Arkansas Medicaid Work Requirements: ARHOME Rollout and 2027 Concerns

Arkansas Medicaid work requirements are returning under ARHOME, the state’s Medicaid expansion program, with a soft launch beginning July 1, 2026 and full enforcement starting January 1, 2027. Enrollees ages 19 to 64 will need to work, volunteer, or attend school at least 80 hours a month — 20 hours a week — unless they qualify for an exemption. The rules stem from a federal mandate signed into law on July 4, 2025, and they apply to roughly 217,000 Arkansans currently covered through ARHOME.¹

Who Has to Meet the Requirement

The rule applies to ARHOME enrollees between the ages of 19 and 64. To stay covered, you’ll need to log at least 80 hours per month of qualifying activity: paid work, volunteering, or school.²

Several groups are exempt. Arkansas’s implementation lists pregnant and postpartum women, disabled veterans, caregivers, and people with special medical needs.² The federal law layered on additional mandatory exemptions: parents and caretakers of children 13 and under, pregnant and postpartum individuals, and people considered “medically frail,” which includes disabilities, substance use disorders, disabling mental health conditions, and serious or complex medical conditions. States can also grant short-term hardship exceptions.³

ARHOME itself covers adults ages 19 to 64 with household incomes at or below 138 percent of the federal poverty level. Coverage is delivered through private plans from Blue Cross Blue Shield or Ambetter, paid for by Medicaid.⁴

The Rollout Timeline

Arkansas is running the program in two phases.

The soft launch begins July 1, 2026. During this phase, the Department of Human Services will run automated checks to determine whether enrollees are working, meeting the requirement another way, or exempt. Notices will go out, but no one loses coverage during the soft launch.⁵

Full enforcement starts January 1, 2027. If DHS can’t confirm you meet the requirement, you’ll get a notice and have 30 days to demonstrate compliance. If you don’t, your Medicaid benefits will be suspended.¹ Suspension is not the same as termination; the state’s design allows benefits to be restored once a person engages, though noncompliance can keep benefits suspended through the end of the calendar year.⁴

One boundary worth knowing: under the federal law, if you lose Medicaid because of the work requirement, you’re also barred from receiving premium tax credits on the ACA Marketplace.³ That closes off the usual fallback for people who fall off Medicaid.

Compliance will be reevaluated every six months once the program is fully operational.⁵

How Reporting Works This Time

Most enrollees won’t need to file monthly paperwork. DHS plans to verify compliance through data matching, cross-referencing wage records and SNAP enrollment data it already has. If the state can confirm you’re working or qualify for an exemption, no action is required on your part.⁵

If your compliance can’t be confirmed automatically, the state is standing up a call center to gather more information, and you’ll be able to report activities by phone, online, or in person at a local DHS county office.⁵ That’s the biggest change from the 2018 version of the program, which required online-only reporting through a portal in a state with limited broadband access.⁶

Under the state’s earlier “Pathway to Prosperity” design, enrollees flagged as not on track would be paired with a “Success Coach” to build a personal development plan rather than facing immediate disenrollment.⁴ DHS is still awaiting final federal implementation guidance, expected by June 2026.⁵

What Happened the First Time

Arkansas was the first state in the country to condition Medicaid on work, launching the requirement in June 2018 under a program then called Arkansas Works. It targeted beneficiaries ages 30 to 49 and required 80 hours a month of work or qualifying activity, with exemptions for pregnancy, disability, full-time school, caregiving, and substance abuse treatment.⁶

By early 2019, more than 18,000 people had lost Medicaid coverage. That was roughly one in four of those subject to the requirements, and 89 percent of the disenrolled remained unenrolled months later.⁷ Research later showed that more than 95 percent of the target population was already working or should have qualified for an exemption, meaning the losses were driven by administrative barriers and not by refusal to work.⁸

A Harvard-led study in Health Affairs tracked what happened to those who lost coverage. About half reported serious problems paying medical bills, with median medical debt of $1,001 compared to zero for those who kept coverage; 56 percent delayed needed care because of cost; and 64 percent delayed filling prescriptions.⁸ The uninsured rate among low-income adults ages 30 to 49 in Arkansas rose from 10.5 percent in 2016 to 14.5 percent in 2018.⁹ The same study found no increase in employment, hours worked, or community engagement over an 18-month follow-up.

