MANUAL TRANSMITTAL
Arkansas Department of Human Services
Division of County Operations
Policy Issuance Number: MS 05-03
Medical Services Policy Manual Issuance Date: April 1, 2005
From: Joni Jones, Director Expiration Date: Until Superseded
Subj: 2005 Federal Poverty Levels
Page to be Deleted Dated Sections to be Added Dated
Appendix F April 1,2004 Appendix F April 1,2005
The attached Appendix F provides the 2005 Federal Poverty Level income guidelines to be effective April 1, 2005 for the following categories.
(a) Medicare Savings Categories
ARSeniors, QMB, SMB and QI-1 – MS 23110 #7
QDWI – MS 23515 #4
(b) Working Disabled – MS 28015 #7
(c) Transitional Medicaid – MS 2062.3
(d) ARKids A and B – MS 16040 #8
(e) SOBRA Pregnant Women –MS 12150 #4
(f) Family Planning Demonstration Waiver – MS 12500
(g) Tuberculosis – MS 31110
Inquiries to: Jack Tiner, 501-682-8259
Diana Teal, 501-682-1562
Carmen Banks, 501-682-8258
Carla Droughn, 501-682-8254