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The acronym ARHOME stands for "Arkansas Health and Opportunity for Me." This plan is the Arkansas government's healthcare program for low-income earners and other vulnerable populations residing in the state. ARHOME plans apply to low-income candidates from 19 to 64 years old, candidates with disabilities, pregnant women, elderly people, and children.
Government officials first introduced ARHOME on January 1, 2022. This improved Medicaid program allows users to direct their Medicaid funding to premiums provided by private health insurance companies. So, ARHOME plans run through either the company Blue Cross and Blue Shield or Ambetter.
The primary goal of the Arkansas Medicaid program is to provide vulnerable populations with comprehensive healthcare options. These healthcare solutions aim to treat health problems, provide preventive care, and improve overall health. The insurance offers health, dental, and prescription coverage for citizens meeting the required criteria for those in Arkansas who do not receive coverage through work, or cannot afford a private health plan in Arkansas.
Medicaid.gov states that the federal government funds 90% of plans through ARHOME, while the state covers the other 10%. Medicaid users in Arkansas earning from 0-100% of the Federal Poverty Line (FPL) do not have to pay for their premiums. On the other hand, individuals earning from 100-138% of the FPL must pay $13 per month and up to $240 a year in co-payments.
Due to the involvement of private healthcare companies, there is no physical or virtual "Arkansas Medicaid card." Rather, policyholders must comply with the terms presented by either Blue Cross and Blue Shield or Ambetter. Both companies offer an ID card that breaks down the policyholder's insurance benefits and provides their information to healthcare providers.
Blue Cross and Blue Shield's plan is simply called "ARHOME" while the name of the Ambetter plan is "Amwell Ambetter Medicaid." Each ID card provides the policyholder's name, policy number, date of birth, and details specific to the chosen plan and premium.
This information allows healthcare providers to determine the level of coverage of the policyholder and divert the required payment to the corresponding insurance company. Without this card, one must pay full price for care.
The easiest way to apply for Arkansas Medicaid is online through the Arkansas Department of Human Resources (DHS)'s portal "Access Arkansas." To apply for ARHOME, you must make an account on the Access Arkansas website and fill in a form with your information.
After successfully filling out the ARHOME form online and getting approved, you must decide between the Blue Cross and Blue Shield or Ambetter plans, which you can read about below.
If you would prefer to apply for Arkansas Medicaid in person, you may check the DHS website to see where the closest office is to your home. As every office is different, you may be able to walk in, or they may require that you make an appointment beforehand.
You can also call the Arkansas DHS at 888-987-1200 to discuss whether you are eligible for ARHOME, for further information, and for application requirements.
When applying for Arkansas Medicaid, ensure you have necessary documents handy as listed below:
As previously stated, candidates who are eligible for an ARHOME plan include:
Furthermore, Arkansas Medicaid also focuses on three vulnerable groups to provide comprehensive healthcare:
As coverage for certain types of disabilities may be limited under the Arkansas Medicaid plan, many people secure more comprehensive benefits by investing in additional disability insurance.
As previously stated, the most convenient way to apply for ARHOME insurance is through the Access Arkansas website. After you have completed the Medicaid application through Access Arkansas and have received approval, you must register with the ARMedicaid website.
The ARMedicaid website provides resources to help you choose your plan and the insurance company you wish to proceed with. This website also provides resources to help you can choose your primary care provider (PCP) and learn more about your ARHOME coverage.
After you have successfully chosen a plan through ARMedicaid, you must then contact your new insurance provider (either Blue Cross Blue and Shield or Ambetter) to proceed with registration. Your new insurance provider will send you your ARHOME ID card and can help you with procedures such as submitting prescription claim forms and explaining your benefits.
The DHS website specifically states that keeping your mailing address and contact information up-to-date is essential to retaining coverage with ARHOME. This information is integral to allowing the DHS to mail letters to Arkansas residents who are eligible for coverage.
When you receive this letter in the mail, you must fill out the attached renewal form and send it back to the DHS. The government refers to this campaign (aimed to help Medicaid users renew their plans) as "Renew Arkansas." Renew Arkansas offers a hotline for Medicaid users with questions about the process, so you can call them at 1-844-872-2660 for help.
Here is a general breakdown of what ARHOME covers for its recipients. Many costs and coverage options are contingent on your income and the exact Medicaid package you have received from the state, so some coverage and costs may vary for your specific plan.
Arkansas Medicaid covers many child, adult, and elderly dental services, including emergency dental services intended to relieve the patient of infection or pain. For non-emergency dental procedures, adults have coverage up to $500 each year. For eligible Arkansawyers, it’s advised to first check to see if the dentist you intend to visit accepts Medicaid. To make sure you actually have coverage for your dental procedures, discuss what dental needs you have and ensure that your dentist obtains a service authorization before the appointment. This step will help you avoid unexpected dental expenses because Arkansas refused to cover it.
