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Demonstration Waiver Projects —
Public Notice and Input Processes for 1115(a) Demonstration Waiver Applications/Renewals/
Amendments/Public Hearings

Waiver Projects Currently Undergoing Application, Renewal, or Amendment

Purpose of this Webpage

In accordance with federal and state law, the Division of Medical Services (DMS) of the Arkansas Department of Human Services (DHS) must notify the public of its intent to submit to the Centers for Medicare and Medicaid Services (CMS) any new 1115 demonstration waiver project or extension renewal or amendment to any previously approved demonstration waiver project [i.e., HIFA, TEFRA, Women’s Health (family planning)] and must make available at least a 30-day public comment period at minimum 30 days prior to submitting to CMS the new 1115 demonstration waiver project or extension renewal or amendment.

Public notices, including the description of the new 1115 Demonstration Waiver project or, extension renewal or amendment to an existing demonstration waiver project to be submitted to CMS, will be posted here along with links to the full public notice and the application/extension/amendment document to be submitted to CMS.

The full public notices will include

  • the address, telephone number and internet address where copies of the new demonstration waiver project or extension or amendment document is available for public review and comment,
  • the postal address where written comments can be sent,
  • the minimum 30-day time period in which comments will be accepted,
  • the locations, dates and times of at least two public hearings convened by the State to seek input, (At least one of the two required public hearings will use telephonic and/or Web conference capabilities to ensure statewide accessibility to the public hearing.)
  • and a link to the CMS website to access comments (HTML, new window) received by CMS during their 30-day public comment period after the application/extension/amendment has been submitted to CMS.

Comments may be provided during scheduled public hearings or in writing during the public comment period. To submit comments, write to

Division of Medical Services
Program Development and Quality Assurance
P.O. Box 1437 (Slot S295)
Little Rock, Arkansas 72203-1437

Locations, dates and times for public hearings will be published on the upcoming public hearings page of this website.

If you need this material in an alternative format, such as large print, please contact the Program Development and Quality Assurance Unit at 501-320-6429.

Arkansas Works 1115 Demonstration Waiver Public Notice and Amended Application

Added 5/19/17
View or print the amended application to be submitted to CMS for Arkansas Works 1115 Demonstration Waiver. (PDF, new window)

Public Notice

Added 6/16/17
View or print public comments regarding the Arkansas Works demonstration waiver amended application. (PDF, new window)

Added 6/13/17
View or print the Arkansas Works Public Hearing Presentation. (PDF, new window)

Added 5/19/17
View or print the public notice regarding the request to amend Arkansas Works Demonstration Waiver. (PDF, new window)

The Arkansas Department of Human Services (DHS), Division of Medical Services (DMS) is providing public notice of its intent to submit to the Centers of Medicare and Medicaid Services (CMS) a written request to amend the Arkansas Works 1115 Demonstration waiver and to hold public hearings to receive comments on the amendments to the Demonstration.

The State will request amendments to the Arkansas Works 1115 Demonstration waiver to: (1) limit income eligibility for individuals in the eligibility group found at Section 1902(a)(10)(A)(i)(VIII) of the Social Security Act (hereinafter “the new adult group”) to less than or equal to 100 percent of the federal poverty level (FPL) as of January 1, 2018; (2) institute work requirements as a condition of Arkansas Works eligibility as of January 1, 2018; (3) eliminate the Arkansas Works employer-sponsored insurance (ESI) premium assistance program on December 31, 2017; and (4) implement its waiver of retroactive eligibility on or after July 1, 2017.

With this amendment, on January 1, 2018, the State will limit income eligibility for individuals in the new adult group to less than or equal to 100 percent of the FPL, including the 5 percent income disregard required for the purposes of determining income eligibility based on modified adjusted gross income (MAGI) standards. The change in the eligibility limit will apply to both Arkansas Works enrollees and medically frail individuals covered under the State’s fee-for-service Medicaid program. When members of the new adult group have their first eligibility redetermination or submit a change in circumstances after January 1, 2018, those determined to have an income above 100 percent of the FPL will no longer be eligible for Arkansas Works or Medicaid fee-for-service coverage. Individuals may enroll in qualified health plans (QHPs) supported by federal tax credits, or, for those individuals with access to ESI, may enroll in ESI.

