The Health Insurance Portability Act of 1996 (HIPPA) guarantees the availability and renewability of health insurance, limiting the use of pre-existing condition restrictions.

The law includes portability provisions intended to help ensure health coverage for employees who move from one job to another, without losing coverage due to pre-existing conditions, by reducing any pre-existing condition limitation time period by the length of time an individual had prior qualifying coverage for the condition. The concept of qualifying prior coverage, also known as "creditable coverage", is that individuals should be given credit for previous insurance when moving from one group plan to another. The individual must provide proof of 18 months of creditable coverage without a significant break of 63 full days or more in order for the insurer not to deny the applicant due to pre-existing conditions. Medicaid will serve as prior creditable coverage, helping beneficiaries to gain access to full-coverage health benefits.

Employers, insurers, and Medicaid programs are required to issue certificates of prior creditable coverage. Medicaid agencies are required to keep records and automatically issue documents that certify prior coverage to beneficiaries. Arkansas has elected to notify Medicaid recipients of creditable coverage by adding an additional sentence at the end of the DCO-55, the blue, computer-generated notice of action. The additional sentence reads "If an individual who is receiving or has received Medicaid is applying for other health insurance and needs verification of ‘creditable coverage,’ please contact your local DHS office."

Anyone requesting verification of creditable coverage will be given copies of the AMEH screen, or screens, showing periods of Medicaid coverage. An attachment (see attached) will also be provided explaining how to read the AMEH screen. As the statement needs to reflect 18 months of coverage without a significant break of 63 full days or more, it may be necessary to access more than one AMEH screen if the customer had previous coverage under other Medicaid case numbers.

Inquiries to: Jack Tiner, 501-682-8259

                     Ann Dawson, 501-682-8254

                     Diana Teal, 501-682-1562