Medicaid, ARHOME, and ARKids Clients

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What does ARKids Pay?

What does ARKids Pay?

ARKids A and B both cover a range of services to keep your kids health. The charts below have information about services, coverage limits, authorizations, and co-payments.

Happy male doctor communicating with child in clinic

ARKids A coverage does not have any out of pocket costs.

Coverage for children in ARKids B will have an annual limit equal to five percent (5%) of the family’s annual gross income (the amount before taxes).

For example, if a family of four has an annual gross income of $40,000 then their out-of-pocket expense can’t be more than $2,000 ($40,000 x .05 = $2,000).

If you need more information, you can always call the ARKids hotline at 1-888-474-8275.

Apply now:

ARKids A (copayment not required)

ProgramCoverage LimitsPrior Authorization
Ambulance (emergency only)Medical necessityNone
Ambulatory Surgical CenterMedical necessityPCP referral
ChiropractorMedical necessityPCP referral
Dental Care (Orthodontia included)Medical necessityPA required for some procedures
Durable Medical EquipmentMedical necessityPA required for some equipment
Emergency Room ServicesMedical necessityNone
EPSDT ScreensAll per protocolPCP or ADH administered
Family PlanningFamily Planning services onlyNone
Federally Qualified Health CenterMedical necessitySee Physician Service
Hearing ServicesMedical necessityPCP referral
Home HealthMedical necessityPCP Rx required
HospiceMedical necessityPhysician certification
ImmunizationsAll per protocolPCP or ADH administered
Inpatient HospitalMedical necessityPA for stays of more than 4 days
Inpatient Psychiatric and Psychiatric Residential Treatment Facility ServicesMedical necessityPA required
Laboratory and X-RayMedical necessityPCP referral
Medical SuppliesMedical necessityPCP Rx required
Nurse MidwifeMedical necessityNone
Outpatient Mental and
Behavioral Health
Medical necessityPCP Rx required
Physician ServicesMedical necessityPCP referral to specialists. Patient must use PCP for access to all services,including the professional component of services rendered in inpatient settings.
Psychology ServicesMedical necessityPhysician Rx required
PodiatryMedical necessityPCP referral
Prescription DrugsMedical necessityPrescription (must use generic and rebate mfg. when available)
Rural Health ClinicMedical necessitySee Physician Services
Therapy Services —
Speech, Occupational, and Physical
Medical necessityPCP referral and prescription required
TransportationFor Medicaid-covered
services only
Vision Care1 eye exam and
1 pair of eyeglasses per 12 months

ARKids B (copayment required)

ProgramCoverage LimitsPrior AuthorizationCopayment*
Ambulance (emergency only)Medical necessityNone$10 per trip
Ambulatory Surgical CenterMedical necessityPCP referral$10 per visit
Certified Nurse MidwifeMedical necessityPCP referral$10 per visit
ChiropractorMedical necessityPCP referral$10 per visit
Dental Care (Orthodontia included)Medical necessitySome restorative services$10 per visit
Durable Medical Equipment$500 per yearPCP prescription plus referral10% per DME item
Emergency Room ServicesMedical necessityNone$10 per visit
Family PlanningFamily Planning
services only
Federally Qualified Health CenterMedical necessityNone$10 per visit
Home HealthMedical necessityPCP referral (limited to 10 visits per State Fiscal Year)$10 per visit
ImmunizationsAll per protocolPCP or ADH administeredNone
Inpatient HospitalMedical necessityPrior approval for stays of more than 4 days10% of first inpatient day
Inpatient Psychiatric Hospital (Emergency Only)Medical necessityPrior approval required10% of first inpatient day
Laboratory and X-RayMedical necessityPCP referral$10 per visit
Medical SuppliesMedical necessityPCP prescriptions(limited to $125 per month, with extension based on medical necessity)None
Nurse Practitioner Medical necessityNone$10 per visit
Tier 1 Mental & Behavioral Health, Outpatient, including substance abuse servicesMedical necessityPCP referral$10 per visit
Physician ServicesMedical necessityPCP 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
PodiatryMedical necessityPCP referral$10 per visit
Prescription DrugsMedical necessityPrescription$5 per prescription (must use generic if obtainable)
Preventive Health ScreeningAll per protocolPCP or ADH administeredNone
Rural Health ClinicMedical necessityNone$10 per visit
Therapy Services, Speech, Occupational, and PhysicalMedical necessityPCP referral$10 per visit
Vision Care1 eye exam and 1 pair of eyeglasses per 12 monthsRoutine exams and diagnostic

$10 per visit; no co-pay for eyeglasses

Apply now: