Since the ARKids First program was implemented in September 1997, many low-income Arkansas families have taken the opportunity to enroll in affordable health care coverage for their otherwise uninsured children. Currently, the ARKids First program covers almost 60,000 children. By any measure, the program has succeeded in reaching families who might otherwise not have health care coverage for their children.

Recent reports have indicated that many of the current ARKids families may be eligible for full Medicaid coverage. Although families who appear to be income eligible are encouraged to apply for regular Medicaid when the ARKids application is approved, some may not follow-through due to the complexity of the application process. This has been a shared concern of the federal Department of Health & Human Services, Health Care Financing Administration, advocacy groups, and DHS.

To simplify the application process, a joint application will be available August 4, 2000 for SOBRA Medicaid category (renamed ARKids A) and ARKids First (renamed ARKids B). Under the umbrella name ARKids First, the combined application form describes the differences in the two types of coverage and allows the applicant to choose the type of coverage for which he or she wants to be considered.

A mail-in application process and self-declaration will also encourage participation and simplify the application process. These changes necessitate other changes, including moving responsibility for processing all ARKids First applications to the county offices. The purpose of this directive is to discuss in detail the changes being made in both the current ARKids First program and the children’s SOBRA category and to provide implementation procedures for the changes that are effective August 4, 2000.

1. Overview of Changes
   
   1. Effective Date: Effective August 4, 2000, SOBRA Medicaid (category 61) for children and the Newborn categories (52 and 63) are being brought under the ARKids First umbrella. SOBRA (61) and Newborn (52 and 63) Medicaid for children will be called ARKids A and ARKids First (01) benefits will be called ARKids B.
   2. Joint Application/Choice of Coverage: The ARKids application form (DCO-995) and re-enrollment form (DCO-975) have been revised to be used for both ARKids A and ARKids B. Both applicants and recipients (at re-enrollment) will have a choice of coverage for their children: ARKids A coverage (category 61), which provides the full range of Medicaid benefits and no co-payments, or ARKids B coverage (category 01), which provides limited coverage and requires small co-payments. There will be no change in the application or certification process for Newborns. For Newborns (categories 52 & 63), this is a name change only.
   3. Mail-in Process/Self-Declaration: The applicant will not be required to visit the local DHS county office for an interview regardless of which ARKids coverage package he or she chooses on the application form and self-declaration will be accepted for most eligibility requirements. The applications may be mailed in or hand delivered to the local county office, then processed based on the eligibility criteria that are currently used for ARKids First and SOBRA Medicaid applicants.
   4. Distribution of New Forms to County Offices: OPPD will email the revised application (DCO-995) to the county offices on August 4, 2000 for immediate use and mail an initial supply of printed forms on the same day.
   5. Distribution of Forms to Community Contacts: County offices should supply the new form to contacts in the community who have assisted families in applying for ARKids First and Medicaid in the past and collect the old forms so they can be destroyed. Arkansas Advocates for Children and Families will also assist in this effort. Please note that the local county office mailing address must be stamped on the back of the form before supplies are distributed in the community or to clients.
   6. ARKids First Unit Application Process: Effective August 4, 2000, the new DCO-995 will be processed in the local county office where the applicant resides. The ARKids First Central Office Eligibility Unit will process old forms received by the unit before September 1, 2000. Effective September 1, 2000, all old DCO-995 applications that are received by the ARKids First Central Office Eligibility Unit will be routed to the county office for processing. All ARKids A and new ARKids B case records will be maintained in the county office of the applicant/recipient's residence effective immediately.
   7. ARKids First Unit Re-enrollment Process/ID Cards: The ARKids First Central Office Eligibility Unit will process re-enrollment for ARKids B (01) cases through August 2001. The Unit will forward ARKids B case files to the county offices as reevaluations are completed. The ARKids First Central Office Eligibility Unit will also be responsible for making new ARKids A (61, 52 and 63) and ARKids B (01) identification cards. Neither card will require a photo ID. Identification cards for existing SOBRA Medicaid and ARKids First cases will not be replaced, except as needed.
2. Processing of ARKids First Applications by County Offices

The applications may be mailed in or hand delivered to the local county office and then processed based on eligibility criteria that are currently used for ARKids First (MS 2300) and SOBRA Medicaid applicants (MS 5720).

