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Arkansas autism waiver application

TEFRA Application Form - Arkansas Department of Human 2026

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The document is an application for assistance from the Arkansas Department of Human Services, specifically for the TEFRA and Autism Waiver programs. It includes sections for personal information, income and resource details, health insurance status, and medical assessments required to determine eligibility for services. The document outlines necessary attachments such as medical evaluations and tax returns, privacy rights regarding personal health information, and instructions for completing the application process.

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Click ‘Get Form’ to open the TEFRA Application Form in our editor.
Begin by filling out the child's personal information, including their name, date of birth, and Social Security Number. Ensure accuracy as this information is crucial for eligibility.
Indicate whether the child has income or resources. If yes, provide details such as source and gross amount. This section helps determine financial eligibility.
Complete the health insurance section by indicating if the child has health insurance. If yes, attach a copy of the insurance card as required.
Fill in the primary care physician's information and any autism diagnosis details if applicable. This is essential for service provision.
Review all sections carefully before signing and dating the application at the end to confirm that all provided information is accurate.

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What is a DHS form 702 in Arkansas?

The DCO-702 is used by facilities to report to the DHS county office all Medicaid-related admissions, discharges, and transfers. The DCO-702 will be completed by facility staff and signed by the facility administrator as soon as possible after the admission or change in status of the patient.

Is TEFRA the same as Medicaid?

TEFRA is a Medicaid waiver program. It provides care to children with a disability in their own homes. Children cared for at home must have medical services available. TEFRA is run by the Division of Medical Services.

Who do I report DHS to in Arkansas?

If you suspect misconduct or have concerns but arent sure who to direct them to please use the DHS Integrity form below. You can make a report through the form and hotlines anonymously. Fraud Hotline for suspected fraud: Please call 1-(800)-422-6641 or email ContactDHSFraud@arkansas.gov.

What is a certificate of good standing in Arkansas?

The Arkansas Corporation Certificate of Good Standing is an official document issued by the Arkansas Secretary of States office that certifies that a corporation or other business entity is in good standing with the state.

How do you qualify for TEFRA?

In Minnesota, the TEFRA program is for children who require an institutional level of care. Children are eligible as a household of one up to 100% FPL or with an income spend-down, but without regard to parental income. Families may have to pay a monthly parental fee based on family size and income.

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How do I apply for TEFRA in Arkansas?

You can apply for the program by filling out the TEFRA application packet and submitting it to your local DHS county office. If you need help or have questions, feel free to call: 1-855-372-1084. Want to learn more about the program and process?

How do I upload documents to DHS Arkansas?

How to Upload Documents? Once you have logged in to your Access Arkansas account, click on Details for the case you want to upload the document for. If you dont see the case, please see section How to Link Your Case for more details. On the right-hand side of the screen click on Upload files.

What is an affidavit for collection of personal property in Arkansas?

An Arkansas small estate affidavit is used to collect the personal property of a person who died when the person had an estate valued at less than $100,000. It cannot be filed until 45 days have elapsed since the death.