The Arkansas Medicaid program provides a wide variety of healthcare related services for low-income and low asset Arkansans. Eligibility requirements for each program vary, but all Medicaid programs are based on lack of financial ability to private pay for healthcare services and being under the applicable asset limits. In the state of Arkansas, the federal government provides funding for the Medicaid programs, which are overseen by the Arkansas Department of Human Services (DHS). The DHS administers the many health insurance programs for low-income Arkansas families, children, pregnant women, and seniors, including managing the Medicaid application process.
The most applicable programs for Arkansas residents 55 and older are Medicaid’s home and community-based services (HCBS) and nursing home care (in long-term care facilities) and health coverage related to those services. Medicare does not cover these needs such as long-term care, in-home services, and personal care services, so Arkansas Medicaid provides these programs for those who cannot afford them. Under these programs, Medicaid will pay providers and nursing facilities directly for those who meet eligibility criteria and achieve enrollment. For those who exceed the applicable income limit, the Arkansas Medicaid member is often required to “spend down” a portion of their Social Security and other income as a co-pay to the nursing facility before services begin. For home and community based services, Medicaid will pay the caregiver (or caregiver agency). This process involves an HCBS Medicaid waiver from other services in order to allow the Arkansas Medicaid member to remain in-home. In Arkansas, the HCBS waiver program is known as the Program of All-Inclusive Care for the Elderly, or PACE. PACE provides in-home care to seniors who would otherwise need a nursing home level of care.
In addition to reviewing an Arkansas resident’s current income and assets to determine eligibility, Arkansas Medicaid has instituted a 5-year look-back period. This means that DHS will examine the resident’s financial history for the previous 5 years, looking for gifts and other transfers which may impact their Medicaid eligibility. If the prospective Medicaid beneficiary has made large gifts or transferred away large sums of assets, they may incur a penalty which will render them ineligible for Arkansas Medicaid’s medical services for a period of time. With proper Medicaid planning strategies and by working with a Medicaid planning professional, strategies can be employed to prevent penalties while preserving eligibility for Medicaid’s long-term care services. Please contact QMC to learn more about ways to receive assistance for care at home, in assisted living, or in a nursing facility today.