Arkansas Medicaid managed care runs through two programs that work very differently. ARHOME, short for Arkansas Health and Opportunity for Me, uses Medicaid dollars to buy private marketplace coverage for most expansion-eligible adults. PASSE, the Provider-Led Arkansas Shared Savings Entity program, is a full-risk managed care arrangement built for Medicaid members with serious behavioral health conditions or intellectual and developmental disabilities. The Division of Medical Services inside the Department of Human Services oversees both.1Arkansas Department of Human Services. Division of Medical Services Which program you land in determines your insurance card, your copays, how you change plans, and how you appeal a denial.
How ARHOME Covers You
ARHOME operates under a federal Section 1115 waiver that lets Arkansas use Medicaid funds as premium assistance.2Medicaid.gov. Arkansas Health and Opportunity for Me (ARHOME) You stay enrolled in Medicaid, but your actual coverage comes through a Qualified Health Plan sold on the Health Insurance Marketplace. In Arkansas, the two carriers are Blue Cross Blue Shield and Ambetter, the plan name Centene uses.3Arkansas Department of Human Services. ARHOME
These plans cover the ten essential health benefit categories required by the Affordable Care Act: outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance use treatment, prescription drugs, rehabilitative services, lab work, preventive care, and pediatric dental and vision.4Arkansas Department of Human Services. ARHOME Workers With Disabilities Transitional Medicaid Cost Sharing A few things that private plans don’t cover are supplied directly by Medicaid as wraparound benefits, including non-emergency medical transportation. Members who are 19 or 20 also get Early and Periodic Screening, Diagnosis, and Treatment services as a wraparound.5Arkansas Department of Human Services. Arkansas Health and Opportunity for Me Section 1115 Demonstration Project Application Summary
How PASSE Covers You
PASSE takes the opposite approach. Each PASSE is a managed care organization that receives a fixed monthly payment per member and takes on the risk of covering all of that person’s medical, behavioral health, and specialized developmental disability services. The program is authorized under the Medicaid Provider-Led Organized Care Act.6Justia. Arkansas Code 20-77-2701 – Title
The core service a PASSE delivers is care coordination. Every member is assigned a care coordinator who must make initial contact within 15 business days of enrollment, maintain monthly contact after that, and meet face-to-face at least once per quarter.7Arkansas Department of Human Services. Care Coordination and Person Centered Service Plan The coordinator builds a person-centered service plan, handles referrals and prior authorizations, and keeps your providers talking to each other. For a member with multiple specialists and therapists, that single point of contact is often the most useful part of the program.
Which Program Applies to You
ARHOME is mandatory for adults aged 19 to 64 whose income is above 16 percent but below 138 percent of the federal poverty level and who are not enrolled in Medicare.8Arkansas Department of Human Services. Overview of Significant Programs for DHS Beneficiaries If you fit, you’ll be placed in a QHP unless you qualify for an exemption.
The main exemption is being “medically frail.” If your health care needs would be disrupted by coverage through a private plan, you stay in traditional fee-for-service Medicaid instead.4Arkansas Department of Human Services. ARHOME Workers With Disabilities Transitional Medicaid Cost Sharing You can self-identify as medically frail during enrollment. Medically frail members also get an Alternative Benefit Plan that includes services QHPs don’t cover, such as personal care assistance and other long-term supports.5Arkansas Department of Human Services. Arkansas Health and Opportunity for Me Section 1115 Demonstration Project Application Summary
PASSE applies to Medicaid beneficiaries of any age with more intensive behavioral health or developmental disability needs. You may qualify if you receive services under the Community and Employment Support waiver (or sit on its wait list), live in a private Intermediate Care Facility for individuals with intellectual or developmental disabilities, or carry a behavioral health diagnosis that requires more than basic counseling and medication management.9Arkansas Department of Human Services. Provider-Led Arkansas Shared Savings Entity Detailed Fact Sheet An independent assessment produces a tier score; Tier 2 opens up intensive community-based services, and Tier 3 opens up the highest level of services, including residential support.10Arkansas Department of Human Services. ARIA Behavioral Health Tier Logic – Adults and Children
Several groups are kept out of PASSE even if their condition would otherwise qualify them: residents of a Human Development Center or skilled nursing facility, people enrolled in the ARChoices home and community-based services waiver, and people who are fully dual-eligible for Medicare and Medicaid.
