Can I keep my current doctor as my ConnectCare doctor?

Yes, if…

• The doctor is not accepting new patients.
• A pediatrician may refuse to take a child older than 16 years of age.
• An obstetrician/gynecologist may refuse to take a male or a female patient younger than 2 years of age.
• An internal medicine doctor may refuse to take anyone 6 years of age or younger.
• A doctor can refuse to take you when your relationship with the doctor does not work out. For example:
  • You miss two or more appointments without calling ahead of time.
  • You are abusive to the doctor or staff.
  • You fail to follow the doctor’s medical instructions.

What if I get sick when I am out of town?

If you are not in the state of Arkansas and cannot wait until you get home to get medical help, you should call your doctor. If you have a true emergency, you should go to the emergency room immediately.

When should I go to my ConnectCare doctor, and when should I go to the Emergency Room?

You should only go to the emergency room when you have a true emergency. If you do not have a true emergency, you should go to your doctor during office hours. Your doctor has your medical history and knows best how to treat you.

Good reasons to go to the Emergency Room:

• Danger of losing life or limb
• Very bad or sudden chest pains
• Poisoning or overdose of medicine
• Choking or having a hard time breathing
• Possible broken bones
• Heavy bleeding
• Fainting or shock
• Suddenly not able to move (paralysis)
• Head or eye injury
• Violent attack (rape, mugging, stab, or gunshot wound)
• Fever above 103 degrees

Good reasons to go to your ConnectCare doctor:

• Earache
• Toothache or baby teething
• Rash
• Colds, cough, sore throat, flu, or sinus problems
• Minor sunburn
• Minor headache
• Broken cast
• Stitches needing to be removed
• Medicine refills

If you go to the Emergency Room when it is not an emergency, you may:

• Wait a long time
• Receive limited healthcare services
• Be sent to your ConnectCare doctor anyway, and
• Be responsible for the bill

How do I get a referral to see a specialist?

My ConnectCare PCP will not take me as a patient anymore.

How do I get a prescription?
Always talk to your doctor about any medicine you are currently taking or that you think you need.

If you need a medicine refill, call your doctor’s office. If your doctor has sent you to another doctor or clinic for healthcare, you should talk to that doctor about medicine he or she has prescribed, or call your pharmacist.

Arkansas Medicaid covers a wide range of services. Some services have limits on how often you can receive those services, and some services require prior approval from Medicaid. Sometimes, Medicaid adds or removes services, depending on the need for the service and the state’s ability to pay for the service. You can contact your local DHS office for more information on these limits and services or contact Medicaid Claims Customer Service Unit Toll-Free 1-800-482-5431 or when you are in the Central Arkansas area, call 682-8501.

The following services are available to both adults and children who are Medicaid eligible. Services marked by an asterisk (*) do not require a referral from your doctor. The other services require a referral from your doctor.

• Family planning*
• Federally Qualified Health Center (FQHC) Services
• Home Heath services
• Inpatient hospital services
• Laboratory and X-ray services
• Nurse-midwife services*
• Nurse Practitioner services
• Nursing Facility services*
• Outpatient hospital services
• Physician services
• Rural Heath Clinic services
• Ambulatory Surgical Center services
• Targeted Case management for Pregnant Women, adults with a developmental disability, recipients age 60 and over
• Certified Registered Nurse Anesthetist (CRNA) *
• Developmental Day Treatment Clinic services*
• Domiciliary Care services*
• Durable Medical Equipment
• End-Stage Renal Disease (ESRD) facility services
• Hyperalimentation services
• Inpatient Rehabilitative Hospital services
• Intermediate Care Facility Services for Mentally Retarded*
• Medical supplies
• Personal Care services
• Podiatrist’s services
• Portable X-Ray services
• Private Duty Nursing services for ventilator dependent
• Prescription drugs*
• Rehabilitative services for persons with Mental Illness*
• Transportation services (ambulance, public and private/Non-profit)*
• Ventilator equipment
• Visual services*

Services for Children and Young People under age 21:

• Eye prosthesis*
• Repairs and replacements of eyeglasses*
• Hearing Aid services
• Medical clearance
• Audiological Exam
• Purchase of Hearing Aid
• Immunization*
• Allergy/Desensitization Injections and Antigens
• Child Health Management services*
• Inpatient Psychiatric Care*
• Cochlear Implantation
• Durable Medical Equipment (DME), e.g., specialized wheelchairs
• Chiropractic services
• Occupational, Physical, Speech Therapy services

The following services are available when determined to be medically necessary because of a Child Health Services (EPSDT) screening referral. These services include, but are not limited to:

• Hospice services
• Targeted Case Management Services for Recipients under age 21
• Orthotic appliances
• Prosthetic devices
• Respiratory services
  

Eye care is covered for people who have Medicaid or ARKids First.

