More than 220,000 Arkansans currently hold health insurance through the state's Medicaid expansion programme. The federal government has rejected Arkansas's request to renew its hybrid expansion waiver, creating uncertainty regarding future coverage.

DHS Secretary Janet Mann informed the Arkansas Legislative Council's Hospital, Medicaid, and Developmental Disabilities Study Subcommittee on 17 August that the department is considering various options, stating: "We are considering everything but ending the program."

The current ARHOME waiver is not scheduled to end the Medicaid expansion at the end of the year, but the state has requested a two-year extension of the waiver to allow for a smoother transition. The expansion model currently involves the state paying 10 per cent of costs, while the federal government covers 90 per cent.

Since the introduction of Medicaid expansion in 2014, the uninsured rate among working-age adults in Arkansas has been halved. The programme has also impacted the state's healthcare infrastructure, where nearly 70 per cent of rural hospitals already operate at a loss.