Medicaid, ARHOME, and ARKids Beneficiaries

Watch for your renewal form, fill it out, and return it to Arkansas Medicaid right away to avoid losing Medicaid coverage if you are eligible.

Forms & Documents

Forms & Documents

SNAP, Health Care, and TEA-RCA Application Form

TitleTypePosted Date
Application for SNAP, Health Care, and TEA-RCA (multi-program application) – EnglishPDF09/01/2022
Application for SNAP, Health Care, and TEA-RCA (multi-program application) – SpanishPDF09/01/2022
Application for SNAP, Health Care, and TEA-RCA (multi-program application) – MarshallesePDF12/03/2020

Health Care Forms & Documents

TitleTypePosted Date
Form 1095-B: Health CoverageLINK01/12/2021
Medicare Savings ApplicationPDF09/30/2022
Medicare Savings Application – SpanishPDF09/30/2022
Medicaid Change Report​PDF
Quick Reference Medicaid Chart 2023PDF04/01/2023
Income Trust FormPDF07/01/2022
Income Trust Fact SheetPDF07/01/2022
Your Guide To Medicaid Estate Recovery In ArkansasPDF01/30/2018

SNAP Forms & Documents

TitleTypePosted Date
SNAP Forms & Documents
Access Arkansas Online Applications for SNAPWEB
SNAP Quick Reference GuidePDF
SNAP Change ReportPDF
SNAP Semi-annual Reporting GuidePDF
Electronic Benefits Transfer Card InformationLINK
Smart Nutrition Active People-Education | SNAP-ED|LINK
SNAP Employment and Training CountiesPDF
SNAP Farmer’s MarketsPDF
SNAP Double Up Food DollarsPDF
SNAP Double Up Food Bucks – How It WorksLINK
SNAP non-discrimination statement (Spanish)PDF
EBT Training Pamphlet | SpanishPDF
EBT Training Pamphlet | EnglishPDF

Transitional Employment Assistance / Refugee Cash Assistance Forms & Documents

TitleTypePosted Date
Transitional Employment Assistance / Refugee Cash Assistance Forms & Documents
TEA Change ReportPDF
TEA ApplicationPDF12/2020
TEA Quick Reference Guide 2023PDF1/2023

Community Services Grants Programs Forms & Documents

TitleTypePosted Date
Community Services Grants Programs Forms & Documents
Arkansas Community Action Agencies 202009/21/2020
Emergency Solutions Grant COVID-19 Subgrantee Contact ListPDF10/13/2020
Emergency Solution Grant Subgrantee Contact ListPDF09/21/2020