Arkansas Submits 1115 Waiver Request With Medicaid Work Requirements

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On January 28, Arkansas a Section 1115 waiver amendment request to establish work requirements for the state’s Medicaid expansion-eligible individuals ages 19 to 64 with incomes at or below 138 percent of the federal poverty level who are covered by a qualified health plan (QHP). (Also see the from Arkansas Gov. Huckabee Sanders to the HHS Secretary nominee, Robert F. Kennedy, Jr.)

Implementation of Arkansas’ previous work requirements (approved in 2018 under the first Trump Administration) resulted in significant coverage losses and was halted in 2019 as a result of , then ultimately rescinded by the Biden Administration.The waiver amendment proposes a modified approach to work requirements in an effort to address legal challenges and respond to program criticism.

Unlike most prior work requirements waivers, individuals would not be required to work a minimum number of hours per month; rather, they would have three months to demonstrate that they are “on track” to employment or other qualifying service activities through participation in mandatory care coordination activities, referred to as “Success Coaching.”

Individuals who decline to participate in or fail to cooperate with Success Coaching would have their QHP premium assistance and cost sharing support—but not their Medicaid eligibility—suspended through the end of the calendar year. Although not expressly discussed in the application, it appears these individuals would revert to the Medicaid fee-for-service program.

The next step is for CMS to open a 30-day period for public comments. If approved, Arkansas’ waiver amendment, as well as any future waivers that impose work requirements, are likely to face legal challenges. Under federal law, Section 1115 waivers are approvable only if they promote Medicaid objectives—a standard the HHS General Counsel said in a December 2024 could not be met for work requirements.

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