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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

Approval Date: 3 Section 1. General Description and Purpose of the State Child Health Plans and State Child Health Plan Requirements (Section 2101)

1.1 The state will use funds provided under Title XXI primarily for (Check appropriate box) (42 CFR 457.70):

1.1.1

Obtaining coverage that meets the requirements for a separate child health program (Section 2103); OR

1.1.2.

Providing expanded benefits under the State’s Medicaid plan (Title XIX); OR

1.1.3.

A combination of both of the above.

A. Background

Arkansas has aggressively pursued health care for children by covering optional benefits and categories that benefit children and developing Medicaid 1115 demonstrations. For example, Arkansas has elected to provide the full range of EPSDT services to children without requiring the EPSDT screen. Also Arkansas was one of the first states in the nation to cover the TEFRA-134 children, authorized by the Tax Equity and Fiscal Responsibility Act of 1982.

Effective 1-1-03, the State began covering TEFRA children in a TEFRA- like 1115 demonstration in which the parents pay a premium based on a sliding scale; some parents are not required to pay a premium. The TEFRA-like demonstration provides for the care of a child in its home, if he/she would qualify for Medicaid as a resident in a Title XIX institution, e.g., a nursing facility or an Intermediate Care Facility for the Mentally Retarded, etc. Parental income and resources are not counted in the child’s eligibility determination; however parental income is counted in the premium amount calculation. The eligibility income limit for this demonstration is three times the SSI limit. The TEFRA-like 1115 demonstration makes Medicaid available to a large segment of the state’s chronically ill children.

In its quest to provide health care for children, the State also opted to cover uninsured children through a Medicaid 1115 demonstration, ARKids First. This demonstration is discussed in item B, below.