Content updated 12/16/16
Although the Health Care Independence Program (often referred to as the Private Option) is ending, Arkansas has received approval for “Arkansas Works.” Arkansas Works will provide the same type of healthcare coverage and will cover the same benefit categories.
Arkansas Works begins January 1st, 2017. The majority of Medicaid beneficiaries in Arkansas Works will not see any change to their coverage for 2017. Below are high-level changes that might drive questions by patients to their providers:
- Arkansas Works will continue to use premium assistance to purchase Qualified Health Plans (QHP) offered through the individual market in the Marketplace for those eligible for expanded coverage.
- Beneficiaries who have access to cost-effective small group employer sponsored insurance (ESI) coverage will be required to enroll with their employers’ ESI if their small group employer has already enrolled with Arkansas Works. Arkansas Medicaid will ensure that the ESI plan complies with federal requirements for cost effectiveness and benefits and will wrap cost sharing to Medicaid allowable limits.
- In 2017, a $13 monthly premium will be charged to the enrollees who have household incomes above 100% of the Federal Poverty Level (FPL) and are also in a QHP/ESI. In subsequent years, enrollees will be required to pay a monthly premium of up to 2% of their household income.
- If an enrollee does not pay their premium, they will not lose eligibility but will accrue a debt to the state.
- The premium payment will be paid to the QHP carrier or to their employer if they are in an ESI.
- Beneficiaries who are determined to be below 100% FPL will not have a premium obligation.