1. Registering Applications

The county office staff will be responsible for registering all ARKids A and B applications. A new REQUIRED field has been added to WIMA called ARKids Ind. This field will be used to keep statistics on the number of applicants who apply for ARKids A, B or Either. The following codes will be used for ARKids First.

Form	Choice	ENTER ARKids Ind	ENTER Category
ARKids First (DCO-995)	ARKids A only	A	61
	ARKids B only	B	01
	Either	E	61
	No selection made	E	61
Newborn1 (DCO-645)	Not Applicable	A1	52 or 63
Pregnant Woman2 (DCO-95)	Not applicable	N2	61

1 WIMA will only accept an "A" in the ARKids Ind field for applications registered under the Newborn categories 52 or 63.

2 If a Pregnant Woman only is registered in category 61, the caseworker will key an "N" in the ARKids Ind field. If a Pregnant Woman is applying for herself and her children, the caseworker will key an "A" or "E" in the ARKids Ind field.

2. Determining Eligibility

1. Eligibility Criteria

Process applications based on eligibility criteria that are currently used for ARKids First (MS 2300) and SOBRA Medicaid applicants (MS 5720) as follows.

Choice	ARKid Ind	Category	Initially Eligibility Determination
ARKids A only	A	61	MS 5720
ARKids B only	B	01	MS 2300
Either	E	61	MS 5720
No selection made	E	61	MS 5720

See Section III for information regarding specific ARKids requirements.

If the applicant selects "ARKids A only" and the children are not eligible for A but they are eligible for ARKids B, the caseworker will take the following steps:

1. Attempt to contact the applicant immediately by phone. Inform the applicant that the children are not eligible for ARKids A but are eligible for ARKids B and ask if he or she would like them to be certified for ARKids B.
2. If the caseworker cannot reach the applicant by phone, mail form letter DCO-996 (see attached) the same day giving the applicant 15 days to respond if they want ARKids B.
3. Dispose of the application upon receipt of the DCO-996 from the applicant or after 15 days from the date the form was sent, whichever occurs earlier.
4. If the applicant declines ARKids B coverage in this situation, use new denial code "096 – Declined ARKids B" to deny the application. This code has been added to track those who decline ARKids B. The notice text for the 096 denial will state that if the applicant changes his or her mind within 30 days, to contact the caseworker and the ARKids B will be approved with no new application.
5. If the applicant doesn't respond within the 15-day notice period, deny the application based on the reason for ARKids A ineligibility.

If the applicant selects "ARKids B only", determine eligibility for ARKids A (61) and ARKids B (01). If they are eligible for ARKids A, which would provide more coverage, the caseworker will take the following steps:

1. Attempt to call the applicant immediately. Inform the applicant that the children are eligible for ARKids A and that it provides more coverage than ARKids B. Ask the applicant to again specify which coverage he or she prefers the children to receive. If they state that they do want to be considered for ARKids A, certify in A. If they refuse ARKids A, send a manual approval notice stating that they have been approved for ARKids B but are eligible for ARKids A. If they change their minds within 30 days and would prefer ARKids A, to please contact their caseworker and coverage can be approved in ARKids A without a new application.
2. If the caseworker cannot reach the applicant by phone, mail form letter DCO-996 (see attached) the same day giving the applicant 15 days to respond if he or she wants ARKids A.
3. Dispose of the application upon receipt of the DCO-996 from the applicant or after 15 days from the date the form was sent, whichever occurs earlier.
4. If the applicant doe not respond, certify in ARKids B.

If the applicant selects "ARKids B only" and does not complete the resource section of the application, the application will be processed as is and eligibility will be determined for category 01 only.

