In 2013, Arkansas opted to expand healthcare coverage to low-income adults earning below 138 percent of the federal poverty level (FPL) through the Patient Protection and Affordable Care Act (ACA). Rather than pursue expanded healthcare coverage through the state’s traditional Medicaid fee-for-service program, Arkansas sought and received approval from the Centers for Medicare and Medicaid Services (CMS) for a Section 1115 demonstration waiver under the Social Security Act (Section 1115 waiver) to expand coverage through premium assistance. The program, now known as Arkansas Works, used federal funds allotted for Medicaid expansion under the ACA to purchase qualified health plans (QHPs) available in the Health Insurance Marketplace (HIM).
Since its initial approval in 2013 and renewal in 2016, the program has experienced various modifications in response to legislative amendments, including the introduction of health independence accounts (HIAs) to incorporate personal responsibility, limitations on use of non-emergency transportation, premium payments for individuals earning between 101 and 138 percent of the FPL, and most recently and significant, adding a work requirement as a condition of eligibility.
As the first state to implement a work requirement, Arkansas will now test — as the waiver application states — “innovative approaches to promoting personal responsibility and work, encouraging movement up the economic ladder, and facilitating transitions between Arkansas Works, employer-sponsored insurance, and the Marketplace for Arkansas Works employees.”