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.
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: https://access.arkansas.gov/
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 Psychiatric and Psychiatric Residential Treatment Facility Services | Medical necessity | PA required |
| Laboratory and X-Ray | 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 | |
| Certified Nurse Midwife | Medical necessity | PCP referral | $10 per visit | |
| Chiropractor | Medical necessity | PCP referral | $10 per visit | |
| Dental Care (Orthodontia included) | Medical necessity | Some restorative services | $10 per visit | |
| Durable Medical Equipment | $500 per year | PCP prescription plus referral | 10% 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 | 10% of first inpatient day | |
| Inpatient Psychiatric Hospital (Emergency Only) | Medical necessity | Prior approval required | 10% of first inpatient day | |
| Laboratory and X-Ray | 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 Practitioner | Medical necessity | None | $10 per visit | |
| Tier 1 Mental & Behavioral Health, Outpatient, including substance abuse services | 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 if obtainable) | |
| Preventive Health Screening | All per protocol | PCP or ADH administered | None | |
| Rural Health Clinic | Medical necessity | None | $10 per visit | |
| Therapy Services, Speech, Occupational, and Physical | Medical necessity | PCP referral | $10 per visit | |
| Vision Care | 1 eye exam and 1 pair of eyeglasses per 12 months | Routine exams and diagnostic |
|
Apply now: https://access.arkansas.gov/