A federal judge blocked the program in March 2019, and the D.C. Circuit affirmed that ruling in February 2020. The Supreme Court later dismissed the case as moot after the Biden administration rescinded the waiver approvals.¹⁰¹¹ The legal question of whether Medicaid work requirements are permissible was never resolved on the merits.

Why the Federal Rule Now Applies

On July 4, 2025, President Trump signed the “One Big, Beautiful Bill,” a budget reconciliation package containing the first federal mandate requiring Medicaid work requirements. It conditions Medicaid eligibility for adults in the ACA expansion group on completing 80 hours a month of work or qualifying activity, effective January 1, 2027.³

Arkansas had already filed its own waiver — the “Pathway to Prosperity” proposal announced by Governor Sarah Huckabee Sanders in January 2025 — but the federal law effectively superseded the state-level process.¹²¹

Concerns Heading Into 2027

Arkansas Advocates for Children and Families has opposed the requirements since 2023, calling them a “misguided policy” and pointing out that 97 percent of people who lost coverage in 2018 were either already complying or eligible for an exemption.¹² AACF has also flagged concerns about administrative capacity: 72 percent of current Medicaid disenrollments in Arkansas are procedural, driven by missing paperwork rather than actual ineligibility, and more than one in five applications already takes longer than 30 days to process.¹³

A June 2025 Milbank Memorial Fund analysis identified specific implementation problems from 2018 that outreach in the new program will need to address. Insurers estimated that only 10 to 15 percent of first-class mail reached enrollees, communications were written above the reading level of the population they targeted, and many people did not realize they were in a Medicaid-related program at all. Limited internet access, transportation, and untreated chronic health conditions further blocked compliance.¹⁰

What to Do If You’re on ARHOME

If you’re currently enrolled in ARHOME, check whether you fall into one of the exempt categories: pregnant or postpartum, parent or caretaker of a child 13 or under, disabled veteran, caregiver, or medically frail. If you don’t, plan to have 80 hours a month of work, school, or volunteer activity in place before enforcement begins in January 2027. Watch for notices from DHS during the soft launch that starts July 1, 2026 — they’ll tell you whether the state can already confirm your compliance or whether you need to report activities through the call center, online, or at a county office. Keep your contact information current with DHS. If you receive a notice of noncompliance after January 1, 2027, you have 30 days to respond before benefits are suspended.

1
Arkansas Department of Human Services. DHS to Launch Soft Implementation of Work and Community Engagement Requirement
2
Arkansas Department of Human Services. ARHOME Community Engagement and Work Requirement
3
Kaiser Family Foundation. A Closer Look at the Work Requirement Provisions in the 2025 Federal Budget Reconciliation Law
4
Medicaid.gov. ARHOME Pathway to Prosperity Demonstration
5
Arkansas Advocate. Arkansas to Soft-Launch Upcoming Medicaid Work Requirement Checks
6
New England Journal of Medicine. Association of Medicaid Work Requirements With Health Insurance Coverage
7
Kaiser Family Foundation. An Overview of Medicaid Work Requirements
8
Health Affairs. Medicaid Work Requirements in Arkansas: Two-Year Impacts
9
Center on Budget and Policy Priorities. States’ Experiences Confirm Harmful Effects of Medicaid Work Requirements
10
Milbank Memorial Fund. Lessons Learned From Arkansas’s Experience With a Medicaid Work Requirement
11
U.S. Supreme Court. Becerra v. Gresham, No. 20-37
12
Arkansas Advocate. Arkansas Files Again for Medicaid Work Requirement Waiver
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Arkansas Advocates for Children and Families. What’s Going on With Arkansas’s Medicaid Work Requirement Proposal