1115 Medicaid Waivers in Arkansas
On March 5, 2018, CMS approved Arkansas’ request to add a work requirement to its Medicaid program. CMS did not approve the state’s request to cut expansion eligibility down to 100 percent of poverty (a “partial expansion”). Implementation of the work reporting requirements began June 1, 2018. On August 14, 2019, a lawsuit was filed in federal court to challenge CMS’s approval of the waiver. Between September 2018 and December 2018, over 18,000 people lost Medicaid coverage due to the work reporting requirements.
On March 27, 2019, the federal district court blocked CMS’s approval of the waiver and the state suspended the work requirement component of its Medicaid program. On April 10, 2019, the Trump administration filed a notice of appeal to challenge the federal district court’s ruling. The U.S. Court of Appeals for the District of Columbia Circuit heard oral arguments on October 11, 2019.
The Arkansas Works program began January 1, 2014 and is approved through December 31, 2021. The state was granted an amendment to its original waiver in December, 2016 that made significant changes to the original waiver, including changing its name from the Arkansas Health Care Independence Program to Arkansas Works. On March 5, 2018 CMS approved Arkansas’ request to add a work requirement to its Medicaid program. CMS did not approve the state’s request to bring expansion eligibility down to 100 percent of poverty (a “partial expansion”).
- Families USA comments on Arkansas Works Waiver Amendment (2017)
- Families USA comments on Arkansas Health Care Independence Program Section 1115 waiver amendment (2014)
- View Federal Comments for All 1115 Medicaid Waivers (2013)
The Arkansas WORKS program covers childless adults in the Medicaid expansion population (19-64) who make less than 138 percent of the federal poverty level, or about $16,000 per year for a single person.
- Premium Assistance (Private Option)
- Impact on oral health
- Retroactive Coverage
- Health Savings Accounts
- Work Requirement
Premium Assistance (Private Option)
All enrollees must receive coverage through a private marketplace plan paid for by state Medicaid funds. This premium assistance program is also called the “private option.” CMS’s March 5 waiver approval did not include this request. Learn more and get advocacy strategies to combat the private option.
- Impact on Oral Health: Adults in the private marketplace plans do not receive dental benefits. In Arkansas’ regular Medicaid program, medically frail adults and adults who are not in the Medicaid expansion population receive limited dental benefits.
Arkansas has received approval to waive three months of retroactive eligibility. Learn more and get advocacy strategies to combat retroactive coverage.
Individuals with incomes above 50 percent of the federal poverty level are required to make monthly payments into an individual Health Independence Account (see below). Enrollee contributions are $5-$25 a month depending on income (no more than 2 percent of income). Nonpayment cannot result in disenrollment, but depending on the enrollee’s income, nonpayment can affect the enrollee’s cost-sharing or receipt of benefits, or it can create a collectable debt to the state. Learn more and get advocacy strategies to combat premiums.
Cost-sharing at the point of service applies when enrollees fail to make contributions to their Independence Account. Cost-sharing must be consistent with the state’s standard Medicaid plan. All out-of-pocket costs are capped at 5 percent of quarterly income. Learn more and get advocacy strategies to combat cost sharing.
Health Savings Accounts
Individual Health Independence Accounts are established for enrollees with incomes over 50 percent of poverty. Accounts are funded by the state and enrollee premium contributions and are used to pay cost-sharing. Enrollees who make at least six account payments in a calendar year receive account credits that can be used to offset future health insurance premiums when the individual is no longer enrolled in the Medicaid expansion program. Learn more and get advocacy strategies to combat HSAs.
Enrollees 19 to 49 must work or engage in specified job training or educational activities for 80 hours/month to retain eligibility unless they meet exemption criteria established by the state. Enrollees will have to demonstrate that they meet this requirement on a monthly basis. Enrollees who fail to meet the requirement for any three months during a plan year will be disenrolled from coverage until the following plan year. Learn more and get advocacy strategies to combat work requirements.