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CMS verbally confirmed its denial of the waiver enabling Arkansas’ Medicaid expansion program, the Arkansas Health and Opportunity for Me program, leaving more than 200,000 residents in limbo amid this developing Arkansas ARHOME Medicaid waiver denial.
How the Arkansas ARHOME Medicaid Waiver Denial Was Confirmed
Republican Gov. Sarah Huckabee Sanders’ office confirmed the update to Becker’s Aug. 4. The governor is expecting a formal notice in writing shortly. This verbal confirmation ahead of official written notice suggests the situation remains fluid, with specific procedural details likely to follow once CMS issues its formal documentation.
Why CMS Denied the Waiver
A spokesperson for the Arkansas Department of Human Services told Becker’s the denial was due to the ARHOME waiver not complying with upcoming budget neutrality rules from HR 1. This regulatory compliance issue, rather than a policy disagreement over program design, appears to be the specific mechanism driving this denial.
What’s at Stake in This Arkansas ARHOME Medicaid Waiver Denial
The current waiver expires at the end of 2026. As of July 1, about 202,000 people were enrolled in ARHOME, meaning a substantial share of the state’s Medicaid expansion population now faces uncertainty about their coverage’s future beyond the current waiver period.
Ongoing Talks About a Temporary Extension
The governor’s administration is in talks with CMS about temporarily extending ARHOME to ensure a smooth transition as legislators decide next steps. “Looking ahead to the next legislative session, CMS has provided the state with an opportunity for bold, conservative healthcare reform, and the governor will work with her partners in the legislature to build a sustainable model that maintains the same high quality of care and saves taxpayer dollars,” a spokesperson from the governor’s office said.
ARHOME’s History Behind This Arkansas ARHOME Medicaid Waiver Denial
In 2022, ARHOME replaced Arkansas Works, the previous expansion program. The state established ARHOME through a section 1115 waiver, which requires periodic renewal approval, rather than a state plan amendment. This waiver-based structure, requiring periodic CMS renewal rather than a more permanent state plan amendment, is precisely what has left the program vulnerable to a denial like this one.
State Officials’ Response to the Denial
“We look forward to robust discussions with a wide range of partners as we develop the next evolution of this program in a way that is functional, practical and sustainable,” the DHS spokesperson told Becker’s. “While it’s too early to know specifics of how this new approach will look, our commitment to connecting eligible Arkansans to effective healthcare will remain our guiding principle at the core of this work.”
How Insurers Are Responding to the Arkansas ARHOME Medicaid Waiver Denial
Arkansas Blue Cross and Blue Shield and Centene’s Ambetter provide insurance through ARHOME. “Arkansas Blue Cross and Blue Shield remains committed to working closely with the Arkansas Department of Human Services and all stakeholders to ensure the ARHOME program continues to provide access to healthcare for eligible citizens of Arkansas in 2027 and beyond,” the insurer said.
Awaiting Further Comment
Becker’s contacted Ambetter and will update this story if more information becomes available, leaving one of the two insurers involved in the program yet to formally weigh in on the denial’s implications for its Arkansas members.
What This Arkansas ARHOME Medicaid Waiver Denial Means Going Forward
With the current waiver set to expire at the end of 2026 and CMS characterizing this as an opportunity for “bold, conservative healthcare reform,” Arkansas lawmakers will need to develop and pass a replacement or renewal framework during the next legislative session to avoid a coverage gap for the roughly 202,000 residents currently enrolled. Given that the denial stems specifically from HR 1 budget neutrality compliance issues, other states operating similar Medicaid expansion waivers may want to review their own programs against these same federal budget rules to avoid facing comparable denials.
What to Watch Going Forward
As Arkansas officials await formal written notice from CMS and continue discussions about a temporary extension, industry observers will likely watch whether the state secures bridge coverage to prevent disruption for current ARHOME enrollees while legislators develop a longer-term replacement program. Given that both Arkansas Blue Cross and Blue Shield and Centene’s Ambetter have a direct stake in the outcome, this Arkansas ARHOME Medicaid waiver denial may also serve as an early test case for how other states’ Section 1115 Medicaid expansion waivers fare under HR 1’s budget neutrality requirements going forward.
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