• If a beneficiary loses coverage amidst a longterm treatment process , will the physician be paid for care that ’ s already been delivered to that patient ?
Wroten asked , “ In short , how is this going to affect the medical care being provided to those under the work requirement ?”
Coverage
With any program starting out , there are some unknowns . While Franklin stopped short of speaking to specific “ what-if ’ patient scenarios , she did share some set-in-place penalties and the policy of DHS to look at certain situations on a case-by-case basis . “ Just as physicians can now check to see if a patient is covered by insurance , they will be able to check for Arkansas Works eligibility / coverage prior to treatment ,” she said . “ If a patient ’ s coverage is not active when he or she receives care , the provider providing the care would not be compensated for those services .
“ We would like for physicians to remember a couple of things about Arkansas Works coverage . First , the requirement to complete and report monthly work and community engagement activities will affect approximately 40,000 out of the approximately 284,000 adults without an exemption during 2018 .”
A beneficiary ’ s coverage , Franklin shared , is tied to his or her “ case ,” which is open or closed at month ’ s end in all cases other than the death of the beneficiary . While an Arkansas Works patient case is open , that patient ’ s coverage is safe – as is the payment for services rendered . “ If a case is active on the date of medical service ,” she clarified , “ then the claim can be billed up to a year after the date of service even if the case has been closed .”
Penalties for Non-compliance
“ Adults who accumulate three months of non-compliance with work requirements during a calendar year will lose their coverage in Arkansas Works for the remainder of the calendar year ,” explained Franklin , noting that those three months do not have to be consecutive and that if a patient ’ s case is closed for non-compliance , providers will be able to see that information by the following day . “ However , beneficiaries may reapply and return to the program if eligible in the following calendar year . Also , it ’ s important to note that individuals who have been disenrolled for non-compliance with work and community engagement requirements may apply [ immediately ] for Medicaid in other categories ( such as pregnancy and disability ) according to eligibility .”
Requirements per DHS .
Exemptions as listed in Arkansas Works communication materials .
Exceptions / Exemptions
In some cases , beneficiaries who are otherwise non-exempt may qualify for what DHS has termed a good cause exemption . This typically requires catastrophic circumstances , which may include natural disaster , fire , hospitalization , or the death of a family member living in the home .
“ There is a process by which Arkansas Works individuals request good cause exemption for not completing work activities or reporting work activities . Normally this would be done by the individual by contacting his or her county office ,” said Franklin . “ If the individual is incapacitated to the point that they cannot report for themselves , then a loved one may make the request . We will handle good cause requests on a case-by-case basis . Individuals whose requests for good cause are approved will have their non-compliance removed and may be reinstated without a new application if their case was closed .”
Help Direct Patients to the Arkansas Works Online Portal
To help themselves and their patients , physicians and other health care professionals can start by understanding the requirements , sharing information and reminders in their clinics , and pointing Medicaid patients towards the help DHS has made available to them – specifically , the information on the DHS public sharepoint site . The reminder to report their work activities on the Arkansas Works – Work Requirement online portal located at access . arkansas . gov .
272 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY VOLUME 114