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Timeline: Medicaid Expansion in Arkansas

At a press conference today, Feb. 16, Gov. Asa Hutchinson said he wanted to “debunk” the argument that supporting Arkansas Medicaid expansion also means support for the Affordable Care Act, a statement he called a “policy announcement.”

While he said he opposes the ACA, “we have to deal with the real world,” where more than 30 states, including Arkansas, have passed some form of Medicaid expansion.

Source: Kaiser Family Foundation

Source: Kaiser Family Foundation

“We should not punish Arkansans by denying health coverage simply because we are frustrated with Washington,” Hutchinson said.

“I hope that Washington replaces Obamacare, but, until then, we would only be punishing Arkansans by turning down federal money.”

Rejecting the federal dollars associated with Medicaid expansion would leave a more than $100 million gap in the state budget, he said.

The passage of ACA and Arkansas Medicaid expansion have been controversial from the start. Here’s a reminder of what has happened:

Timeline of Arkansas Medicaid Expansion

Obamacare’s Medicaid expansion presented states with a critical decision. The U.S. Supreme Court ruled that states did not have to accept it. But turning it down meant saying no to federal funds that could have helped low income populations get health coverage. Predictably, many blue states gladly took the money. Many red states (worried the federal funds would be temporary) rejected it.

Arkansas, with a Democratic governor (at the time) and a Republican Legislature, found a third way, one that is still unfolding.

Here is a timeline of major events in in Arkansas Medicaid expansion:

March 23, 2010

The Patient Protection and Affordable Care Act, often known as Obamacare, is signed into law. Among its many provisions, it calls for expanding eligibility for Medicaid (government health insurance for persons with low income) to a greater number of people.

June 28, 2012

The U.S. Supreme Court rules that states cannot be forced (by loss of all Medicaid funds) to participate in Obamacare’s Medicaid expansion provision. Each state must take up the issue of whether to participate.

April 23, 2013

Rather than accept or reject Medicaid expansion, then-Gov. Beebe works with the Arkansas Legislature to craft an alternative “private option.” Instead of expanding Medicaid, the state would use federal Medicaid expansion funds to help the newly eligible buy private insurance coverage. A number of other states have since followed Arkansas’s lead.

Sept. 27, 2013

The federal Centers for Medicare and Medicaid Service (CMS) approves Arkansas’s private option plan.

March 4, 2014

With only one vote to spare in the House, the Arkansas Legislature approves the private option for another year.

Dec. 31, 2014

Some 213,000 Arkansans have enrolled in the private option.

Feb. 5, 2015

The Arkansas Legislature approves private option funding through Dec. 31, 2016, on Gov. Asa Hutchinson’s recommendation, while also creating a task force to look at alternatives beyond 2016.

Dec. 29, 2015

Hutchinson sends a letter to Sylvia Burwell, secretary of the federal Department of Health and Human Services. It states that, in spring 2016, the governor anticipates sending a request to replace the private option with a new plan called Arkansas Works. It will require the newly eligible Medicaid populations to enroll in employer-sponsored insurance when possible, with expanded Medicaid funds being used for premium assistance. It will also incentivize healthy lifestyle choices and employment for those who are able. And, it will require cost sharing by those with incomes or assets beyond a certain threshold.


Details to be worked out for the new Arkansas Works program, planned to take effect in 2017. Hutchinson has said he plans to call a special legislative session to address the private option in 2016.

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