If the applicant selects "A" or "E" and appears to be income eligible for ARKids "A" but fails to complete the resource/asset section of the application, the caseworker will take the following steps:

1. Attempt to contact the applicant by telephone to obtain the client’s declaration of resource/asset values.
2. If the worker cannot reach the applicant, mail form letter DCO-996 (see attachment) the same day giving the applicant 15 days to respond if he or she wants the children considered for ARKids A.
3. Dispose of the application upon receipt of the DCO-996 from the applicant or after 15 days from the date the form was sent, whichever occurs earlier.
4. If the applicant does not respond, and selected "E", approve the case in ARKids B. If the applicant does not respond, and selected "A" only, deny the application using denial code 096, as the DCO-996 gives them the opportunity to be considered for ARKids B and not provide their assets.

5. Applicant Selects "Either" or makes No Selection

If the applicant selects "either" or makes no selection, eligibility will be determined in category 61 first, then category 01.

100. Self Declaration and Verification

1. Self Declaration

Verification of income, resources, collateral statements to verify residency, and proof of relationship are no longer required. Self-declaration of these eligibility factors will be accepted. If the county has verification of income and resources through other programs (e.g., Food Stamps), that information can be used in ARKids First. If there are discrepancies in what the client has declared and what the county has previously verified, the caseworker will do the following:

Verified Information is:	Declared Information is:	Action:
Under the limit	Under the limit	Certify if otherwise eligible
Over the limit	Under the limit	Follow-up with the client and obtain current verification
Under the limit	Over the limit	Follow-up with the client and obtain current verification
Over the limit	Over the limit	Deny the application

2. Verification

The only requirements that must be verified are age and alien status for non-citizens. If the applicant does not or cannot provide verification of age, as requested on the initial application (DCO-995), the county office worker will search any existing files for proof of birth or search the Health Department screen for proof. If a previous file cannot be located, but the system shows the applicant has a previous TEA or Medicaid case certified prior to 08/04/00, the worker can print the WACE screen for the child in question and file it in the document section of the case as proof of age. This should be done before a 15-day notice is sent requesting the applicant to provide verification.

4. Disposing of an Application

An application may be registered in one category and approved in a different category as follows.

Choice	Situation	Registered In	Approve In
ARKids A only	Eligible for 61	61	61
ARKids A only	Not eligible for 61, but meets eligibility criteria for 01 and accepts 01	61	01
ARKids B only	Eligible for 01 only	01	01
ARKids B only	Eligible for 61. Applicant indicates they want ARKids A even though they applied for B only.	01	61
Either or no selection	Eligible for 61	61	61
Either or no selection	Not eligible for 61, but eligible for 01	61	01

Do not reuse closed category 61 case numbers for category 01 approvals, nor closed category 01 case numbers for category 61 approvals. Since the ARKids A and B cards are different, the only way for the client to receive the appropriate card would be to certify using a new case number. You may certify a category 01 on a closed category 01, or a closed category 61 on a closed category 61.

5. Special Situations

1. A Pregnant Minor is sometimes not eligible as a child under ARKids A (61) but is eligible as a pregnant woman under category 61, since parent’s income is deemed to the child and the resources of a deemer are not counted. A pregnant minor may also be eligible for ARKids B. ARKids B provides obstetrical services like category 61, but requires a co-pay. SOBRA for pregnant women only covers pregnancy related services. A pregnant minor is allowed to receive dual coverage in the ARKids B (01) category and PW coverage in Category 61. The PW (61) category requires her suffix number to be in the 100 series (e.g., 101) as a pregnant minor, and the ARKids B suffix number to be in the 200 series (e.g., 201) as a dependent child.

For Example: A mother applies for Medicaid for her pregnant daughter who is 15. The caseworker first determines eligibility under ARKids A (61) so that the child can receive the most benefits. The minor is ineligible for ARKids A due to the parent's countable resources of $7000. The minor PW is eligible for 61 PW coverage as the parent's resources are not deemed to a minor PW. The child would also be eligible under ARKids B since there is no asset test for that category. The caseworker certifies the minor in both categories so that the child can receive all the coverage for which she is entitled.

