HJAR Jul/Aug 2021

26 JUL / AUG 2021 I  HEALTHCARE JOURNAL OF ARKANSAS POLICY COLUMN POLICY EIGHT YEARS AGO, Arkansas became the first Southern state to opt to extend health- care coverage to more of its low-income population under the Medicaid expansion provisions of the federal Patient Protection and Affordable Care Act. Instead of simply adding to the state’s Medicaid roles, Arkan- sas created an innovative program using mostly federal funds to purchase private health insurance for Arkansans earning up to 138% of the federal poverty level. The program, which currently provides cover- age to more than 300,000 Arkansans, has evolved over the years; it is now poised to enter a new iteration, to be known as Ar- kansas Health and Opportunity for Me, or ARHOME. TheArkansas General Assembly approved enabling legislation this year for ARHOME, which will take effect next year, pending fed- eral approval. Legislators also mustered the required three-fourths majority vote in each chamber to approve funding for the of this year. With a work and community engagement requirement as a condition of enrollment no longer an option, ARHOME proposes instead to incentivize enrollees to work. A person who fails to meet work or other cri- teria would not lose coverage but could be moved to the traditional fee-for-services Medicaid program. The criteria that enroll- ees must meet to maintain private health insurance coverage are not listed in theAR- HOME legislation, but they will have to be spelled out in the state’s request for a federal Medicaid waiver authorizing the program. Sponsoring legislators have said the criteria will align with the work requirement of the Supplemental NutritionAssistance Program, which calls for most recipients to work or attend school or work training. As with the Medicaid program in general, the waiver is a partnership between the state and federal governments, and federal feedback on this proposal is yet to come. program, as they have every year since 2013 despite sometimes tough political fights. The programwill continue to use federal Medic- aid dollars to provide healthcare coverage to low-income adults through a premium as- sistance model, and the federal government will continue to pay 90% of the program’s costs, but ARHOME will introduce several new features. The General Assembly approved the ARHOME legislation less than a month after the Biden administration rescinded approval of Arkansas’ work and commu- nity engagement requirement for Medicaid expansion enrollees. The requirement was phased in beginning in June 2018, with the approval of the Trump administration, but a federal judge’s order halted the require- ment in March 2019, by which time more than 18,000 people had lost coverage due to noncompliance. The state was appealing the judge’s ruling when federal approval for the requirement was withdrawn in March ARHOME TheNext Phase ofMedicaid Expansion inArkansas