For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Arkansas is advisable. Some preventive and restorative services covered by Arkansas Medicaid include:
Medicaid recipients under the age of 21 have much more comprehensive coverage unless they are part of the ARKids B plan. Dental coverage for children under 21 includes the following:
Arkansas Medicaid plans cover many prescriptions with a co-pay. Here are the general co-pays for different types of prescriptions:
Most drugs require prior approval before ARHOME's plan covers them. You may request prior approval from your PCP or directly from the company that supplies your policy. Arkansas Blue Cross and Blue Shield and Ambetter also provide comprehensive information on their pharmacy benefits, which are contingent on your plan.
Arkansas Medicaid also provides some coverage for vision. Medicaid plans for recipients 21 and older cover one eye exam and one pair of glasses every 24 months. These plans also cover prescription service fees every 24 months with a possible co-payment of $2.00.
ARHOME also provides coverage for some other services if considered necessary to the health and well-being of a patient. Arkansas Medicaid covers services such as chiropractic care (with a referral from PCP), hearing treatments, podiatry, and mental health, though these services may come with a co-payment.
Arkansas Medicaid does not provide out-of-state coverage. Because each Medicaid program is specific to the state in which you reside, you cannot transfer your coverage to another state. The only time you can use ARHOME outside of Arkansas is for emergency health care required for a life-threatening situation.
Furthermore, Arkansas Medicaid does not provide travel insurance. If you plan to take an international trip, or even an out-of-state adventure, your Medicaid plan will not cover any medical expenses outside of the geographic fences of Arkansas. If you are traveling outside of Arkansas for leisure, invest in proper travelers insurance.
ARHOME covers some students and all seniors. Students with disabilities and/or low income will receive Medicaid coverage from the state of Arkansas. Otherwise, ARHOME does not provide coverage for students.
Seniors 65 and up will receive healthcare coverage from Arkansas Medicaid so long as they fill out their application form on time. Elderly Arkansawyer residents may also qualify for Long-Term Services and Supports (LTSS).
There are a few options for seniors who need long-term care. These options include ARChoices in Homecare, Level II Assisted Living, DDS Waiver, and Nursing Facilities. PACE also includes care options for adults 55 and up who need nursing facility care.
Through the aforementioned options, Medicaid recipients may choose between a nursing home and home/community-based services (such as attendant care, home-delivered meals, personal emergency response systems, etc.).
The state of Arkansas offers Medicaid for those considered to be part of certain subgroups such as members of indigenous communities and military personnel, either past or present. The following briefly outlines the eligibility requirements and application process for each group:
Arkansas Medicaid does provide benefits for American Indians. American Indians are eligible for Medicaid coverage just like any other eligible individuals. Medicaid is a joint federal and state program that provides health coverage for low-income individuals and families, including American Indians and Alaska Natives. In order to qualify for Medicaid, individuals must meet certain income and eligibility requirements set by the state. American Indians who are members of a federally recognized tribe or are eligible for Indian Health Service (IHS) care are also eligible for additional health services beyond what is covered by regular Medicaid. These additional services may include access to IHS facilities and providers.
Arkansas Medicaid may provide coverage for military personnel and their families, depending on their eligibility. While military personnel and their families typically have access to healthcare through TRICARE, the healthcare program for the U.S. military, there may be instances where they are eligible for Medicaid as well. In some cases, military families may have incomes that fall within the Medicaid eligibility limits or have specific healthcare needs that TRICARE does not fully cover.
Arkansas Medicaid coverage has specific limits. Below is a partial list of services and treatments that Arkansas Medicaid will not cover. Check with your healthcare plan provider if you are not sure about coverage limitations:
Here is a breakdown of common procedures and coverage eligibility. It is important to note that many of these services require prior approval from Medicaid.
