One of the most difficult tasks many special needs families face is providing the level of care necessary to allow their child to live as full and productive a life as possible. Such care often outstrips the medical capacity of the parents and generally comes with a heavy price tag.

At the same time, studies have shown that on both counts — medical outcome and cost — children who are able to receive treatment and service in the home fare considerably better than those who receive institutionalized care.

The state of Arkansas provides several programs to assist families in caring for their child’s special needs, particularly for families in lower income brackets.

ARKids First

ARKids First is the state’s insurance program to provide medical care services to children under age 19.

“ARKids is available to all families with children under age 19 who meet the income guidelines,” said Mary Franklin, director of the Division of County Operations at the Arkansas Department of Human Services in Little Rock. “There is no special requirement that there be any special needs or additional needs for a child to get ARKids; basically, do they meet the eligibility requirements, which involves income and citizenship.”

ARKids defines eligibility according to a two-tier structure. ARKids A includes those children who qualify for Medicaid, who can take advantage of ARKids First medical services without copay, additional insurance or other financial contribution.

ARKids B is for families that earn too much to qualify for Medicaid, but fall within the other financial parameters of the program. These participants are required to co-pay when medical services are received, up to an annual limit.

Parents can apply for ARKids First online, by calling 1-888-474-8275 weekdays 8 a.m.-4:30 p.m. or by visiting a local DHS office.

TEFRA

A second state program, TEFRA 134(a), is a provision of the Tax Equity and Fiscal Responsibility Act of 1982, which allows states to extend Medicaid coverage to certain disabled children to receive care in their homes rather than in institutions.

In addition to citizenship, eligibility is determined according to three considerations regarding the child’s condition. First, the child must meet the Social Security Administration definition of disabled, as established by an evaluation. Second, children must have a medical condition that would require current or future institutional placement in a care facility or institution for treatment or improvement; and third, said care must be available for administering in a home setting.

Unlike ARKids and other Medicaid programs, parental income and resources are not a consideration when determining eligibility. However, the child’s income and resources are weighed as a means for determining eligibility. Each situation is different, but forms of income that typically affect eligibility include investments in the child’s name or income from those investments, some Social Security survival benefits or child support paid to the custodial parent but used for the benefit of the child.

In more complicated situations, life insurance policies that accrue cash value may also be counted. However, payouts from any life insurance holdings are not factored or claimed by the state in the event of the child’s death.

“There is no estate recovery attached to TEFRA eligibility like there is in long-term care types of Medicaid,” Franklin said. “Proceeds of a life insurance policy after the child dies wouldn’t have any impact.”

Once eligibility is established, the parents’ income determines whether or not the family is required to pay a premium to access services. Families that earn below 150 percent of the federal poverty level pay nothing; other families pay a monthly fee on a graduated scale according to income, to a maximum of $458/month for families earning more than $200,000 annually.

For full details or to start the application process, visit a local DHS office or call DHS at 501-682-1001. There is not an option to apply online, but all forms and information are available at the Department of Human Services' website.