What Does ARHOME Medicaid Cover? Benefits, Costs, and Eligibility

ARHOME Medicaid covers doctor visits, hospital care, prescription drugs, mental and behavioral health services, maternity care, and preventive care through a private health plan from Arkansas Blue Cross Blue Shield, Ambetter, or QualChoice, with limited adult dental and additional Medicaid-only benefits like non-emergency transportation layered on top. Most enrollees pay nothing for premiums and face only small copays, if any.

ARHOME, short for Arkansas Health and Opportunity for Me, is the state’s Medicaid expansion program for adults ages 19 to 64 with household income at or below 138 percent of the federal poverty level. Instead of enrolling you directly in Medicaid, the Arkansas Department of Human Services uses Medicaid dollars to buy you a private qualified health plan.¹

Medical and Hospital Care

Your ARHOME plan pays for inpatient and outpatient hospital services, physician and specialist visits, emergency room care, lab work and X-rays, preventive care and immunizations, and ambulatory surgical center services. Wellness exams and other preventive services are covered at no cost to you.²³

Prescription Drugs

Each ARHOME plan runs its own pharmacy benefit. Arkansas Blue Cross Blue Shield, for example, uses a six-tier formulary for 2026, with some drugs requiring prior authorization, step therapy, or quantity limits. You fill prescriptions at in-network pharmacies, and mail order is available for maintenance medications through CVS Caremark. Preventive drugs are covered in full.⁴⁵ Ambetter covers both brand-name and generic drugs and also offers home delivery.⁶

One coverage difference matters if you need addiction treatment. ARHOME qualified health plans pay for the full continuum of substance use disorder residential care, which traditional Arkansas Medicaid does not cover for adults because of federal restrictions on payments to institutions for mental disease.⁷

Mental and Behavioral Health

Both ARHOME insurers include mental and behavioral health services. Ambetter offers virtual 24/7 behavioral health care in addition to in-person visits.⁶⁸⁷

Dental Coverage

Adult dental coverage exists but it is limited. Covered services include oral exams, X-rays, fluoride treatments, sealants, crowns, and orthodontic care, capped at $500 per year. Unused amounts do not carry over, and you pay anything above the cap. Since November 2024, adult dental is handled through Medicaid fee-for-service rather than the private plans.⁹ Under Arkansas Act 1025 of 2025, the cap is scheduled to rise to $1,000 in late 2026 for beneficiaries with special needs, pending federal approval.¹⁰

Wraparound Benefits Through Medicaid

Some services the private plans do not include are added back through Medicaid’s fee-for-service system:

Non-emergency medical transportation to Medicaid-covered appointments if you have no other way to get there. Rides must be scheduled at least three business days ahead.¹¹
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefits for enrollees ages 19 and 20, which provide a broader set of preventive and treatment services than standard adult coverage.¹

Medically Frail Enrollees

If you self-identify as medically frail during the application process, you stay in traditional Medicaid fee-for-service rather than moving to a private plan. That path adds long-term services and supports and personal care assistance with daily living, and it exempts you from all copayments.¹¹²

Life360 HOMEs for Specific Groups

ARHOME also funds Life360 HOMEs, which provide intensive care coordination and support for health-related social needs like housing and food. There are three tracks: Maternal Life360 for high-risk pregnancies through two years postpartum; Rural Life360 for people with serious mental illness or substance use disorder in rural areas; and Success Life360 for young adults with a foster care, juvenile justice, or veteran homelessness background.¹³ As of January 2025, only the Maternal track was fully operational. The Rural track was paused over hospital reimbursement issues, and the Success track was paused because its eligible population was considered too narrow to attract providers.¹⁴

What You Pay

ARHOME has no deductibles and no coinsurance. There is no premium if your income is at or below 100 percent of the federal poverty level. Between 101 and 138 percent, you owe a monthly premium of $22.44 or $26.88 depending on income, but you will not lose coverage for missing a payment.¹⁵

Copays apply once your household income is above 20 percent of the federal poverty level. Most services cost $4.70 or $9.40, with the higher charge for things like non-emergency ER visits, non-preferred brand drugs, and specialty drugs. Emergency services, preventive care, family planning, inpatient hospitalization, and pregnancy-related care carry no copay.³

Total copays are capped each quarter. The cap runs from roughly $27 for households between 21 and 40 percent of poverty up to $163 for those between 121 and 138 percent. Once you hit the cap, you owe nothing more that quarter. Medically frail enrollees, American Indians and Alaska Natives, and 19- and 20-year-olds receiving EPSDT services pay nothing at all.¹⁵¹⁶

Who Qualifies

To enroll, you must be 19 to 64, an Arkansas resident, and have household income at or below 138 percent of the federal poverty level. For a single person that came to about $415 a week as of April 2025. There is no asset or resource test.¹⁷

Several groups are not eligible for ARHOME specifically, even if they otherwise fit the income rules: pregnant women (who go into a separate Medicaid pregnancy category), people enrolled in Medicare, and people who qualify under the Parent/Caretaker Relative Medicaid category. Coverage is retroactive to 30 days before your application date.¹⁷

You can apply online at Access.Arkansas.gov, by phone, by mail, or at a DHS county office.¹⁸ Plan changes are allowed once a year between November 1 and January 15, and must be completed by December 15 to take effect January 1.¹⁹

Work Requirement Starting in 2026

Beginning July 1, 2026, ARHOME enrollees ages 19 to 64 will need to work, volunteer, or attend school at least 80 hours a month. The state will run this as a soft launch first, using automated data checks and notifications with no penalties. Pregnant and postpartum women, disabled veterans, caregivers, and people with special medical needs are exempt.²⁰

Full enforcement begins January 1, 2027. Enrollees who do not meet the requirement and refuse to participate in Success Coaching will have coverage suspended through the end of the calendar year. Coverage can be reinstated once you notify DHS that you will cooperate with a personal development plan.²⁰

1
Arkansas Department of Human Services. ARHOME Summary
2
Arkansas Department of Human Services. Covered Services
3
Arkansas Department of Human Services. ARHOME Cost-Sharing Information
4
Arkansas Blue Cross Blue Shield. ARHOME Pharmacy Information
5
Health Advantage. Using Your Pharmacy Benefits
6
Ambetter from Arkansas Health & Wellness. ARHOME Quick Reference Guide
7
AFMC. SUD Treatment Presentation
8
Arkansas Department of Human Services. PASSE Program
9
Arkansas Department of Human Services. Dental Beneficiaries
10
ACHI. Dental Coverage for Seniors
11
Arkansas Department of Human Services. Non-Emergency Transportation Program
12
Medicaid.gov. ARHOME Premium Assistance Waiver
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CMS. HHS Approves Arkansas Medicaid Waiver
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Medicaid.gov. Life360 HOME Evaluation Design Approval
15
Arkansas Department of Human Services. ARHOME Cost-Sharing Rule
16
Arkansas Department of Human Services. ARHOME Quarterly Report
17
Arkansas Department of Human Services. Medicaid Quick Reference Chart
18
Arkansas Department of Human Services. Apply for Services
19
Arkansas Blue Cross Blue Shield. ARHOME Plans
20
Arkansas Department of Human Services. DHS Work and Community Engagement Requirement