Cost Sharing for Adult Medicaid Clients

The Arkansas Medicaid program covers medical costs so you don’t have big bills after an emergency or illness. You may pay a small share as well. 

The out-of-pocket costs are small but important. This is a summary of what you may need to pay.

Components of cost sharing:

• Copay: A small fee clients pay when they receive a medical service or fill a prescription.
• Copay limit: Limits to the total amount clients pay each quarter (3-month period). Once a client meets the limit, he/she will not pay co-pays for the rest of that quarter. The client starts paying co-pays again the next quarter.

	Beginning 2023
Adult clients who pay to cost sharing	Adult clients above 20% of FPL who are in the following programs: ARHOME: Only Individuals enrolled in a QHP and those awaiting enrollment in a QHP; medically frail clients will NOT have cost sharingWorkers with Disabilities, and Transitional Medicaid Adult Exemptions: Individuals in these Medicaid programs who do NOT have to pay copays include: Under 20% FPL Individuals in hospice Medically frail Pregnant women 19- and 20-year-olds American Indian/Alaskan Native
Service-specific copay amounts	Adults pay $4.70/$9.40, depending on the service. (These copay amounts to not apply to ARKids B.) Exemptions Services that are exempt from copays (copays are not charged) include: Emergency services Preventive services Family planning services and supplies Inpatient hospitalization Pregnancy-related services
Copay limits	Quarterly copay limit is based on household federal poverty level
Clients’ copays contributing to copay limit	The ARHOME clients and all Medicaid clients who pay copays in the individual’s family. Example: two adults in a family in ARHOME at 40% FPL. If they each are charged $15 in copays, their total copays would be limited to $27. (ARKids B copays do not count toward the copay limit, but TEFRA premiums do.)

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