Medical Services Manual Transmittal

MANUAL TRANSMITTAL

Arkansas Department of Human Services

Division of County Operations

Policy Directive Issuance Number: MS 99-4
TEA 99-4

Medical Services Policy Manual and
Transitional Employment Assistance Manual Issuance Date: March 15, 1999

From: Ruth Whitney, Director Expiration Date: Until Superseded

Subj: Ensuring Medicaid for TEA Households

A recent system review of TEA households with two parents has caused some concern that counties are possibly not utilizing all of their options in determining Medicaid eligibility. We discovered households where no family member was receiving Medicaid in any category. We are most concerned that counties are not using the Unemployed Parent (UP) rules (FA 2241 – 2241.4) in determining deprivation. The UP rules may be used in both TEA Medicaid (category 20) and UP-Medically Needy (categories 76 and 77). The following is a list of steps that counties should follow in determining Medicaid eligibility for families.

STEP 1

Is one parent absent?

If yes, the children meet deprivation. Continue determining eligibility under category 20, 26 or 27.

If no, continue to STEP 2

STEP 2

Does at least one parent receive Social Security Disability or disability benefits through SSI (FA 2243.3)?

If yes, the children meet deprivation. Continue determining eligibility under category 20, 26 or 27.

If no, continue to STEP 3

STEP 3

Determine if the Principal Wage Earner (PWE) meets the UP requirements:

STEP 3(a) Determine who is the PWE (FA 2241.1)

STEP 3(b) Determine hours the PWE works per month

Over 100, doesn’t meet deprivation under UP unless excess is temporary, go to STEP 4 {FA 2241.2 (2)}

Under 100 or temporarily over 100, continue

STEP 3(c) Determine if PWE meets the 6 "quarters of work" or "quarters of coverage" (FA 2241.3), or has received unemployment compensation within the year prior to application (FA 2241.4). Remember that education can substitute for up to 4 "quarters of work".

If met, the children are deprived. Continue determining eligibility under category 20, 76 or 77
If not met, go to STEP 4

STEP 4

If a parent is claiming a physical or mental incapacity, submit the Social Report (DCO-108), Consent for Release of Information (DHS-81s) and Confidential Report of Medical Examination (DCO-107), if needed, to MRT for a disability determination, unless the disabled parent is age 70 or older. Be sure and put on the Social Report that this is category 20 or 2M. Disability requirements for AFDC related Medicaid are not as restrictive as Aid to the Disabled categories of Medicaid.

If MRT finds the parent physically or mentally incapacitated, the children meet deprivation, continue determining eligibility under category 20, 26 or 27.
If a parent is not disabled, go to STEP 5.

STEP 5

If the family does not meet deprivation, determine if any family members would qualify for any other Medicaid category.

For children, determine if they would be eligible under U-18 or SOBRA. If not, they should be referred to the ARKids Unit for an ARKids determination.
For adults, determine if they would qualify for a Pregnant Woman category or the Family Planning Waiver.

Medicaid is a very important component of welfare reform. Counties should make every effort to certify TEA cash recipients in Medicaid if they are eligible. If TEA household members are not certified for Medicaid, the county must clearly document in the case record that Medicaid was considered and why it was not provided for each individual.

Inquiries to: Jack Tiner, 501-682-8259

Ann Dawson, 501-682-8254

Boyce Lovett, 501-682-1562