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ARKANSAS DEPARTMENT OF HUMAN SERVICES TEFRA and AUTISM WAIVER Application for Assistance If you need this material in a different format, such as large print, please contact your local DHS county.

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How to fill out the AR DCO-9700 online

This guide provides a clear, user-friendly approach to filling out the AR DCO-9700 form online. Designed to assist users regardless of their legal expertise, it breaks down each section to simplify the application process for assistance programs.

Follow the steps to successfully complete the AR DCO-9700 online.

  1. Click ‘Get Form’ button to access the AR DCO-9700 and open it in the online editor.
  2. Begin by selecting the type of services you are requesting, such as Autism Waiver or TEFRA. Indicate the preferred option clearly.
  3. Enter the child's name and date of birth in the designated fields, ensuring accuracy to avoid processing issues.
  4. Provide the child’s age in years and months, and specify if the child is a U.S. citizen by selecting 'Yes' or 'No.'
  5. Fill in the demographic information including race, parent or guardian name, current address, city, state, zip code, phone, county, and email address.
  6. Answer the questions regarding the child’s income, resources, and health insurance. If applicable, detail the income sources and amounts.
  7. Provide the primary care physician's name and the date of autism diagnosis if applicable. Confirm if you expect any changes in the above information.
  8. If applying for TEFRA, attach the most recent Federal Income Tax Return and list the number of household dependents.
  9. For Autism Waiver applications, ensure to include evaluation reports from relevant healthcare professionals as specified.
  10. Review all entered information for accuracy, then save the form. You can download, print, or share the completed document as needed.

Complete your AR DCO-9700 form online today to ensure timely processing of your assistance request.

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Who is eligible? A child must meet all of the following: 1. Child is under age 19 years [NOTE: Beginning at age 18, the person usually doesn't need TEFRA, since parent income is no longer counted if the youth is disabled.]

2022 Federal Poverty Level Guidelines Person in household100%150%113,59020,385218,31027,465323,03034,545427,75041,6254 more rows

The Tax Equity and Fiscal Responsibility Act (TEFRA) is a Medicaid program that can help families with children younger than 19 years old who have a disability receive care in their homes rather than an institution. The TEFRA program can help pay for the cost of those services for eligible children.

The purpose of the Autism Waiver is to provide one-on-one, intensive early intervention treatment for beneficiaries ages eighteen (18) months through seven (7) years with a diagnosis of Autism Spectrum Disorder (ASD) . The waiver participants must meet the ICF/IID level of care and have a diagnosis of ASD.

Tax Equity and Fiscal Responsibility Act (TEFRA) | PLEXIS Healthcare Systems.

The child must have a medical condition that would require institutional placement in a hospital, a skilled nursing facility, an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), an Alternative Home placement, or be at risk for future institutional placement.

To apply online, please visit the Access Arkansas online application portal. You may also find out if you qualify through the Marketplace application. To learn more about the program, please visit the Arkansas Medicaid page....Arkansas Medicaid Program? Household Size*Maximum Income Level (Per Year)1$19,3922$26,2283$33,0644$39,9004 more rows

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