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MEDICAL SERVICES POLICY MANUAL,SECTION F

F 100 Non Financial Eligibility Requirements

Adult Expansion Group An individual who is eligible for or enrolled in Medicare is not eligible for the Adult Expansion Group. ARKids B Children who are enrolled in a group health plan will not be eligible for ARKids B unless one (1) of the following conditions is met: NOTE: 45 CFR 146.145 defines a group health plan to be an employee welfare benefit plan to the extent that the plan provides medical care to employees (current and former) or their dependents directly through insurance, reimbursement, or otherwise. These plans are considered comprehensive health plans compliant with the Affordable Care Act (ACA) and would not include supplemental health policies. a. The child has special health care needs. Special health care needs are defined as the health care and related needs of children who have chronic physical, developmental, behavioral, or emotional conditions. Such needs are of a type or amount beyond that required by children generally. b. Health insurance coverage is available to a child through a person other than the child’s custodialadult and is determined to be inaccessible (for example, the absent parent lives out- of-state and covers the child on their HMO, which the child cannot access due to distance). This determination will be made on a case-by-case basis by the eligibility worker based on information provided by the applicant.

The applicant’s declarationregarding the child’s health insurance coverage will be accepted.

This is a special requirement for ARKids B only and does not apply to ARKids A or other Health Care categories.