Arkansas’ Medicaid expansion program, which provides health coverage to more than 200,000 low-income residents, could face significant changes depending on the outcome of the upcoming gubernatorial election. Each of the three candidates has outlined priorities for the program, officially known as Arkansas Health and Opportunity for Me (ARHOME), as its federal waiver is set to expire on December 31.
The Arkansas Department of Human Services (DHS) has requested a two-year extension of the program to provide time for designing a replacement. The program’s continuation has been complicated by issues of federal budget neutrality, a requirement that Medicaid not cost the federal government more than what would be spent without it. ARHOME, originally introduced in 2013 as the Private Option, uses federal funds to purchase private health insurance for low-income individuals.
Libertarian candidate Colt Shelby emphasized the importance of extending Medicaid expansion permanently, describing it as “a crucial lifeline” for rural hospitals. He stated his intent to evaluate all Medicaid programs and reform the state’s system through targeted efforts, including “rooting out abuse” and ensuring resources go to Arkansans in need. Shelby also called for greater flexibility from the federal government and bringing in more insurance carriers to bolster the marketplace. Additionally, he suggested incentivizing employers to offer full-time jobs with health benefits to reduce dependence on Medicaid.
Democratic State Senator Fred Love expressed strong support for maintaining Medicaid expansion to sustain rural hospitals and maternity care, warning that cutting off coverage would worsen the state’s healthcare challenges. “The quality of life as we know it will decline, when mothers who are in labor have to drive 50-100 miles to the nearest hospital to deliver their baby,” he said. Love noted that less than a third of the state’s counties have hospitals with labor and delivery services and cited Medicaid funding as a key factor in keeping such facilities operational. He criticized what he described as a lack of viable alternatives proposed by past administrations and pledged to prioritize the safety and quality of life for Arkansas residents.
Republican Governor Sarah Huckabee Sanders highlighted proposals to overhaul the program, including implementing work requirements for able-bodied Medicaid recipients. Under her administration, the state has sought federal approval to transition Medicaid expansion enrollees to a system that mandates employment, volunteering, schooling, or caregiving to remain eligible. In a letter sent earlier this month, DHS Secretary Janet Mann called the requested two-year waiver extension a “prudent step” to allow officials sufficient time to develop and implement a new plan. Arkansas was the first state in the nation to adopt work requirements for Medicaid expansion in 2018, but the policy was blocked by a federal judge the following year.
The federal government has yet to respond to Arkansas’ waiver request, leaving the future of ARHOME—and the healthcare of many families—uncertain. The decision, in part, rests with voters as they choose the state’s next governor in November.