Arkansas’ ARChoices in Homecare, or ARChoices for short, is a statewide Medicaid program for seniors and adults who are physically disabled. Intended to prevent nursing home admissions of those at risk, the program provides long-term home and community based services (HCBS) to promote independent living. The exact services and supports one receives is based on their specific needs and circumstances, but potential benefits include adult day care, in-home and out-of-home respite care, home delivered meals, attendant care (personal care services / homemaker services), and personal emergency response systems.
Personal care services / attendant care may be provided by licensed agency workers or program participants have the option of self-directed care via a program called Independent Choices. With participant-directed care, program participants are given a cash allowance with which to purchase attendant care services (and goods that reduce the need for attendant care). This allows them to hire, train, and manage the caregiver of their choosing. Friends and relatives, such as an adult child, can be hired, but spouses and legal guardians are prohibited from being hired. A financial management service (FMS) agency handles the financial aspects of employment responsibilities, such as tax withholding and caregiver payments.
Program participants can reside in their own private home or that of a loved one. Previously, they could also live in adult family homes (adult foster care homes), but adult family services were terminated in 2019. Persons cannot reside in assisted living residences.
AR seniors who wish to reside in assisted living should consider the: Living Choices Program or Personal Care Program.
Arkansas’ ARChoices In Homecare Waiver is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver. It was implemented in 2016 and is a combination of two previous waivers: Elder Choices (EC) and Alternatives for Adults with Physical Disabilities (AAPD). ARChoices is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. Instead, the number of participant enrollment slots are limited, and when full, a waiting list for program participation forms.
Your request has been received. You’ll be contacted within one business day.Wait List Alternatives: Are you interested in connecting with a Medicaid Planning Professional to discuss alternatives to ARChoices in Homecare? Wait-lists can last from months to years, but there are other Medicaid programs that offer immediate care outside of nursing homes.
An individual care plan, formally called an individualized person-centered service plan, determines the exact benefits a program participant receives.
– Adult Day Care / Adult Day Health Care
– Attendant Care – assistance with activities of daily living, instrumental activities of daily living, and health-related tasks (i.e., bathing, dressing, toileting, mobility, eating, meal preparation, laundry, shopping for essentials, housekeeping, monitoring of blood glucose)
– Home Delivered Meals
– Home Modifications – for safety and accessibility (i.e., grab bars and wheelchair ramps)
– Personal Emergency Response Systems
– Prevocational Services
– Respite Care – in-home and out-of-home
ARChoices in Homecare is for Arkansas residents who are elderly (aged 65 and older) or physically disabled and between the ages of 21 and 64. Program participants who are disabled can continue to receive waiver services upon turning 65 years old. Additional eligibility criteria is below.
The American Council on Aging provides a quick and easy Medicaid Eligibility Test for AR seniors.Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR). This figure increases each January, and in 2024, is $2,829 / month. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,829 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Only the applicant spouse’s income is considered, which is limited to $2,829 / month. Furthermore, the non-applicant spouse may be entitled to a Spousal Income Allowance, called a Monthly Maintenance Needs Allowance, from their applicant spouse.
Arkansas has set a minimum Spousal Income Allowance of $2,555 / month (eff. July 2024 – June 2025). This allows an applicant spouse to supplement their non-applicant spouse’s monthly income, bringing their income up to this amount. The state also sets a maximum income allowance, which in 2024, is $3,853.50 / month. While this potentially allows a non-applicant spouse a higher income allowance, any additional amount above the minimum income allowance is dependent on one’s shelter and utility costs. A Spousal Income Allowance, however, can never push a non-applicant’s total monthly income over $3,853.50.
Assets
In 2024, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can retain up to $2,000 in assets and the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA) to prevent spousal impoverishment.
The CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $154,140. If the non-applicant’s share of assets falls under $30,828, they can keep 100% of the assets, up to $30,828.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because AR Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.
To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our AR Medicaid Spend Down Calculator.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Fortunately, for eligibility purposes, Arkansas Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a minor child (under 21 years old) living in the home.
– The applicant has a permanently disabled or blind child (of any age) living in the home.