Children - Ages 20 and Younger

The following eye care is included for children who have Medicaid or ARKids First:

• Eye Exams
  • Children may receive one eye exam every twelve months.
• Co-pays
  • Medicaid & ARKids First A: (Co-pays are not required for vision care services.)
  • ARKids First B: ($10.00 co-pays are required for vision care services.)
• Eyeglasses & Contact Lenses
  • Children may receive one pair of glasses every twelve months.
  • Only plastic or polycarbonate lenses are covered.
  • Eyeglasses repairs can only be made if purchased through the Arkansas Medicaid Program (All repairs are made by the doctor’s office).
  • If the glasses are lost or broken beyond repair within the twelve month benefit limit period, one additional pair will be available through the optical laboratory.
    • After the first replacement pair, any additional pair will require Medicaid approval (There is no co-pay required for replacement eyeglasses that have been approved by Medicaid).
  • Contact lenses are covered if medically necessary (Medicaid approval is required).
    • Bifocal contact lenses are not covered by Medicaid.
• Other Vision Services
  • Eye prosthesis and polishing services are covered (Medicaid approval is required).

Children - Ages 21 and Older

The following eye care is included for adults who have regular Medicaid:

• Eye Exams
  • Adults may receive one eye exam every twelve months.
• Co-pays
  • Medicaid adults are required to pay $2.00 co-pays for exam services.
• Co-pays are not required for Medicaid adults who are in nursing facilities or in group homes.
• Eyeglasses & Contact Lenses
  • If needed, adults may receive one pair of eyeglasses every twelve months (Bifocals, Trifocals, and Progressive lenses are covered if medically necessary; Medicaid approval is required).
  • Adult diabetics may receive a second pair of eyeglasses within the twelve month period if their prescription has changed (Medicaid approval is required).
  • Only plastic or polycarbonate lenses are covered.
  • Repairs can only be made if purchased through the Arkansas Medicaid Program (All repairs are made by the doctor's office).
  • Contact lenses are covered if medically necessary (Medicaid approval is required).
    • Bifocal contact lenses are not covered by Medicaid.
• Other Vision Services
  • Eye prosthesis and polishing services are covered (Medicaid approval is required).
    • Only one visual prosthetic device may be covered every 24 months from the last date of service.

For more information about eye care:

• Call the Medicaid Client Assistance helpline 1-800-482-8988 (TDD: 501-682-8820)

To get a list of eye doctors (Optometrists) in your area:

• Call the ConnectCare helpline 1-800-275-1131 (TDD: 1-800-285-1131)

OR

• Go to the Medicaid website - Find a Medicaid Provider
  • Under Specialty, select Optometrists.

Can I get dental care?

Dental care is covered for people who have regular Medicaid or ARKids First.

Children - Ages 20 and Younger

Medicaid and ARKids First A

The following dental care is covered for children who have ARKids First A or Medicaid:

• One office visit, one cleaning, one set of x-rays and one fluoride treatment (every six months and one day)
• Panoramic x-ray or full mouth series of x-rays (once every 5 years)
• Dental sealants for 1st & 2nd permanent molars only (once per lifetime)
• Simple tooth pulling
• Surgical tooth pulling
• Fillings
• Crowns (some crowns will need approval from Medicaid))
• Root canals
• Orthodontic care such as braces, if needed for medical reasons (all orthodontic care must be approved by Medicaid)

Other dental care may be covered for children who have ARKids First A or Medicaid upon approval from Medicaid.

ARKids First B

Dental care is also covered for children who have ARKids First B.

Orthodontic care (braces) is NOT covered under ARKids First B

ARKids First B requires $10.00 co-pays for dental care services.

Adults - Ages 21 and Older

Dental care is covered for adults who have regular Medicaid.

Medicaid will pay up to $500 per state fiscal year (July 1 to June 30) for most dental care.

Dental care for adults includes:

• One office visit, one cleaning, one set of x-rays and one fluoride treatment (per state fiscal year)
• Simple tooth pulling
• Surgical tooth pulling (if Medicaid approves it first)
• Fillings
• One set of dentures (per lifetime)
• Complete dentures do not require Medicaid approval
• Partial dentures do require Medicaid approval

It’s up to you to make sure Medicaid will pay for other dental care if you need it.

ConnectCare - Dental Coordinated Care

ConnectCare services include Dental Coordinated Care.

The Dental Coordinated Care helpline is available Monday through Friday from 8:00 am to 4:30 pm to help with the following:

• Answer dental benefit questions
• Find a Medicaid dentist or dental specialist
• Schedule dental appointments
• Schedule rides to dental appointments (Medicaid and ARKids First A only)
• Dental appointment reminders
• Reschedule dental appointments
• Spanish interpretation available (for Dental Coordinated Care services)

For more information about dental care:
Call the Dental Coordinated Care helpline 1-800-322-5580 (TDD: 1-800-285-1131).

To get a list of Medicaid dentists or dental specialists in your area:

• Call the Dental Coordinated Care helpline 1-800-322-5580 (TDD: 1-800-285-1131)

OR

• Go to the Medicaid website - Find a Medicaid Provider
  • Under Specialty, select dental or the dental specialty that you may need. For example, Oral Surgeon

Who do I call if I have a problem with Medicaid eligibilty, lost Medicaid card, or DHS problems?

You may call Client assistance at 1-800-482-8988.