Health Care Independence Program (HCIP) Terminations

Updated February 2017   Fact Sheet PDF


Introduction

HCIP provides health care coverage to both Arkansans who are U.S. citizens and certain legally‐residing immigrants aged 19 to 64. Their household incomes must be below 138% of the Federal Poverty Level (FPL). This program provides private insurance coverage to eligible adults with no monthly costs. Arkansas uses federal Medicaid dollars to pay the monthly premiums. If you are eligible, you may have a small co‐pay for doctor visits, prescriptions, and certain other medical services. You can apply online at access.arkansas.gov.

 

HCIP is the same as “private option.” It is sometimes called the “Private Option” because health care is provided through a private insurance plan.

 

Federal Poverty Level

Depending on your family size, 138% of the FPL is about $16,242 annually for an individual (family of one) and $21,983 for a family of two.

 

Medicaid vs. Private Insurance Plan

Most people in the program will receive a private insurance plan at no cost to them. But, about 10% of people are better served by Medicaid. This is due to chronic conditions, extensive medical needs, or trouble handling daily activities, like taking medicine or caring for themselves. Medicaid provides extra services that better manage those issues.

 

Services

The program allows you to pick an insurance plan that has the services that best meet your health care needs. All plans cover outpatient services, emergency services, hospital stays, prescription drugs, preventive and wellness services, maternity and newborn care, mental health and substance abuse disorder services, and laboratory services. To read more about these basic benefits, go to arhealthconnector.org.

 

Eligibility

Income

If you have too much income, the information you provide to the DHS will be electronically sent to the Health Insurance Marketplace. They will use the information to determine your eligibility for tax credits and cost‐sharing reductions. These programs may help you purchase a Qualified Health Plan available through the Health Insurance Marketplace. For more information, go to healthcare.gov.

 

Children Under 18

They are not eligible. You must be at least 19 for HCIP. However, children under 19 may be eligible for ARKids First. If you have children under 19 living with you, they must also be covered for you to be eligible for coverage. If they do not have health care coverage, you should apply for ARKids at access.arkansas.gov.

 

Health Care Redetermination Notices

Arkansas is in the process of verifying continued eligibility for people getting Medicaid/HCIP benefits. As of August 2015, almost 50,000 people in Arkansas had received Health Care Redetermination Notices from the United States Department of Human Services (DHS). This Notice tells people to submit proof of income within 10 days from the Date of Notice listed in the letter. You should submit copies of the requested proof along with a copy of the Health Care Redetermination Notice by one of the following:

  • mailing your documents to the address on the DHS Notice
  • taking your documents to a DHS County Office
 

Make sure that your Social Security Number and Date of Birth are on the documents. Get proof of submission from DHS if possible, or make a note for yourself of the date and address where you mailed the documents.

 

Proof of Income

The DHS will accept any of the following as proof of income:

  • a check stub (for the previous month)
  • a letter from an employer verifying income
  • a Verification of Earnings Form (DCO97) completed by an employer
  • a Benefit Award Letter, such as Social Security or Unemployment Benefits
  • for the self-employed:
    • a tax return, including Schedule C
    • if you have not filed, provide an extension and last year’s return
  • for the unemployed: provide a letter saying you have no income, and sign the letter
 

If you do not provide the required documents by the deadline and do not receive an extension, you will lose your health insurance. But, if you can provide proof of income within 90 days of the termination date, you could be reinstated if eligible.

 

10-Day Deadline

If you miss the 10-day deadline, call any DHS County Office to ask for an extension. This will stop your case from being closed for you not responding. Make a note of the person you talked to and the new date for providing proof of income.

 

Terminating Benefits

If the proof of income is not received on time, Medicaid recipients will receive a Health Care Notice terminating their benefits. Anyone who is terminated for failing to submit proof of income has 90 days to provide proof of income and be re-enrolled if eligible.

 

If your coverage was terminated and you believe you are still eligible, you should submit the proof of income as explained above. If you miss the 90-day deadline, you can re-apply for Medicaid or HCIP. People who re-enroll within 90 days will first be put into traditional Medicaid. You should be placed back on your private plan within two months.

 

Paying Out-of-Pocket While Waiting to Be Reinstated

Keep copies of all your receipts. If family members or friends are loaning you the money, write down the agreement. Both of you should also sign it. Once your insurance is back on, ask the doctor or pharmacist to refund the money and bill Medicaid instead.

 

This fact sheet is a collaboration of the Center for Arkansas Legal Services and Legal Aid of Arkansas, Inc. These nonprofit organizations provide free legal assistance to eligible Arkansans who meet income, asset, and other guidelines. Legal assistance may also include advice and counsel, brief services, or full representation depending on the situation. For more information about civil legal aid in Arkansas, please visit arlegalservices.org. For information specific to Legal Aid of Arkansas, Inc., visit arlegalaid.org. Apply for services online or by calling 1-800-9-LAW-AID (1-800-952-9243).
The information and statements of law in this fact sheet should not be considered legal advice. This fact sheet is provided as a broad guide to help you understand how certain legal matters are handled in general. Courts may interpret the law differently. Before you take action, talk to an attorney and follow his or her advice. Always do what the court tells you to do.
Content provided by: Center for Arkansas Legal Services

 

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