UPDATED: Health insurer Centene to stop participating in Arkansas’ Medicaid expansion

Centene Corp., the parent company of multiple Arkansas health insurance plans, will stop participating in the state’s Medicaid expansion program next year, the Department of Human Services confirmed Monday.

Arkansas receives billions of federal dollars each year to fund and administer Medicaid, the low-cost insurance program for low-income people and people with disabilities. 

ARHOME, the state’s Medicaid expansion, currently provides six insurance plans with three from Centene and three from BlueCross Blue Shield. These qualified health plans serve low-income Arkansans between the ages of 19 and 64.

DHS will transfer enrollees in the three Centene plans — Ambetter, QCA Health Plan and QualChoice Life and Health — to other plans for which they are eligible, agency spokesperson Gavin Lesnick said Monday.

“No action is needed by beneficiaries at this time,” Lesnick said. “DHS will provide additional information on next steps, including open enrollment instructions, in the near future.”

BlueCross BlueShield’s three Medicaid expansion plans are Arkansas Blue Cross Blue Shield, Health Advantage and Octave.

After 13 years, ARHOME “is not sustainable for our continued participation in 2027” due to Centene’s “current funding challenges,” a spokesperson said in a Tuesday statement. The company’s insurance plans will still be available on the insurance marketplace.

Centene last month offered buyouts to most of its employees after seeing a drop in enrollees in individual coverage through the Affordable Care Act. 

About one-third of the more than 211,000 Arkansans in the ARHOME program are on Centene plans, Lesnick said.

Under ARHOME, the state pays healthcare providers for all Medicaid services that an enrollee needs under an insurance company’s managed care contract with DHS.

Arkansas has begun a ‘soft launch’ of Medicaid work requirements. What does that mean?

Arkansas Medicaid recipients who are not on ARHOME receive fee-for-service coverage, meaning the state pays healthcare providers directly for each service provided to a Medicaid beneficiary. More than 625,000 Arkansans are on Medicaid but not on an ARHOME plan, Lesnick said.

In 2013, Arkansas was the first Southern state to expand Medicaid under the Affordable Care Act. The state tried to implement work requirements for Medicaid recipients in 2018, and more than 18,000 Arkansans lost coverage before a federal judge blocked the policy in 2019. Arkansas instituted ARHOME without work requirements in 2021.

New work requirements will be reinstated next year under the One Big Beautiful Bill Act. Enrollees must complete 80 hours of work, community service, higher education, work programming or a combination of the four each month, unless they meet certain exemption criteria.

DHS began checking last week to ensure that Medicaid recipients are in compliance with the federal mandates in preparation for January. People who do not currently meet the requirements will maintain their coverage until then.