2. If the children are not eligible under ARKids A or ARKids B, the same application may be used to determine eligibility for a child in any Medicaid category for which they might be eligible. If the applicant makes application on the DCO-95, DCO-180 or DCO-180P, ARKids A and B coverage will be determined using those forms. A new application does not need to be completed.
3. If the parent completes the DCO-995 and wants to be considered for Medicaid, he or she can complete just the information needed on the DCO-95 for the parent's eligibility, sign the DCO-95 and it will be used as an addendum to the DCO-995. The parent does not have to complete the entire DCO-95 for eligibility to be determined. This does not waive the interview or verification requirements for the adult’s eligibility.
4. The DCO-95 may be used in determining eligibility for both ARKids A and B for a Pregnant Woman and her Children. Both the Pregnant Woman and the children may be approved under the same category 61 case, as is currently being done. The Pregnant Woman (101 suffix) will receive a letter requiring a photo Medicaid ID card. The children (200 series suffix) will receive an ARKids A card.

3. Requirements Specific to ARKids First Determinations
   
   1. Primary Care Physician (PCP) - MS 1190

The applicant must select a primary care physician before the ARKids B (01) application can be certified. There is a place on the DCO-995 to make the PCP selection. If the applicant does not make a selection, the application will be denied after the appropriate notice (15 days) and DCO-2609 has been sent. This is a special condition of the ARKids First Demonstration Waiver.

The ARKids A (61) application can be certified without a PCP selection; however, the worker should follow up after certification to make sure a PCP is selected if the client has not selected one.

When an application is made for ARKids A or B coverage and one or both parents are absent, the worker can process the case without the DCO-90 being signed. There will be no child support edits requiring absent parent referrals for both categories 61 and 01 on ACES.

After approval, the worker will follow up by sending PUB-394, Important Child Support Information (see attached) which encourages participation with child support activities and requests that the applicant sign the DCO-90 and provide information on the absent parent on the DCO-116. When the DCO-90 is received back into the county office, a referral is made to OCSE. If the DCO-90 is not received back, no referral is made to OCSE.

If the county office learns that an applicant or recipient already has an active child support case with the OCSE on the absent parent of the child or children for whom they are applying, the county office will request the casehead to review and sign a DCO-90. However, in this situation a referral can be made without a signed DCO-90.

Although a child can never lose eligibility for Medicaid due to a parent or specified relative not cooperating with OCSE, caseworkers should never advise clients that they do not have to cooperate. Federal law requires that they cooperate in establishing medical support and paternity. Caseworkers should make every effort to obtain the information to make a proper referral to OCSE. If the parent does not cooperate, he or she cannot be eligible for any category of Medicaid except for Pregnant Women and Family Planning Waiver.

3. Insurance Coverage ARKids B (01) - MS 2330 # 10

If a family currently has primary comprehensive insurance coverage or had it within the past 6 months, they are not eligible for ARKids B coverage, unless certain conditions are met as specified. Please refer to MS 2330#10, for further explanations. The ARKids B look back period for dropping group and/or employer based health insurance is 6 months preceding the date of application. Children receiving health insurance under non-group and/or non-employer based plans meet the insurance requirement under the ARKids B program immediately.

Note: Extended insurance under COBRA, available for individuals who leave employment, will be treated as a non-employer based plan.

Caseworkers should also follow the last paragraph of MS 2330#10 in regard to declaration of insurance.

ARKids A (61) does not have an insurance rule.

4. Continuous Eligibility for ARKids B (01)

As a special condition of the ARKids First Demonstration Waiver, children certified and re-enrolled under ARKids B (01) are guaranteed 12 months of coverage. Changes in income, resources and other eligibility criteria during the year will not affect the child’s eligibility. The only way a child can lose eligibility during the year is if he moves out of state or reach the age of 19.

Since ARKids A (61) is regular Medicaid for children and not part of the ARKids First Demonstration Waiver, children certified under this category must meet all eligibility requirements during the year. If the county learns of changes between re-enrollment periods, they must assess the change to determine if eligibility continues for the child under ARKids A.

