Arkansas to seek ARHOME work requirement waiver

The state of Arkansas will ask the Biden administration for a waiver allowing it to require Medicaid expansion beneficiaries to work. Unlike the state’s previous attempt at a work requirement, they would move to traditional Medicaid if they chose not to.

Gov. Sarah Huckabee Sanders announced the waiver request in a press conference Wednesday (Feb. 15).

She said ARHOME recipients would be required to work, go to school or volunteer in order to continue receiving the benefits. Otherwise, they would be shifted to traditional Medicaid.

The move would require a waiver amendment approval from the federal Centers for Medicare and Medicaid Services. Department of Human Services Director Kristi Putnam said that amendment was expected to be published for a 30-day public comment period on April 23 and then formally submitted on June 1. The proposed effective date is Jan. 1, 2024.

At the end of December, 345,085 Arkansans were enrolled in the ARHOME program, which is the state’s Medicaid expansion program created under the Affordable Care Act, otherwise known as Obamacare.

Instead of enrolling recipients in traditional Medicaid, the state, under Gov. Mike Beebe, in 2013 created a unique program where private insurance policies would cover them.

Households with incomes up to 138% of the federal poverty level are eligible. For a one-person family, that’s about $18,000, Putnam said.

Under Gov. Asa Hutchinson, Arkansas instituted a requirement for some Medicaid recipients to work at least 80 hours a month or engage in education or community service activities. Those who didn’t participate lost their healthcare coverage. A federal judge in 2019 disallowed that requirement. At the time, the program was known as “Arkansas Works.”

Sanders said her waiver request differs from that one because beneficiaries who don’t work would be moved to traditional Medicaid, not dropped from the rolls. She said she expects the waiver request to be approved.

“By making this innovation, we are complying with past court rulings and ensuring our plan can actually go into effect while still maintaining the same goal, which is moving Arkansas from government dependency to prosperity,” she said.

The federal government pays 90% of the cost of the Medicaid expansion program, while it pays about 70-77% of the traditional Medicaid fee-for-service program. However, in this scenario, state Medicaid officials said the enhanced match rate of 90% would still apply for the eligibility category regardless of the payment model.

Putnam said DHS officials have not determined how the waiver if approved would affect the budget. She expects the number of beneficiaries who will leave the ARHOME program to be “minimal.”

She said exemptions would be provided for certain individuals, but those have yet to be determined.

ARHOME, or Arkansas Health and Opportunity for Me, is the latest version of the Medicaid expansion program. Created by Act 530 of 2021, it includes Life360 HOMEs with extra support for women with high-risk pregnancies, rural individuals with mental illness or substance abuse issues, and young adults at risk of long-term poverty and poor health outcomes.

Putnam said current ARHOME participants would have a reason to stay in the program rather than move to traditional Medicaid because of the support provided by the Life360s. She said they can be connected to social service resources and more active case coordination that goes beyond basic health care needs.

Sanders said the move would help address Arkansas’ workforce challenges. Industry groups have told her they can’t find enough workers. She noted that she has launched other initiatives to address the issue, including her Arkansas LEARNS education platform and her creation of the Governor’s Workforce Cabinet and chief workforce officer.

“However, Arkansas is still too far behind in making sure that able-bodied citizens are working, and we’ve got to get more people off the sidelines and in the game,” she said.

Putnam said DHS would work with the Workforce Cabinet and chief workforce officer to integrate the initiative with the state’s other workforce efforts.

Sen. Missy Irvin, R-Mountain View, the Senate sponsor of Act 530 of 2021, expressed support for Sanders’ waiver request.

“I think this actually fits perfectly with the Life360 HOME concept of really surrounding that person with all types of opportunities for them to grow as a person and to help them with better outcomes both in their health, but also their outcome in life,” she said.

She said the cost would be offset by people being involved in meaningful work. She said many individuals don’t stay on the program for long.