Issue Spotlight: Gubernatorial candidates on future of Arkansas’ Medicaid expansion 

When Medicaid was created in 1965, it was only for parents of young children and people with disabilities. The Affordable Care Act allowed states to expand coverage, and in 2013, Arkansas became the first state to use a hybrid expansion model that purchases private health insurance for low-income people with federal funds. 

The federal waiver for Arkansas’ program, originally known as the Private Option and now called Arkansas Health and Opportunity for Me, or ARHOME, expires on Dec. 31. 

The state has asked the Centers for Medicare and Medicaid Services to keep Arkansas’ expansion valid for two more years to give the state time to develop a new program.  

Here’s what Arkansas’ three gubernatorial candidates said about how they would tackle this issue if they win November’s election:

Libertarian Colt Shelby 

Colt Shelby said the governor should take a lead role in ensuring Arkansas’ version of Medicaid expansion is extended indefinitely. The program is critical to providing more than 200,000 Arkansans healthcare, and that coverage is “a crucial lifeline” for rural hospitals, he said.

Shelby said every Medicaid program needs to be evaluated, and as governor, he would create a team to reform Arkansas Medicaid.

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Shelby said in an email that the federal government “has to give flexibility with Medicaid to better address our specific health care needs.”

“We have to stop trying to copy and paste things that are not working,” he wrote.

BlueCross BlueShield provides three of ARHOME’s six plans. Centene Corporation, who provides the other three plans, has announced it will stop participating in the program next year. 

Supporting Arkansas’ Medicaid expansion includes bringing additional carriers into the marketplace, Shelby said. 

“Our Governor should work to help expand healthcare coverage and to support our rural healthcare providers and not be a consistent roadblock,” he said. “I will not tolerate the current cronies and the current political profiteers to determine health care.”

Shelby said he would ask big corporations to hire full-time employees instead of having people work less than 40 hours “so they can avoid insurance.” Additionally, Shelby said he would focus on a one-on-one program to identify the workforce and connect them to good-paying jobs that provide healthcare, which would avoid the need for Medicaid coverage.

“I would root out any abuse in the system and build more accountability to make sure those billing Medicaid are playing by the rules,” he said. 

Democratic Sen. Fred Love

State Sen. Fred Love said cutting Arkansans off Medicaid is the quickest way to close more maternity wards and rural hospitals, an issue the state is already struggling with. Hospitals depend on Medicaid funding to stay open, especially in communities where there isn’t another payer source available, he said.

“We’ve been down this road before,” Love said in an email. “That’s exactly why Arkansas adopted the Private Option in 2013 and 2014, to reduce uncompensated care and prevent hospitals from collapsing under the weight of unpaid medical bills.”

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The Trump and Sanders administrations have offered “no serious alternative” to Medicaid expansion, Love said. Their response to Arkansas mothers and families amounts to saying “You’re on your own. Figure it out,” he said. 

“This isn’t a healthcare plan. It’s an abandonment of responsibility,” Love said. “The quality of life as we know it will decline, when mothers who are in labor have to drive 50-100 miles to the nearest hospital to deliver their baby.”

Less than a third of Arkansas counties have hospitals with labor and delivery units, which sometimes results in women giving birth in ambulances during the long drive to the nearest facility.

As governor, Love said would prioritize keeping all Arkansans safe and with the best quality of life possible.

“The first thing we must do is, elect officials who actually care about Arkansans, not just by saying they do, but show it with actions,” he said. “Having a state surplus isn’t doing us any good, if lives are at risk.”

Republican Gov. Sarah Huckabee Sanders

In response to questions about how she would address Medicaid expansion, Sanders’ campaign manager referred the Advocate to a letter Department of Human Services Secretary Janet Mann sent to the Centers for Medicare and Medicaid Services earlier this month. 

In the letter, Mann notes the program’s rejection was due to a 2025 federal law imposing budget neutrality, which requires ARHOME to not cost the federal government more than would be projected without the program. 

Mann requests a two-year extension of Arkansas’ current program waiver to provide sufficient time to wind down the existing program while developing and implementing a new system. Mann said she believed the extension is a “prudent step” that will allow officials to work with state lawmakers to develop a solution. 

“Helping capable individuals transition off the sidelines so we can focus resources on those truly in need remains a top priority,” Mann wrote. “Shifting to a new program on the same day we initiate the new work requirement policy could distract from those efforts.”

When Sanders took office in 2023, the state sought federal approval for requiring able-bodied Medicaid recipients to work, volunteer, attend school or have dependent children in order to remain eligible. Officials said Medicaid expansion enrollees who didn’t meet the requirement would not lose coverage. The state sought another work requirement waiver in 2025.

Arkansas was the first state to impose work requirements on Medicaid expansion, and more than 18,000 Arkansans lost coverage before a federal judge blocked the policy in 2019. 

Arkansas is preparing to implement work requirements for Medicaid expansion mandated by the federal One Big Beautiful Bill Act signed by President Donald Trump last year.