Arkansas seeks 2-year reprieve for state's hybrid Medicaid expansion

Arkansas officials asked the federal government Wednesday to allow the state's hybrid Medicaid expansion to continue through the end of 2028 after the Trump administration denied its request to renew the program providing health coverage to more than 200,000 people.

Last week, the federal Centers for Medicare and Medicaid Services verbally rejected Arkansas' request to extend the waiver for Arkansas Health and Opportunity for Me, known as ARHOME, through the end of 2031. The current waiver expires Dec. 31.

DHS Secretary Janet Mann sent CMS a letter asking to keep ARHOME valid for two more years in order to give the state time to create and implement a new Medicaid program, agency spokesperson Gavin Lesnick said in an email.

"CMS has signaled it will support efforts to ensure a smooth transition, and DHS looks forward to productive discussions on the extension in the near future," Lesnick said.

Mann's letter notes that ARHOME's non-renewal resulted from the One Big Beautiful Bill Act of 2025. The law imposed new rules regarding budget neutrality, which requires ARHOME not cost the federal government more than would be projected without the program.

Medical providers and experts have expressed concern about the added costs an already strained Arkansas healthcare system could face without the expansion.

Extra time to work with lawmakers on a new Medicaid system will allow DHS to act "as both good caretakers of the eligible individuals who rely on our services and good stewards of the taxpayer dollars that finance our critical mission," Mann wrote.

Arkansas was the first Southern state to expand Medicaid under the Affordable Care Act, but used a first-in-the-nation model that used expansion funds to purchase private insurance for those eligible. Centene announced its upcoming withdrawal from the program last month, and Lesnick said Thursday that this change is unrelated to CMS rejecting ARHOME.

Republican legislative leaders said last week that they hoped CMS would give them time to determine whether to change the state Medicaid program to managed care, fee-for-service or another model.

Senate President Pro Tempore Bart Hester, a Cave Springs Republican, said he doesn't believe his colleagues will support continuing Medicaid expansion in next year's legislative session. Arkansas' Medicaid expansion program has faced multiple attempts to kill it or limit who can access it since it began in 2013.

The state has been preparing to roll out new requirements for the expansion that'll take effect next year under the One Big Beautiful Bill, with thousands expected to lose coverage because of the mandate.

Arkansas previously imposed work requirements on Medicaid expansion recipients in 2018, but a federal judge struck down the program after more than 18,000 Arkansans lost coverage.

"Helping capable individuals transition off the sidelines so we can focus resources on those truly in need remains a top priority," Mann wrote to CMS. "Shifting to a new program on the same day we initiate the new work requirement policy could distract from those efforts."

Camille Richoux, health policy director for Arkansas Advocates for Children and Families, said last week that losing Medicaid expansion would be "devastating" for Arkansas. Health experts have credited Arkansas' expansion for a drop in the state's uninsured rate and for a reduction in hospitals' costs for treating patients without insurance.

Richoux said in a Thursday statement that AACF supports the state's effort to seek extra time to change its Medicaid model.

"Taking the time to thoughtfully build and carefully transition to a new system is the best way to minimize disruptions in coverage, protect patients and Arkansas's larger health care system, and give state officials the opportunity to get this transition right," Richoux said.

A spokesperson for CMS said the agency does not comment on pending waiver requests.

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