More than 200,000 low-income Arkansans could see changes to their health coverage next year after the Trump administration declined to renew Arkansas’ long-running Medicaid expansion waiver under its current terms. The state’s ARHOME program uses federal Medicaid funding to purchase private health insurance for eligible adults, a model Arkansas has operated since 2013.
The Centers for Medicare & Medicaid Services has raised concerns that the 13-year-old waiver does not meet stricter federal “budget neutrality” requirements taking effect in 2027. Arkansas had requested a five-year renewal but is now seeking a two-year extension while officials work with CMS on a new arrangement. The current waiver is scheduled to expire Dec. 31, 2026.
The decision could have consequences beyond Arkansas. Nearly every state operates at least one Medicaid waiver, and federal officials are now applying tighter rules to new and renewed demonstrations. Arkansas officials say they intend to maintain expanded Medicaid coverage, but beneficiaries could eventually face changes in insurers, provider access, or how their coverage is delivered.