Beginning on January 1, 2018, the State will institute work requirements as a condition of Arkansas Works eligibility. Once work requirements are fully implemented, all Arkansas Works enrollees who are ages 19-49 must work or engage in specified educational, job training, or job search activities for at least 80 hours per month to remain covered through Arkansas Works, unless they meet exemption criteria established by the State. Arkansas Works enrollees who are subject to work requirements will be required to demonstrate that they are meeting the work requirements on a monthly basis. Arkansas Works enrollees who fail to meet the work requirements for any three months during a plan year will be disenrolled from Arkansas Works and will not be permitted to re-enroll until the following plan year. Individuals who experience a catastrophic event will be exempt from work requirements.

Under this amendment, the State will also eliminate its ESI premium assistance program under the Demonstration on December 31, 2017. As of January 1, 2018, all Arkansas Works beneficiaries who were enrolled in ESI premium assistance and who remain eligible for Arkansas Works will transition to QHP coverage.

Finally, as part of this amendment, the State will modify the terms and conditions associated with implementing its waiver of retroactive eligibility. Beginning on or after July 1, 2017, the State will no longer provide retroactive coverage to the new adult group, including both Arkansas Works enrollees and medically frail individuals covered through the State’s fee-for-service Medicaid program. Coverage will be effective as of the first day of the month that an individual applies for coverage.

The State will request the following waivers to implement the changes to the Demonstration:

  • § 1902(a)(10)(B): To enable the State to phase out demonstration eligibility for individuals with incomes above 100 percent of the FPL.
  • § 1902(a)(3): To enable the State to prohibit re-enrollment for the remainder of the calendar year for individuals disenrolled from coverage for failing to meet work requirements.

In addition, the State will request to modify its existing waivers to reflect that it: will no longer operate an ESI premium assistance program under the Demonstration; will limit income eligibility for the new adult group to 100 percent of the FPL; and plans to implement its waiver of retroactive eligibility by modifying the current terms and conditions to remove language on the enrollment backlog, reasonable opportunity, and hospital presumptive eligibility. Specifically, the State will request the following changes:

  • § 1902(a)(23)(A): To enable Arkansas to limit beneficiaries’ freedom of choice among providers to the providers participating in the network of the Arkansas Works beneficiary’s QHP. No waiver of freedom of choice is authorized for family planning providers.
  • § 1902(a)(13) and § 1902(a)(30): To permit Arkansas to provide for payment to providers equal to the market-based rates determined by the QHP.
  • § 1902(a)(14) insofar as it incorporates § 1916 and § 1916A: To enable the State to collect monthly premiums for individuals with incomes above 100 percent of the FPL who remain enrolled in the Demonstration.
  • § 1902(a)(10)(B): To enable the State to impose targeted cost sharing on individuals in the eligibility group found at § 1902(a)(10)(A)(i)(VIII) of the Act with incomes above 100 percent of the FPL who remain enrolled in the Demonstration.
  • § 1902(a)(34): To enable the state to not provide retroactive eligibility for the affected populations; current conditions related to the enrollment backlog, reasonable opportunity, and hospital presumptive eligibility will no longer apply.

The State will seek to eliminate the following waiver and expenditure authorities related to its ESI premium assistance program:

Waiver
  • § 1902(a)(4) insofar as it incorporates 42 CFR 431.53: To relieve the State of its obligation to provide non-emergency medical transportation to and from providers for individuals who are enrolled in employer-sponsored insurance and have not demonstrated a need for such transportation.

Expenditure Authorities

  • Premium Assistance Payments for Employer-Sponsored Insurance. Expenditures for the employee share of cost-effective small group employer-sponsored insurance when the employer contributes at least 25 percent of the overall cost of the coverage for individuals enrolled in the new adult group described in Section 1902(a)(10)(A)(i)(VIII) of the Act, that would not meet the requirements for premium assistance under the state plan.
  • Employer Incentives for New Or Expanded Employer-Sponsored Insurance: Expenditures for the employer share of cost-effective small group employer-sponsored insurance attributable to individuals receiving premium assistance under Demonstration expenditure authority #2 [Premium Assistance Payments for Employer-Sponsored Insurance], to the extent that the remaining employer contribution is no less than 25 percent of the overall cost of the coverage, limited to a three year period per employer and only for employers who either (1) offer coverage effective on or after January 1, 2017 and had not offered coverage in calendar year 2016 or (2) offer non-grandfathered small group coverage effective on or after January 1, 2017 and had previously offered only grandfathered coverage.

The State continues to evaluate whether it will request other waivers or expenditure authorities.

The amendments to the Demonstration will further the objectives of Title XIX by providing continuity and smoothing the “seams” across the continuum of coverage, improving provider access, and promoting independence through employment.

These amendments will be statewide and will operate from calendar years 2018 through 2021, with the exception of the waiver of retroactive eligibility that will be implemented on or after July 1, 2017. The State anticipates that this amendment will affect most of the approximately 280,000 individuals covered under the Demonstration.

