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.
|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.)|