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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

Proposed Extension of the Health Care Independence Program 1115 Waiver

Proposed Extension of the Health Care Independence Program 1115 Waiver

Public Notice

Added 12/1/15
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 application to request the extension of its 1115 demonstration waiver and to hold public hearings to receive comments on this extension request.

The State will request an extension of its 1115 demonstration waiver (the “Demonstration”). 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).

The State anticipates submitting an application to amend the Demonstration in Spring of 2016 to replace the Health Care Independence Program implemented under the current 1115 waiver authority with a program reflecting the features now under consideration by the Governor, the Arkansas Legislative Task Force on Healthcare Reform, and the Arkansas Legislature.

Under the current Demonstration, the State uses premium assistance to purchase 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 (collectively “Health Care Independence Program beneficiaries”). Individuals who are medically frail do not participate in the Demonstration. Health Care Independence Program beneficiaries currently receive the Alternative Benefit Plan (ABP) through a QHP that they select and have cost sharing obligations consistent with both the State Plan and with the cost-sharing rules applicable to individuals with comparable incomes in the Marketplace.

Preliminary evidence indicates that the current Demonstration has furthered the objectives of Title XIX by promoting continuity of coverage for individuals, improving access to providers, smoothing the “seams” across the continuum of coverage, and furthering quality improvement and delivery system reform initiatives. The current Demonstration provides integrated coverage for low-income Arkansans, leveraging the efficiencies of the private market to improve continuity, access, and quality for Health Care Independence Program beneficiaries. Additionally, by greatly expanding the size of the population enrolling in QHPs offered through the Marketplace, the Demonstration is driving health care system reform and more competitive premium pricing for all individuals purchasing coverage through the Marketplace.

The Demonstration is and will remain statewide. Approximately 225,000 individuals have received coverage through the Demonstration. The State expects that roughly the same number of individuals will remain covered under the Demonstration after extension. To date, it has cost less to cover the populations enrolled through the Demonstration that it otherwise would have cost to cover them through the standard Medicaid program.

Throughout the period of the extension, the Demonstration will continue to test hypotheses related to provider access, churning, emergency room use, cost-comparability, usage of Medicaid wrap benefits, quality improvement, preventive services, and uncompensated care costs.

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

  • Waiver of § 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; 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 who are not current with their Independence Account payments.
  • Waiver of § 1902(a)(23): To the extent necessary to enable Arkansas to limit beneficiaries’ freedom of choice among providers to the providers participating in the network of the Health Care Independence Program beneficiary’s Qualified Health Plan.
  • Waiver of § 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 providing primary coverage for services under the Demonstration.
  • Waiver of § 1902(a)(54) insofar as it incorporates § 1927(d)(5): To permit Arkansas to require that requests for prior authorization for drugs be addressed within 72 hours, rather than 24 hours as is currently required in their state policy. A 72- hour supply of the requested medication will be provided in the event of an emergency.
  • Waiver of § 1902(a)(14) insofar as it incorporates § 1916 and § 1916A: To the extent necessary to enable the state to collect monthly contributions for individuals with incomes between 50 and 133 percent of the federal poverty level (FPL).
  • Expenditure Authority for Premium Assistance and Cost-Sharing Reduction Payments: To make 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.

The State may request additional waivers in its subsequent waiver amendment to reflect changes to the Demonstration currently under consideration by the Governor, the Arkansas Legislative Task Force on Healthcare Reform, and the Arkansas Legislature.

The complete version of the current draft of the extension application is available for public review below.

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 December 31, 2015. Comments may be provided during scheduled public hearings or in writing during the public comment period. To submit comments, email hciw@arkansas.gov or write to

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

You may also view comments submitted by others below.

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 will host two public hearings during the public comment period.

December 2, 2015 – 5:30-7:30pm
Central Arkansas Library System: Main Library
East Room
100 S Rock St
Little Rock, AR 72201

Individuals may access the hearing on December 2nd by webinar. To participate by webinar, please register at: https://attendee.gotowebinar.com/register/7648526510036286466 (HTML, new window)

December 8, 2015 – 2-4pm
Division of Agriculture Research & Extension
2301 S. University Ave
Little Rock, AR 72204

Individuals may access the hearing on December 8th by webinar. To participate by webinar, please register at: https://attendee.gotowebinar.com/register/931366983882912770 (HTML, new window)

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.

View or print the proposed 1115 Waiver Extension Application. (PDF, new window)

View or print public comments regarding the 1115 Waiver Extension Application. (PDF, new window)