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Arkansas Medicaid

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Asian-American girl, dancing and yellingWhat does ARKids pay?

The following tables summarize the benefits offered under ARKids A and ARKids B.

ARKids A
(copayment not required)

Program

Coverage Limits

Prior
Authorization

Ambulance (emergency only)

Medical necessity

None

Ambulatory Surgical Center

Medical necessity

PCP referral

Chiropractor

Medical necessity

PCP referral

Dental Care (orthodontia included)

Medical necessity

PA required for some procedures

Durable Medical Equipment

Medical necessity

PA required for some equipment

Emergency Room Services

Medical necessity

None

EPSDT Screens

All per protocol

PCP or ADH administered

Family Planning

Family Planning services only

None

Federally Qualified Health Center

Medical necessity

See Physician Service

Hearing Services

Medical necessity

PCP referral

Home Health

Medical necessity

PCP Rx required

Hospice

Medical necessity

Physician certification

Immunizations

All per protocol

PCP or ADH administered

Inpatient Hospital

Medical necessity

PA for stays of more than 4 days

Inpatient Psych

Medical necessity

PA required

Laboratory and X­Ray

Medical necessity

PCP referral

Medical Supplies

Medical necessity

PCP Rx required

Nurse Midwife

Medical necessity

None

Outpatient Mental and Behavioral Health

Medical necessity

PCP Rx required

Physician Services

Medical necessity

PCP referral to specialists. Patient must use PCP for access to all services, including the professional component of services rendered in inpatient settings.

Psychology Services

Medical necessity

Physician Rx required

Podiatry

Medical necessity

PCP referral

Prescription Drugs

Medical necessity

Prescription (must use generic and rebate mfg. when available)

Rural Health Clinic

Medical necessity

See Physician Services

Therapy Services--Speech, Occupational, and Physical

Medical necessity

PCP referral and prescription required

Transportation

For Medicaid-covered services only

None

Vision Care

1 eye exam and 1 pair of eyeglasses per 12 months

None

   

ARKids B
(copayment required)

Program

Coverage Limits

Prior Authorization

Copayment*

Ambulance (emergency only)

Medical necessity

None

$10 per trip

Ambulatory Surgical Center

Medical necessity

PCP referral

$10 per visit

Chiropractor

Medical necessity

PCP referral

$10 per visit

Dental Care (no orthodontia)

Medical necessity

Some
restorative services

$10 per visit

Durable Medical Equipment

$500 per year

PCP prescription plus referral

20% per DME item

Emergency Room Services

Medical necessity

None

$10 per visit

Family Planning

Family Planning services only

None

None

Federally Qualified Health Center

Medical necessity

None

$10 per visit

Home Health

Medical necessity

PCP referral (limited to 10 visits per State Fiscal Year)

$10 per visit

Immunizations

All per protocol

PCP or ADH administered

None

Inpatient Hospital

Medical necessity

Prior approval for stays of more than 4 days

20% of first inpatient day

Laboratory and X­Ray

Medical necessity

PCP referral

$10 per visit

Medical Supplies

Medical necessity

PCP prescriptions (limited to $125 per month, with extension based on medical necessity)

None

Nurse Midwife

Medical necessity

None

$10 per visit

Outpatient Mental and Behavioral Health

Medical necessity

PCP referral

$10 per visit

Physician Services

Medical necessity

PCP referral to specialists. Patient must use PCP for access to all services, including the professional component of services rendered in inpatient settings.

$10 per visit

Podiatry

Medical necessity

PCP referral

$10 per visit

Prescription Drugs

Medical necessity

Prescription

$5 per prescription (must use generic and rebate mfg. when available)

Preventive Health Screening

All per protocol

PCP or ADH administered

None

Rural Health Clinic

Medical necessity

None

$10 per visit

Speech Therapy

Medical necessity

PCP referral

$10 per visit

Vision Care

1 eye exam and 1 pair of eyeglasses per 12 months

Routine exams and diagnostic

$10 per visit