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State’s Public Notice and Input Processes for 1115 Demonstration Waiver Project Applications/Renewals/
Amendments/Public Hearings

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 below after scheduling is finalized.

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.

Page Contents

Arkansas Works 1115 Demonstration Waiver Application
Application to replace the Health Care Independence Program Demonstration with Arkansas Works

Arkansas Works 1115 Demonstration Waiver Application

Added 6/30/16
View or print the application submitted to CMS for Arkansas Works 1115 Demonstration Waiver. (PDF, new window)

Application to replace the Health Care Independence Program Demonstration with Arkansas Works

Public Notice

Added 5/19/16
The Arkansas Department of Human Services (DHS), Division of Medical Services (DMS) is providing public notice of its intent to submit to the Centers for Medicare and Medicaid Services (CMS) a written application requesting approval to replace the existing program authorized under Arkansas’s Health Care Independence Program Demonstration with Arkansas Works.

The current approved Demonstration is available from the Medicaid.gov website via the following link: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ar/ar-private-option-ca.pdf (PDF, new window).

Arkansas’s 1115 waiver demonstration (“Demonstration”) has been tremendously successful in furthering the objectives of Title XIX and improving the health insurance Marketplace for all Arkansans–particularly the 240,000 covered through the Demonstration–and Governor Asa Hutchinson and the Arkansas General Assembly have opted for a more innovative program that strengthens the individual premium assistance model by emphasizing personal responsibility, promoting work, and enhancing program integrity. To that end, Arkansas proposes to replace its current Health Care Independence Program when it expires on December 31, 2016 with Arkansas Works–a new approach to health coverage for Arkansans.

To implement Arkansas Works, the State will use premium assistance to purchase either cost-effective employer-sponsored insurance (ESI) or qualified health plans (QHPs) offered in the individual market through the Marketplace for individuals eligible for expanded coverage under Title XIX of the Social Security Act who are either (1) childless adults between the ages of 19 and 65 with incomes below 138% of the federal poverty level (FPL) who are not enrolled in Medicare or (2) parents between the ages of 19 and 65 with incomes between 17 and 138% FPL who are not enrolled in Medicare. Individuals in two groups—(1) those who are medically frail or (2) other individuals with exceptional medical needs for whom coverage through the Marketplace is determined to be impractical, overly complex, or would undermine continuity or effectiveness of care—will not participate in the Demonstration, unless they have access to cost-effective ESI and choose to receive the Alternative Benefit Plan (ABP). All individuals covered through the Demonstration are referred to as “Arkansas Works beneficiaries.”

Arkansas Works beneficiaries will receive the ABP through either their ESI or the QHP that they select. Arkansas Works beneficiaries with incomes above 100% FPL will continue to pay cost-sharing, consistent with the State Plan. Arkansas Works beneficiaries with incomes above 100% FPL will no longer be required to contribute to Independence Accounts; instead, they will be required to pay premiums, consistent with the premiums for populations with comparable incomes purchasing coverage through the Marketplace.

The Demonstration will further the objectives of Title XIX by promoting continuity of coverage for individuals (and in the longer run, families), improving access to providers, smoothing the “seams” across the continuum of coverage, and furthering quality improvement and delivery system reform initiatives. Additionally, the Demonstration will:

  • Encourage employer-based insurance;
  • Incentivize work and work opportunities;
  • Promote personal responsibility; and
  • Enhance program integrity.

The Demonstration will be statewide and will operate during calendar years 2017 through 2021. The State anticipates that approximately 272,000 individuals will enroll in the Demonstration by 2021. The State expects that, over the life of the Demonstration, covering Arkansas Works beneficiaries will be comparable to what the costs would have been for covering the same group of Arkansas adults using traditional Medicaid.

The Demonstration will test hypotheses related to access to care, quality of care, churning, cost-comparability, availability of ESI, incentive benefits, and the elimination of retroactive coverage.

The State will request the following waivers and expenditure authorities to operate the Demonstration:

Waivers

  • § 1902(a)(23)(A): To make premium assistance for QHPs in the Marketplace and for ESI mandatory for Demonstration enrollees and to permit the State to limit beneficiaries’ freedom of choice among providers to the providers participating in the network of the beneficiary’s QHP or ESI.
  • § 1902(a)(13) and § 1902(a)(30): To the extent necessary to permit Arkansas to provide for payment to providers equal to the market-based rates determined by the Qualified Health Plan or ESI providing primary coverage for services under Arkansas Works.
  • § 1902(a)(54) insofar as it incorporates Section 1927(d)(5): To permit the State to require that requests for prior authorization for drugs be addressed within 72 hours, rather than 24 hours. A 72-hour supply of the requested medication will be provided in the event of an emergency.
  • § 1902(a)(10)(B): To the extent necessary to enable the State to impose targeted cost sharing on individuals in the eligibility group found at Section 1902(a)(10)(A)(i)(VIII) of the Act.
  • § 1902(a)(14) insofar as it incorporates § 1916 and § 1916A: To the extent necessary to enable the State to collect monthly premiums for individuals with incomes between 100 and 138 percent of the federal poverty level (FPL).
  • § 1902(a)(34): To enable the State not to provide medical coverage to Arkansas Works beneficiaries for any time prior to the first day of the month in which an individual applies.
  • § 1902(a)(4) insofar as it incorporates 42 CFR § 431.53: To the extent necessary to relieve Arkansas of the requirement to assure transportation to and from medical providers for Arkansas Works beneficiaries enrolled in ESI premium assistance.

Expenditure Authorities

  • Premium Assistance and Cost Sharing Reduction Payments Expenditures. For part or all of the cost of private insurance premiums, and for payments to reduce cost sharing for certain individuals eligible under the approved State Plan new adult group described in section 1902(a)(10)(A)(i)(XVIII) of the Act.
  • ESI Premium Assistance Payments. To cover up to 75% of the cost of ESI premiums for individuals participating in the Arkansas Works ESI premium assistance program.
  • Limited-Purpose Health Credit Expenditures. To issue limited-purpose health credits to eligible enrollees who made a required number of contributions prior to Independence Account Termination.

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

The complete version of the current draft of the Demonstration application (PDF, new window) is available for public review as of Wednesday, May 18. The Demonstration application may also be viewed from 8 a.m. – 4:30 p.m. Monday through Friday at:

Arkansas Department of Human Services
700 Main Street
Little Rock, AR 72201
Contacts: Becky Murphy or Jean Hecker

Public comments may be submitted until midnight on June 17, 2016. 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 or print comments regarding the Arkansas Works Application that others have submitted. (PDF, new window) Comments may also be viewed from 8 a.m. – 4:30 p.m. Monday through Friday at:

Arkansas Department of Human Services
700 Main Street
Little Rock, AR 72201
Contacts: Becky Murphy or Jean Hecker

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

Little Rock
Thursday, May 26, 2016
11:00 a.m. – 1:00 p.m.
University of Arkansas Cooperative Extension Service
2301 S University Avenue
Little Rock, Arkansas, 72204

Individuals had access to the hearing by webinar at: https://attendee.gotowebinar.com/register/5714384405162657281 (HTML, new window)

Pine Bluff
Wednesday, June 1, 2016
5:30 – 7:30 p.m.
Jefferson Regional Medical Center
Classrooms J & R
1600 W 40th Avenue
Pine Bluff, Arkansas, 71603

Individuals had access to the hearing by webinar at: https://attendee.gotowebinar.com/register/3709682237634052353 (HTML, new window)