medicaid.

15. When a juvenile, who receives SSI Medicaid, is adjudicated to DYS custody the Social Security Administration is automatically notified Because the incarcerated individual is not eligible any longer to SSI Medicaid, the Social Security Admin will either suspend or close the Medicaid case. At that point, the only way the juvenile can get Medicaid is for an application for Medicaid to be completed by their parent/guardian and submitted to the Federal Funds Unit in DYS. At times the Social Security admin fails to close or suspend the Medicaid case, which prevents the Federal Funds Unit from processing a newly submitted application since a person can only have ONE Medicaid case open at a time. When this happens, the SSI Medicaid can be used to pay for Medical services that occur when the juvenile is placed at a Medicaid approved facility. * Because only some Foster care cases can be re-opened when the juvenile is placed in DYS custody and placed in a Medicaid approved facility, and because we never know if/when an SSI Medicaid case will close; these cases, when listed on the Insurance report, are listed as closed.

16. The DHS county offices are also notified when a juvenile is placed in DYS custody. Because the incarcerated individual is not eligible any longer to Medicaid, the County DHS office will either suspend or close the Medicaid case. The DYS Federal Funds Unit is a special unit that works with only incarcerated juveniles. When a new juvenile appears on the Daily Census report we receive, they are added to the current Insurance/Un-Insurance spreadsheet and we check to see if the juvenile has or has had Medicaid or private health insurance, whether it is open, suspended, or closed, and/if a new application might needed for the individual. When we are notified that a juvenile has been placed in a Medicaid approved facility we check to see if the juvenile has or has had Medicaid, whether it is open, suspended, or closed, and/if a new application is needed for the individual.

17. Because changes can be constantly happening to a person’s Medicaid case, it is suggested that anyone who needs to know up to the minute Medicaid information on a DYS incarcerated juvenile call the Federal Funds Unit to inquire. Robin Nicpan – (501) 320-6143 Marie Kenney – (501) 321-6149

18. If we are unable to un-suspend a Medicaid case for a juvenile; or if his case has been closed; the only solution to get Medicaid for the juvenile is to have his parent/guardian complete a Medicaid application. If you must get an application for the juvenile, there are 2 things to keep in mind.

19. How old is the juvenile? If the juvenile is aged 18 or older, they can apply for themselves. If the juvenile is 17 or younger, their parent or legal guardian must apply for them. Which application do you need? DCO- 151 or DCO-152 The easiest way to remember this; the DCO-151 ends with a 1 (for one person) the DCO-152 ends with a 2 (for two or more people – Family application).

20. DCO-151 This application is for SINGLE applying adults 18 years or older.

21. DCO-152 This application is a Family application meaning 2 or more people will be listed on this paperwork.

22. The parent/guardian MUST include everyone living in the household.

23. Person 1 is the parent/guardian and this is where they include their personal information. Please answer all questions including number 7, even if the health coverage of the parent/guardian does not cover the incarcerated juvenile.

24. Because under the MAGI methodology, the Medicaid household composition is based on the federal income tax filing status and it is used to determine whose income will be considered in determining eligibility, it is very important that the parent/guardian complete this section.

25. Each person will have their own income section; which includes employment and unearned income.

26. Beginning on page 5 of the application is where a second person in the household will be listed. If the parent/guardian is married then their spouse will be Person 2. If no spouse, then person 2 will be the oldest juvenile in the household. Working from oldest to youngest pages 5 and 6 will need to be completed for each person.

27. Because the application only includes enough information pages for 2 people, you will need to make additional copies of page 5 and 6 for each additional person in the household. If there is no way to get needed copies for each additional person, attach a sheet of paper with the needed information on it for each additional person.

28. When you get to page 7 MAKE SURE the parent/guardian signs the application. If there is no signature, this is not a completed application and this will stall processing while we wait for a signed page to be returned!

29. You can remove the voter registration page as the incarcerated individual CANNOT vote.

30. Remember that the Federal Funds Unit has been speciallytrained to work with incarcerated juveniles and will process the application once returned to us. DO NOT send the application to the local DHS office because the incarcerated individual will be DENIED Medicaid.

31. This presentation was created by Marie Kenney. If you have any questions or comments feel free to contact me. Marie Kenney Federal Funds Manager OFA (Shared Services – DYS) (501) 320-6149