5. Requests for Information

For both ARKids A (61) and ARKids B (01), procedures at MS 2344 and MS 2347.2 will be followed whenever the application is received through the mail and there is no interview. That is, when initially requesting information, the caseworker will send a 15-day notice. If the applicant needs additional time, a second 10-day notice will be sent.

4. Routing of Applications Received by the ARKids Central Unit
   
   1. Forms Received Prior to September 1, 2000

The ARKids Unit will continue to process any old Form DCO-995 received in the Unit during the month of August. Upon disposition of the application, the case record will be routed to the county office in which the family resides.

2. Forms Received on and after September 1, 2000

1. Effective September 1, 2000, when an old DCO-995 is received into the ARKids Unit, the worker will take the following steps:

1. Log the application and date stamp the application with the date it was received in the ARKids First Central Office Eligibility Unit.
2. Screen the application for potential ARKids A (61) eligibility. If they are potentially income eligible for ARKids A (61), the ARKids Unit will send a DCO-999 (see attached) to the applicant along with a revised DCO-995 (R. 08-00) and an envelope with the local county office address for the client’s resident county.
3. Attach a copy of the DCO-999 and a cover letter to the application packet and previous case record (if applicable) and route to the local county office.

2. Upon receipt of an old DCO-995 from the ARKids Unit, the county office will:

1. Register the application in ARKids B (01). The application date is the date received by the ARKids First Central Office Eligibility Unit.
2. Process and certify in ARKids B (01), if eligible.
3. Notify the client of ARKids B approval and if income eligible for ARKids A (61), state that in the manual notification and send another new DCO-995 (R. 08-00).
4. If the applicant later submits a new or revised application, determine eligibility in ARKids A (61) and if eligible, convert ARKids B (01) to ARKids A (61) by closing ARKids B (01) and approving the ARKids A (61) with a new register number, A Action Type and 101 Action Reason. Remember to get a new case number.
5. If a revised application (DCO-995) is not returned by the recipient, the case will remain active in ARKids B (01) with limited benefits.

3. If a revised DCO-995 joint application form is received by the ARKids Unit, it will be promptly date stamped and logged, then routed to the applicant’s local county office for processing. The local DHS county office will use the date the application was received at the ARKids Unit as the application date.

The revised Annual Review form (DCO-975) also explains the differences in the ARKids A and B coverage packages. The recipient will have a choice at re-enrollment to be considered for ARKids A (61), ARKids B (01) or either, as they do on the DCO-995. Space is provided on the form for the recipient’s declaration of assets, so that a determination can be made for ARKids A (61).

1. Reevaluations to be processed by the ARKids First Central Office Eligibility Unit

August 2000 and September 2000 re-enrollments will be on the old DCO- 975.

The ARKids First Central Office Eligibility Unit at the Pulaski North Office will continue to process ARKids B (01) reevaluations for the next year. The DCO-975 is currently a system-generated form that is mailed directly to the client from Little Rock. This process will continue for the new DCO-975.

Since re-enrollment forms are sent at the end of the 10^th month, the client will be sent the old DCO-975 for August and September. For those months the ARKids worker will:

1. Complete the re-evaluation process, and key the review date into the system.
2. Screen the case for ARKids A potential eligibility and if potentially income eligible, send out a new DCO-975 (R. 08-00) and a DCO-999 to the recipient with a return envelope addressed to their local DHS county office.
3. Route the case and a copy of the explanation letter along with a cover memo to the recipient’s local county office for processing.

2. Re-enrollments in October, 2000 and later

A new DCO-975 (R. 08-00) will be sent for re-enrollments due in October, 2000 and later. The ARKids Unit worker will complete the following:

1. Complete the ARKids B (01) re-enrollment and key the review date into the system.
2. Attach a cover memo along with the DCO-975 to the top of the case record and route to the local county office.
3. When the county office receives the case, the caseworker will screen the DCO-975 to determine if they are potentially eligible for ARKids A (61), if the casehead requested consideration for ARKids A or did not indicate a choice.

If the recipient fails to return the Annual Review Form (DCO-975) or requested information, or is found otherwise ineligible for ARKids B, the case will be closed after appropriate notice has been sent, then routed to the county office to be filed.