Picking and Changing Your Plan
Under ARHOME, once you’re found eligible you have 42 days to pick a Blue Cross Blue Shield or Ambetter plan. If you don’t choose, DHS assigns one for you.5Arkansas Department of Human Services. Arkansas Health and Opportunity for Me Section 1115 Demonstration Project Application Summary
Federal managed care rules give you a free switch for the first 90 days following your initial enrollment or the date the state notified you of enrollment, whichever is later. No reason required. After that window, you’re generally locked in until the next annual open enrollment period, though you can still request a change for cause at any time. For-cause reasons include moving out of the plan’s service area, the plan refusing a service for moral or religious reasons, or inadequate access to covered services in the plan’s network.11eCFR. 42 CFR 438.56 – Disenrollment Requirements and Limitations
PASSE assignment doesn’t involve a choice at all. DHS uses an attribution formula that looks at your claims from the previous 12 months and places you with the PASSE whose network best matches your existing primary care, specialty, and pharmacy relationships. The weighting tilts toward your behavioral health and developmental disability specialists, since those are the hardest relationships to replace.12Arkansas Department of Human Services. Provider-Led Arkansas Shared Savings Entity (PASSE) Program Medicaid Provider Manual
What You’ll Pay
ARHOME members with income above 20 percent of the federal poverty level may owe small copays, either $4.70 or $9.40 depending on the service. The copays are capped quarterly, so once you hit the limit for a three-month period you owe nothing more until the next quarter.13Arkansas Department of Human Services. ARHOME Cost-Sharing Information
Several categories of care have no copay regardless of income: emergency care, preventive services, family planning, inpatient hospitalization, and pregnancy-related services. Some members never pay copays at all, including people below 20 percent of the federal poverty level, people in hospice, medically frail individuals, pregnant women, 19- and 20-year-olds, and American Indian or Alaska Native members.13Arkansas Department of Human Services. ARHOME Cost-Sharing Information
PASSE members have no cost-sharing. Medically frail members in fee-for-service Medicaid also pay no copays.5Arkansas Department of Human Services. Arkansas Health and Opportunity for Me Section 1115 Demonstration Project Application Summary
If Your Plan Denies a Service
Managed care plans deny, reduce, or terminate services. When yours does, you have two tracks: a grievance for complaints about customer service or access, and an appeal for actual coverage decisions.
A grievance covers things like long wait times, poor customer service, or trouble reaching a provider. You have 45 days from the event to file one with your PASSE, and the plan has 30 days to resolve it and send you a written answer.14Arkansas Department of Human Services. Medicaid Administrative Reconsiderations and Appeals
An appeal is for an adverse action: a denied service, a reduction in services you already receive, or a refusal to pay a claim. You, your guardian, or your provider can file it. Standard appeals must be resolved within 30 calendar days. If waiting that long could seriously harm your health, you or your provider can request an expedited appeal, which must be resolved within 72 hours.15eCFR. 42 CFR 438.408 – Resolution and Notification – Grievances and Appeals
Pay attention to this timing detail. If your plan sends notice that it is cutting or ending a service you already receive, and you file your appeal before the effective date in that notice, the plan generally has to keep providing the service while your appeal is pending.14Arkansas Department of Human Services. Medicaid Administrative Reconsiderations and Appeals Wait until after the effective date, and you lose that protection. The clock starts the day the notice arrives.
If the internal appeal doesn’t go your way, the written resolution must tell you how to request a state fair hearing.14Arkansas Department of Human Services. Medicaid Administrative Reconsiderations and Appeals A fair hearing is an independent administrative proceeding under the Arkansas Administrative Procedure Act, conducted by a neutral decision-maker rather than the plan that denied you.
Work Requirements Coming to ARHOME
Starting July 1, 2026, DHS will begin a soft implementation of work and community engagement requirements for ARHOME. Healthy adults in the program will need to work, volunteer, or attend school for at least 20 hours per week, or 80 hours per month.16Arkansas Department of Human Services. DHS to Launch Soft Implementation of Work and Community Engagement Requirement Starting July 1
No one loses coverage during 2026. DHS will run automated compliance checks and notify beneficiaries where they stand so people can adjust. The hard deadline is January 1, 2027. After that date, a non-exempt beneficiary who isn’t meeting the requirement will get 30 days to come into compliance before benefits are suspended.16Arkansas Department of Human Services. DHS to Launch Soft Implementation of Work and Community Engagement Requirement Starting July 1
Federal law defines community engagement broadly: working, enrolling in an educational program, completing community service, participating in a work program, or any combination.17Medicaid.gov. CMCS Informational Bulletin – Section 71119 of the Working Families Tax Cut Legislation The requirement applies only to the adult expansion population under the income-based eligibility group. PASSE members, medically frail individuals, and other exempt populations are not covered by it. If you’re on ARHOME now, watch for DHS notices through the second half of 2026 even though penalties haven’t started.
What’s Changing in the Waiver
The current ARHOME Section 1115 waiver expires December 31, 2026.2Medicaid.gov. Arkansas Health and Opportunity for Me (ARHOME) DHS has submitted a renewal for a new demonstration period beginning January 1, 2027. Beyond the work requirement, the proposal would raise the minimum Medical Loss Ratio for QHP carriers from 80 to 85 percent, require QHPs to send pharmacy rebates to the state, and expand the Life360 HOME care coordination program so Federally Qualified Health Centers and other Medicaid providers can participate alongside hospitals. DHS has also proposed voluntary success coaching services beginning July 1, 2028, aimed at connecting beneficiaries at risk of long-term poverty with employment, education, and training; declining would carry no penalty.18Arkansas Department of Human Services. ARHOME Demonstration Project Public Notice – Waiver Renewal CMS still has to act on the renewal, so the final shape of the program for 2027 and beyond is not yet set.