The Arkansas Department of Human Services building on Main Street in downtown Little Rock. (Photo by John Sykes/Arkansas Advocate)
In a state led by Republicans who have often portrayed social services as handouts that keep people in poverty, Arkansas’ Medicaid expansion program has faced multiple attempts to kill it or limit who can access it.
More than 837,000 Arkansans are on Medicaid, the federally-funded, low-cost insurance program for low-income people and people with disabilities. More than 211,000 Arkansans are enrolled in the expansion known as Arkansas Health and Opportunity for Me, or ARHOME.
When Medicaid began in 1965, it was exclusively for parents of young children and people with disabilities. The Affordable Care Act of 2010, also known as Obamacare, required states to expand Medicaid to cover all adults with low incomes up to 138% of the federal poverty level. That amounts to about $20,780 for an individual.
The U.S. Supreme Court ruled in 2012 that Medicaid expansion was optional. Today, 40 states and the District of Columbia have expanded Medicaid while 10 states have repeatedly resisted.
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Arkansas’ Medicaid expansion system faces an upcoming challenge, since one of the insurance companies supporting the system is about to back out.
Arkansas is also among a handful of states with a trigger law to end the expansion program if federal funding for Medicaid is reduced.
How does ARHOME work?
Arkansas in 2013 became not only the first Southern state to expand Medicaid, but also the first state to use a hybrid expansion model that purchases private health insurance for low-income people with federal funds.
The state pays healthcare providers for all Medicaid services that an enrollee needs under an insurance company’s managed care contract with the state Department of Human Services.
Centene Corp. provides three of the six ARHOME plans, and BlueCross BlueShield provides the other three. These qualified health plans serve low-income Arkansans between the ages of 19 and 64.
Centene announced earlier this month that it will withdraw from ARHOME in 2027. Anything that reduces the number of payment sources for patients strains the healthcare system, said University of Arkansas for Medical Sciences Chancellor C. Lowry Barnes.
Medicaid expansion meant only 1% of UAMS’ patients were self-paying for a time, but that percentage has been increasing, Barnes said.
Why is Centene leaving ARHOME?
After 13 years, ARHOME “is not sustainable for our continued participation in 2027” due to Centene’s “current funding challenges,” a spokesperson said July 7.
In June, Centene offered buyouts to most of its employees after seeing a drop in enrollees in individual coverage through the ACA.
The Department of Human Services will transfer enrollees on Centene’s three plans to other plans for which they are eligible, agency spokesperson Gavin Lesnick said. DHS does not require any action from Centene enrollees.
What is Medicaid expansion’s history in Arkansas?
The name of Arkansas’ expansion, formerly called the private option and later Arkansas Works, has changed, but the concept hasn’t.
The expansion came up for a vote when Arkansas’ government was divided, with Republicans holding a majority in the Legislature and Democrat Mike Beebe in the governor’s office.
Supporters of the hybrid model called it a conservative alternative to the expansion model under the federal health overhaul.
Republicans won the governor’s office and expanded their majorities in 2014 with several lawmakers running on a promise to kill Medicaid expansion.
Opponents did not have the votes to kill the program in 2015. But the proposal faced an uphill battle over the years in getting the three-fourths vote needed to reauthorize it.
That dynamic prompted a bizarre gimmick in 2016, when supporters of expansion wrote a provision into the Medicaid budget that would have ended the program. Republican Gov. Asa Hutchinson, an advocate of keeping the expansion, vetoed that part of the budget bill.
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Arkansas was also the first state to impose work requirements on Medicaid expansion, one of 13 states to receive permission for such a mandate during President Donald Trump’s first administration.
More than 18,000 Arkansans lost coverage before a federal judge blocked the policy in 2019. The state launched ARHOME without work requirements on Jan. 1, 2022.
Critics have said the requirements did not lead to an increase in employment and led to an increase in uninsured in the state. A 2019 New England Journal of Medicine study backed up this criticism, and a 2023 Congressional Budget Office analysis of proposed federal Medicaid work requirements cited Arkansas as proof the proposal would not work.
In 2023, the state asked the federal Centers for Medicare and Medicaid Services for permission to require able-bodied ARHOME recipients to work, volunteer, attend school or have dependent children in order to remain eligible for Medicaid expansion. The state submitted a similar request in 2025.
Those who did not meet the work requirements would have received fee-for-service Medicaid instead of losing coverage entirely.
What federal changes to Medicaid are coming up?
The federal tax and spending legislation known as the One Big Beautiful Bill Act of 2025 overrode state-level Medicaid work requirement requests by implementing its own mandate that will go into effect Jan. 1, 2027.
Final Rules for Medicaid Work Requirements Are Out. Here’s What You Need To Know.
Medicaid expansion enrollees will have to complete 80 hours of work, community service, higher education, work programming or a combination of the four each month, unless they meet certain exemption criteria.
On July 1, DHS began checking to ensure that Medicaid recipients are in compliance with the federal mandates in preparation for January. People who do not currently meet the requirements will maintain their coverage until then.
The six-month window will be used to test the department’s “automated process” for verifying eligibility and compliance with the new work requirements and prepare for full implementation, Lesnick said.
Arkansas is among the states that would see the smallest declines in Medicaid enrollment under strict state-level implementation of the work mandate, but 37% to 46% of enrollees could still lose coverage by 2028, according to a March report from the Urban Institute.
Courtesy of Arkansas Advocate