While one’s home is generally safe from Medicaid’s asset limit, it is not necessarily safe from Medicaid’s Estate Recovery Program.
An applicant must require an intermediate Nursing Facility Level of Care (NFLOC); they cannot require a skilled nursing facility level of care. For an applicant to meet the functional need for an intermediate level of care, one of the following statements must be true:
– The applicant cannot complete at least one of the following Activities of Daily Living (ADLs) without a substantial amount of assistance or complete dependence on someone else: eating, toileting, or transferring (moving from one position to another) / locomotion (moving from one location to another by walking / wheelchair).
– The applicant cannot complete at least two of the following Activities of Daily Living (ADLs) without limited assistance from someone else: eating, toileting, or transferring (moving from one position to another) / locomotion (moving from one location to another by walking / wheelchair).
– The applicant has Alzheimer’s disease or a related dementia, and due to cognitive impairment, requires extensive supervision due to inappropriate behaviors that create a serious safety or health hazard. To be clear, a diagnosis of dementia in and of itself does not mean one will meet an intermediate NFLOC.
– The applicant requires daily monitoring or assessment by a medical professional because of a life-threatening medical condition if not treated.
Functional need is assessed in-person by a registered nurse employed by an Independent Assessment Contractor. The Arkansas Independent Assessment (ARIA), which consists of more than 300 questions, is the tool that is used. One area of consideration is an applicant’s abilities and limitations to complete their Activities of Daily Living, such as bathing, dressing, and toileting. As part of the assessment process, a tier level between 0 and 3 is assigned. Tiers 0 and 1 indicate one’s functional needs are not great enough for ARChoices services, tier 2 indicates that one’s functional needs qualify for ARChoices services, and tier 3 indicates that one’s needs are too great for ARChoices services. ARIA results are reviewed by a nurse from the DHS’ Office of Long Term Care who makes the final level of care determination.
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for AR Medicaid. There are a variety of Medicaid planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
When persons have income over the limits, Miller Trusts, called Income Trusts in Arkansas, can help. “Excess” income is deposited into the trust, no longer counting as income.
When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) can be utilized. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Persons can also spend down “excess” assets on non-countable assets, such as home furnishings, clothing, and home repair projects. There are many other planning strategies available when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid Planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Arkansas to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of the strategies violate Medicaid’s 60-month Look-Back Rule, and therefore, should only be implemented with careful planning. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
Prior to applying for ARChoices, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants must gather documentation for submission. Examples include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, bank statements up to 60-months prior to application, and proof of income. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.
Since the ARChoices in Homecare is not an entitlement program, there may be a waiting list for program participation. The waiver is approved for approximately 11,425 beneficiaries per year. Of these participant slots, 100 are reserved for persons transitioning from a nursing home back to community living through the Money Follows the Person Program. If a waiting list exists, priority is given to persons residing in a nursing home with a minimum 90 day stay and persons living in an approved Level II assisted living facility with a minimum 6 month stay. This means applicants who submitted an application at a later date than other applicants may be awarded a participant slot first based on priority.
Persons can apply for ARChoices in Homecare online at Access Arkansas, by completing and submitting the Arkansas Department of Human Services Long-Term Services and Supports Application, or by contacting their local Department of Human Services (DHS) office.
Learn more about ARChoices in Homecare. Persons can also contact the Division of Medical Services at 501-682-8292 or the Choices in Living Resource Center, Arkansas’ Aging and Disability Resource Center, at 866-801-3435.
ARChoices is administered by the Division of Medical Services (DMS), the Division of Provider Services and Quality Assurance (DPSQA), and the Division of Aging, Adult, and Behavioral Health Services (DAABHS). The Division of County Operations (DCO) determines financial eligibility and the Office of Long Term Care (OLTC) determines functional eligibility. All divisions are within the Arkansas Department of Human Services (DHS). Independent Choices is operated by DSPQA.
The Medicaid application process in Arkansas can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as a waiting list may exist, approved applicants may spend many months, or longer, waiting to receive benefits.
What are 1915(c) HCBS Medicaid Waivers?
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a Nursing Home Level of Care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.