| Dental | |
|---|---|
| Dental care is covered for children with ARKids First or for people with regular Medicaid. Children under 21 with ARKids First A will receive Medicaid coverage for almost all dental care, including braces with pre-approval. For adults, Medicaid covers up to $500 per year of dental work, including X-rays and exams and surgical tooth pulling such as wisdom tooth extraction (with prior approval from Medicaid). | |
| X-Rays | Yes (conditions may apply) |
| Sealants | Yes (conditions may apply) |
| Root canals | Yes (conditions may apply) |
| Annual exams | Yes (conditions may apply) |
| Fillings | Yes (conditions may apply) |
| Fluoride treatments | Yes (conditions may apply) |
| Extractions | Yes (conditions may apply) |
| Dental Emergencies | Yes (conditions may apply) |
| Orthodontic care, such as brace | Yes (for children under 21, not under ARKids B plan) |
| Vision | |
|---|---|
| Eye Exams | Yes, every 24 months for recipients. (Completely free for children with ARKids First. Adults must cover a co-payment.) |
| Glasses | Yes, every 24 months for recipients. (Completely free for children with ARKids First. Adults must cover a co-payment.) |
| Laser Eye Surgery | No |
| Surgery | |
|---|---|
| Rhinoplasty | Arkansas Medicaid generally does not cover cosmetic surgeries for adults such as rhinoplasty and breast reductions. In the case that you require any cosmetic surgery for an accident, illness, or other life-threatening events, you may be able to request prior authorization. Children under 21 may receive corrective rhinoplasty surgery through Medicaid. |
| Breast Reduction | Arkansas Medicaid generally does not cover cosmetic surgeries for adults such as rhinoplasty and breast reductions. In the case that you require any cosmetic surgery for an accident, illness, or other life-threatening events, you may be able to request prior authorization. |
| Hospital | |
|---|---|
| Hospital stays | Medicaid pays for hospital stays for inpatient care. For adults over 21, there is a limited number of days that Medicaid will cover. For children under 21, there is no limit. In some cases, you may have to cover a co-payment as well. |
| Ambulance transportation | Arkansas Medicaid only covers ambulance transportation for certain life-threatening cases. |
| Giving birth | Arkansas Medicaid covers giving birth along with other prenatal services for mothers, such as routine prenatal clinic visits, prenatal education/counseling, postpartum services, and treatment. The Department of Health provides most of these services through specific clinics, so contact the DoH or DHS for more information. |
| Sexual Health | |
|---|---|
| Gynecologist visits | Yes, ARHOME covers pelvic exams, mammograms, and pap tests for all ages from a gynecologist. If you are over 21, there is a limit to how much Medicaid will pay for these services. |
| Erectile Dysfunction | Arkansas Medicaid does not typically provide coverage for erectile dysfunction (using prescriptions for pills such as Viagra), though in rare cases you may be able to get pre-approval for a prescription with a co-payment. |
| Birth Control | Yes (IUDs are unlikely but may be possible with prior approval and sufficient evidence supporting the need). |
| Fertility Treatment | No |
| Specialist Services | |
|---|---|
| Dermatology | You must get a referral from your PCP to see a dermatologist to receive coverage from Medicaid. You may have to pay a co-payment. |
| Physiotherapy | Medicaid covers physiotherapy for children under 21 with a referral. Adults must obtain prior authorization from Medicaid and may receive this service if physically disabled or severely injured. |
| Massage Therapy | Like physiotherapy, patients may receive massage therapy with prior authorization and a referral from a PCP for rare cases. Otherwise, massage does not fall within Medicaid's coverage. |
| Podiatry and Foot Care | ARHOME will pay for a limited number of visits to a podiatrist for adults over 21 with a referral from a PCP. |
| Allergy Testing | ARHOME may cover allergy testing for specific cases but it is not common. You must receive prior authorization from Medicaid and a referral from a PCP to participate in allergy testing. Even then, you may not receive coverage. |
| Sleep Physician Services and CPAP Machines | Arkansas Medicaid will likely cover sleep testing related to sleep apnea with prior authorization and a referral. One must perform the test in a hospital-based sleep lab or sleep clinic with a professional. Medicaid does not cover other sleep-related physician services. Medicaid partially covers CPAP machines for patients that fall within the AHI index between 5 and 15 (scale regarding the severity of sleep apnea). You need a prescription from your doctor and a sleep test, as well as a diagnosis of obstructive sleep apnea. |
Though Arkansas Medicaid provides a surprisingly comprehensive amount of coverage for medical services, the program is far from perfect. As previously stated, many services require referrals and prior authorizations that could take months to obtain. Medicaid also does not provide out-of-state or travel insurance.
Furthermore, Medicaid provides limited sessions for many services such as vision, therapy, podiatry, dental services, and more. As such, if you have chronic problems with physical ailments that require the attention of a specialist or hospital stays, extending your coverage is recommendable.
Publicly-funded healthcare programs and clinics are often slower to provide care than institutions that run with private health insurance. Thus, if you have begun suffering from a certain condition or require more urgent care, extending your coverage with a private insurance company can greatly speed up the process.
If you or your children receive medical coverage from Arkansas Medicaid, consider contacting an insurance broker about your options. For example, the experts at Insurdinary offer online broker services. Whether you have a disability, struggle with critical illness, or need travel insurance, Insurdinary's expert staff can help.
Our services are free of charge, simple, and fast. We'll find you the best insurance options at the lowest prices by researching hundreds of insurance companies and eligible plans for you.
If you would like more information about extending your ARHOME coverage, contact the professional and efficient insurance brokers at Insurdinary by emailing info@insurdinary.com or filling out our convenient online form today.
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