The Arkansas Health and Opportunity for Me (ARHOME) program is the state’s specific approach to expanding Medicaid coverage to low-income adults. This program provides comprehensive healthcare benefits by using federal and state funds to purchase private health insurance plans for eligible residents. ARHOME ensures that the state’s working-age population has access to healthcare through the established infrastructure of the commercial health insurance market. This mechanism aims to offer a seamless transition for individuals whose income may fluctuate, potentially moving them between Medicaid eligibility and subsidized Marketplace coverage.
Defining ARHOME and Its Operating Model
ARHOME is the current iteration of Arkansas’s unique Medicaid expansion model, which began as the “Private Option” in 2013. This model operates under a Section 1115 Demonstration Waiver from the federal Centers for Medicare and Medicaid Services (CMS), allowing the state to deviate from traditional Medicaid structures. The program’s foundational premise is a premium assistance model, which directs Medicaid funds to subsidize the purchase of commercial health insurance.
Instead of enrolling beneficiaries directly into a state-run Medicaid managed care program, the state buys Qualified Health Plans (QHPs) from private carriers on the Health Insurance Marketplace. The state typically purchases silver-level plans to cover the eligible population. This strategy is intended to integrate the Medicaid expansion population into the same health plans and provider networks used by other private insurance consumers.
The state makes monthly capitated payments to the private insurers to cover the premiums for the ARHOME members. This approach is designed to foster continuity of care and better health outcomes. ARHOME also incorporates new initiatives, such as the Life360 HOMEs, which focus on addressing social determinants of health for specific target groups, including high-risk pregnant women and rural residents.
Who Qualifies for ARHOME Coverage
Eligibility for ARHOME is based on specific criteria tied to residency, age, and income, targeting the Affordable Care Act’s expansion population. Applicants must be Arkansas residents between the ages of 19 and 64. Applicants cannot be eligible for Medicare, which covers most individuals aged 65 and older or those with certain disabilities.
The primary financial requirement is that an individual’s Modified Adjusted Gross Income (MAGI) must be at or below 138% of the Federal Poverty Level (FPL). For instance, a single adult may qualify with an annual income up to approximately $21,597. This income threshold ensures the program covers low-income working adults who do not qualify for other categories of traditional Medicaid.
Individuals already covered by traditional Medicaid pathways, such as those who are elderly, disabled, or pregnant, are not eligible for ARHOME. This program is designed to fill the coverage gap for able-bodied adults who would not have qualified for Medicaid prior to the ACA expansion. The state performs an annual redetermination to confirm that all members continue to meet these requirements.
Essential Health Benefits and Member Costs
The private health plans purchased through ARHOME are required to cover the ten categories of Essential Health Benefits (EHBs) mandated by the ACA. This comprehensive coverage includes hospitalization, ambulatory patient services, prescription drugs, mental health services, maternity care, and preventive services.
The financial responsibility for ARHOME members is designed to be affordable, especially for those with the lowest incomes. Individuals with household incomes at or below 100% of the FPL have no cost-sharing obligations, paying no premiums, copayments, or deductibles. Those with incomes between 100% and 138% of the FPL may be subject to low-cost copayments and potentially a small monthly premium, depending on state guidelines.
The total amount an ARHOME member may pay out-of-pocket for premiums and copayments is capped at 5% of their household income per quarter. This ceiling ensures that healthcare costs do not become a significant financial burden. Because coverage is provided by private Qualified Health Plans, members access care through the plan’s commercial network of doctors and hospitals.
Navigating the Enrollment Process
Prospective ARHOME applicants can begin the enrollment process through the state’s online portal, Access Arkansas, which is the most efficient application method. Applications can also be submitted in person at a local Department of Human Services (DHS) county office, by phone, or via mail.
Applicants must provide documentation to verify their income, residency status, and citizenship or lawful presence in the United States. This documentation helps the state determine eligibility based on the Modified Adjusted Gross Income rules. Assistance is available through DHS staff, certified application counselors, or navigators.
Once the application is submitted, it undergoes a review process. Once approved, the individual is enrolled in a private QHP chosen by the state, and coverage becomes active. Members are then issued a health insurance card from the private carrier to use when accessing medical services.