The Demonstration, including the proposed amendments, will test hypotheses related to access to care, quality of care, churning, cost-comparability, the elimination of retroactive coverage, and the impact of work requirements. The State expects that, over the life of the Demonstration, covering Arkansas Works enrollees will be comparable to what the costs would have been for covering the same group of Arkansas adults using traditional Medicaid. The State does not anticipate that the amendments to the Demonstration will affect its current waiver trend rate or per capita cost estimates, which can be found below.

Mandatory Enrollment Group Trend Demonstration Year (DY) 4 (2017) - Per Member Per Month (PMPM) DY 5 (2018)- PMPM DY 6 (2019)- PMPM DY 7 (2020)- PMPM DY 8 (2021)- PMPM
New Adult Group 4.7% $570.50 $597.32 $625.39 $654.79 $685.56

View or print the amended application to be submitted to CMS for Arkansas Works 1115 Demonstration Waiver. (PDF, new window)

The Demonstration application may also be viewed from 8 AM – 4:30 PM Monday through Friday at:
Arkansas Department of Human Services
700 Main Street
Little Rock, AR 72201
Contact: Becky Murphy

Public comments may be submitted until midnight on Sunday, June 18, 2017. Comments may be submitted by email to hciw@arkansas.gov or by regular mail to
PO Box 1437, S-295,
Little Rock, AR 72203-1437.

View comments that others have submitted
Comments may also be viewed from 8 AM – 4:30 PM Monday through Friday at:
Arkansas Department of Human Services
700 Main Street
Little Rock, AR 72201
Contact: Becky Murphy

The State held two public hearings during the public comment period.

Arkansas Works Waiver Amendment Public Hearing
May 25, 2017
5:30 pm – 7:30 pm CDT
Central Arkansas Main Library
Little Rock
Darragh Center Auditorium
100 S. Rock St
Little Rock, AR 72201

Webinar: May 25, 2017 at 5:30 pm CDT.

Arkansas Works Waiver Amendment Public Hearing
June 6, 2017
5:30 pm – 7:30 pm CDT
Arkansas State University in Jonesboro
Cooper Alumni Center
2600 Alumni Blvd.
Jonesboro, AR 72401

Webinar: June 6, 2017 at 5:30 pm CDT.

Tax Equity and Fiscal Responsibility Act (TEFRA) 1115 (a) Demonstration Waiver Extension Renewal Application

Updated 9/18/17
Arkansas is submitting an extension renewal request to the Centers for Medicare and Medicaid Services (CMS) for a three-year extension renewal of its TEFRA-like 1115 demonstration waiver. A second 30-day comment period has been extended an additional 10 days (September 8 – October 17, 2017.)

All comments MUST be submitted no later than October 17, 2017. Comments may be provided in writing to:
Division of Medical Services
Office of Policy Development
700 South Main Street
PO Box 1437, S-295
Little Rock, AR 72203-1437

or by email to becky.murphy@dhs.arkansas.gov

Document File Name File Size
TEFRA Supporting Documentation TEFRARenewalSupportDoc.doc 95k
Attachment B – Narrative Summary for the Initial TEFRA-like Demonstration TEFRAAttachB.pdf 1MB
Attachment C – Other Health Insurance Coverage TEFRAAttachC.pdf 567k
Attachment D – Newspaper Notices of Public Input Hearings TEFRAAttachD.pdf 606k
Attachment E – Website Posting for Notice of Public Input Hearings TEFRAAttachE.pdf 596k
Attachment F – Hot Springs Public Hearing Transcript TEFRAAttachF.pdf 583k
Attachment G – Little Rock Public Hearing Transcript TEFRAAttachG.pdf 669k
Attachment H – State's Response to Special Terms and Conditions TEFRAAttachH.pdf 459k
Attachment I – Beneficiary Satisfaction Survey Report TEFRAAttachI.pdf 4MB
Attachment J – Renewal Evaluation Design TEFRAAttachJ.pdf 847k
Attachment K – Evaluation Design Plan postings on the Medicaid website TEFRAAttachK.pdf 2.5MBk
Attachment L –  Interim Evaluation Report TEFRAAttachL.pdf 1MB
Attachment M – Financial/Cost Neutrality TEFRAAttachM.xls 46k
Attachment N – Clippings of Copies of Comprehensive Public Notices Run in Newspaper TEFRAAttachN.pdf 384k

TEFRA Demonstration Waiver Public Notices

To view or print a document, click a link below.