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Medical Services – Appendix G, ARKids Extent of Services 01/01/19 Appendix G Page 1 of 1 Extent of Services Both ARKids A and ARKids B provide basic health insurance coverage. Infants and children found eligible for benefits under ARKids A are entitled to the full range of services that Medicaid provides, including Child Health Services (EPSDT). There are no copayments in ARKids A for individuals under the age of 18. Participants in ARKids B are not eligible for the full range of Medicaid services. Co-payments and coinsurance will apply, as appropriate, for all services with the exception of immunizations, preventive health screenings, family planning, and prenatal care. There is no co-pay for dental checkups. Child Health Services (EPSDT) are not offered. Based on the family’s countable income and size, eligibility will be determined in the appropriate ARKids category. Below is a chart that shows a summary comparison of the two ARKids benefit packages: Coverage Type Description ARKids A ARKids B Basic Coverage Physician, prescription drugs, hospital, ambulance (emergency only), dental and orthodontia, medical equipment, medical supplies, emergency department services, eye glasses, family planning, health screens, home health services, laboratory and x-ray, inpatient and outpatient psychiatric, podiatry, speech, occupational and physical therapy, vision, chiropractor, immunizations, nurse midwife, and nurse practitioner. Yes Yes Additional Coverage Audiology, child health management services, developmental day treatment clinic services, end stage renal disease services, hearing aids, hospice, hyperalimentation, nursing facilities, orthotics, personal care, transportation (non-emergency), private duty nursing, prosthetics, ventilator services, and targeted case management. Yes No Screenings (through Child Health Services) If the child receives periodic Child Health Services checkups, benefits are unlimited for covered services that are medically necessary. Yes No Co-Payments ARKids B requires co-pays as follows: $5.00 per prescription drug, $10.00 per medical visit, $10.00 per emergency ambulance trip, 10% of the 1st day of inpatient hospitalization, and 10% of Medicaid allowed amount for each item of durable medical equipment. A co-payment is not required for preventative health screens, family planning services, and dental checkups. ARKids B families will have an annual cumulative cost- sharing (co-payments & coinsurance) maximum of 5% of the family’s gross annual income. The annual period is the state fiscal year (SFY) of July 1 through June 30th. The annual cost-sharing maximum will be recalculated and the cumulative cost-sharing counter will be reset each July 1. Note: A co-pay of $.50 to $3.00 for prescription drugs and a small percentage of the first day cost in a hospital will be required for an 18 year old receiving ARKids A. No Yes