Note: The Annual Review Form (DCO-975) will be system generated and mailed from Central Office for ARKids A (61) and B (01) reevaluations. Beginning in August, DCO-975s for ARKids A (61) will be sent out for the review month of October. Once the forms are being system generated, each county office will receive a print out listing the cases to which the form was sent and will stop receiving the DCO-75s for these cases. For the first year, the system generated DCO-975 will also contain a DCO-998 (see attached) explaining the name change for category 61. For the few months before the DCO-975 is system generated, the county will manually mail the DCO-975 with a copy of the DCO-998 to the family.

4. County Office Conversion Process for Active ARKids B (01) Cases

As the cases are received by the county office from the ARKids First Central Office Eligibility Unit, the receiving caseworker will:

1. Check the system to make sure the reevaluation date was keyed.
2. Screen for potential ARKids A (61) eligibility.
3. If potentially eligible for ARKids A and the reevaluation was completed from an old DCO- 975, mail out the new DCO-975 (R. 08-00) with a DCO-999 stating they may be eligible for ARKids A (61). When the DCO-975 returns,determine if they would be eligible for ARKids A (61). If the client does not return the DCO-975, no further action will be taken.
4. If the reevaluation was completed from a new DCO-975, determine if the children will be eligible under ARKids A (61).
5. If all of the children are determined eligible:

1. Close the ARKids B case.
2. Obtain a register number by using an old application.
3. Approve in ARKids A (61) under a new case number.
4. Coincide Medicaid begin and end dates for each child.

NOTE: If only some children are eligible for ARKids A (61) coverage (e.g., children under age 6), leave the ARKids B (01) eligible children in the case and get a new case number for the ARKids A (61) eligibles.

6. Reassign PCP’s, using the choice in the ARKids B case.

5. Re-enrollments processed by county office

Current category 61 cases due for re-evaluation will continue to be processed by the county office.

6. ARKids Indicator on WACE

Whenever a reevaluation date is keyed or the case is closed in categories 01 or 61, entry to a new REQUIRED field on WACE called ARK-I must be keyed based on the client's choice on the re-enrollment form (DCO-975). Also, whenever a 61 or an 01 is closed so that the case can be opened in another ARKids category, the caseworker should use the new closure code 085, Closure, Elected Coverage in Other ARKids Category. The caseworker should take the following action at reevaluation:

Open Category	Choice	ARKids Ind Code	Action
61	ARKids A only	A	Case remains open. If no longer eligible, but children are eligible for 01, contact client.
61	Either ARKids	E	Case remains open unless no longer eligible. If eligible in 01, close 61 using 085 action reason and open 01 with new case #.
61	ARKids B only	B	Contact client to make sure they really want less coverage for their children. If so, close 61 using 085 action reason, register and approve in 01
01	ARKids B only	B	Case remains open. If eligible for 61, contact client to make sure they know they can get more coverage under 61
01	Either ARKids	E	If eligible for 61, close 01 using 085 action reason and register and approve in 61; otherwise case remains open.
01	ARKids A only	A	Close 01 using 085 action reason and register and approve 61 if eligible. If not eligible for 61, but still eligible for 01, inform the client.

An "N" should be keyed to the ARKids Ind field whenever the case is closed for any reason other than certifying the child in the other ARKids category.

When an ARKids A (61) case is processed using self declaration for Income and resources (assets) the following will apply when keying to the ANSWER system,

1. Income

If income has been verified through another program, the worker should use that income as "representative", then run the SOBRA or ARKids A (61) budget.

If we are processing the case with self-declared income, the worker should show the type of income, the frequency of income and the begin date. The check type will be shown as "estimated" income to run the budget.

2. Resources

If resources were self declared for ARKids A, but verified in another program (Food Stamps, TEA, etc.), we would need to show an end date in the system for "other" since this is used when assets are self declared. The worker should then run the budget using the verified assets from the other program. This should be done to prevent the system from counting the same resource twice.

If the resources were self-declared, the worker would need to show them in ANSWER as "other", then show the total amount declared.