Medicaid Costs and Coverage in Arkansas

“How much is Medicaid in Arkansans?” is a question many residents may ask themselves when considering healthcare coverage. Asking yourself “How much does Medicaid cost in AR?” is a good way for you to plan your budget if you feel that you are eligible for these benefits. Medicaid cost estimates are primarily based on type of Medicaid coverage you qualify for, as well as your household situation. For more information on what services are covered by Medicaid in Arkansas, as well as the costs associated with Medicaid programs in the state, continue reading the information in the sections below. You will also get insight into the various types of Medicaid programs that are available in Arkansas and certain services that are not covered in the state. Keep in mind that Medicaid costs and coverage can change at any time.

How much does Medicaid cost in Arkansas?

The cost of Medicaid coverage in Arkansas depends on many components, which may include things like how much you must pay at the time of visit, as well as any monthly premiums. When calculating your Medicaid cost estimates you should take your copay into account, which is a fixed price you must pay at the time of service. The different types of Medicaid insurance determine the amount, which is usually minimal. The copayment that your Arkansas Medicaid insurance coverage requires of you is related to the allowable cost. This is the maximum that an insurance company will pay for a medical service. Coinsurance is different from a copayment in that you will be responsible for paying a percentage of the cost of a service. This percentage is also determined by your Medicaid provider. The copay or coinsurance amount may also differ depending on the type of service you receive. Another component of your Medicaid coverage costs is your deductible, which is a fixed rate you must pay out of pocket before Medicaid will cover the cost of a service. Unlike private insurance, Medicaid deductibles are designed to be accessible to the individuals that receive Medicaid benefits. Once you meet your deductible, you will only be required to pay your copayment or coinsurance.

What services are covered by Medicaid in Arkansas?

When it comes to Medicaid covered services in Arkansas, it is necessary to understand that Medicaid has two categories of covered services: mandatory and optional. Medicaid benefits recipients must have certain coverage minimums, as mandated by federal laws. Any additional coverage comes at the discretion of the state. The following two sections will explain mandatory and optional Medicaid coverage.

Mandatory Medicaid Coverage in Arkansas

Mandatory Medicaid services are those that every state must offer its residents according to United States government regulations. These mandatory Medicaid program benefits include a wide variety of services, such as:

  • Professional Certified midwife services.
  • Child health services.
  • Family planning services.
  • Home health services.
  • Dentistry services, including medical and surgical.

Arkansas Medicaid coverage deemed mandatory typically includes services for all beneficiaries, regardless of age. Nevertheless, some age limits may be in place for certain services. Child Health Services, for instance, is only applicable to beneficiaries under the age of 21.

Optional Medicaid Coverage in Arkansas

Optional Medicaid coverage in Arkansas includes services that the state is not mandated to cover but does as an added benefit to beneficiaries who complete the application process. Medicaid optional benefits include many specialty and specialist services, such as the following:

  • Chiropractic services
  • Dental services
  • Hospice services
  • Prescription drugs
  • Medicare crossovers

There are no age limits for many of these services, although some are targeted to certain populations. Many of the more specific specialty services are targeted towards patients under the age of 21.

For more details on what Medicaid covers, download our comprehensive guide.

What does Medicaid not cover in Arkansas?

Arkansas Medicaid benefits do cover many services and treatments, but there are many things that are not covered under these benefits. These include experimental or alternative treatments, such as homeopathy and participation in medical studies. Medicaid coverage also does not pay for anything not considered medically necessary for the treatment of your illness. Additionally, your Medicaid insurance benefits do not cover cosmetic surgery, private nursing, massage or services rendered by a family member or friend. Certain drugs are also not covered by Medicaid, including fertility drugs, cosmetic treatments and weight loss medications.

Types of Medicaid Insurance in Arkansas

Arkansas Medicaid also offers a variety of sub-programs under the Medicaid umbrella that provide specific services to particular communities. These programs include the following:

  • The Program of All-Inclusive Care for the Elderly (PACE)
  • Long term care
  • Workers with Disabilities program
  • ARChoices

The Arkansas Medicaid Program of All-Inclusive Care for the Elderly (PACE) provides seniors with comprehensive health and social services benefits to assist with their specific needs in the later years of their life. These services include coordinating care for patients who require nursing home care.

Long term care is reserved for individuals with Medicaid coverage who currently live in nursing homes. They may qualify for Medicaid’s long term care program if they are deemed medically needy and meet the income and resource requirements, among other criteria.

The Arkansas Medicaid Workers with Disabilities program is for individuals who are disabled but are still working, either part time or full time. If they qualify, they will qualify for full Medicaid coverage. However, their income will determine how much their copayments will be. Individuals with a lower income will pay the normal Medicaid coverage copay, while individuals with a higher income will pay higher copays.

ARChoices is a program under Arkansas Medicaid that provides home and community-based services either for adults ages 21 to 64 who have a disability or for seniors 65 years old or older who would otherwise need to live in a nursing home, as long as they also meet the income and resource requirements.

Download our comprehensive guide for more information on what Medicaid costs and the services it covers.