Gov. Sarah Huckabee Sanders Unveils New Medicaid Work Requirement Plan

Gov. Sarah Huckabee Sanders, Secretary of the Arkansas Department of Human Services Kristi Putnam and Deputy Secretary for Programs and State Medicaid Director Janet Mann held a press conference Jan. 28 to announce the new program. (Arkansas Governor's Office)

Gov. Sarah Huckabee Sanders announced Tuesday a new Medicaid work requirement plan that would mandate recipients of the state’s ARHOME Medicaid expansion program to work, attend school, volunteer or care for children to maintain their benefits.

Sanders sent a letter to Robert F. Kennedy Jr., President Donald Trump’s pick for secretary of the U.S. Department of Health and Human Services, asking him to grant Arkansas a waiver to implement the program “when” he becomes secretary.

“Our goal is never to take services away from those who need it but to help people stand on their own two feet so they don’t have to count on the government,” the letter states.

The program, titled “Pathway to Prosperity,” would require all able-bodied, working-age (19-64) adults to provide evidence of meeting one of the work conditions to receive benefits.

“220,000 able-bodied, working-age adults in Arkansas receive free health care courtesy of the Arkansas taxpayer,” Sanders said during a press conference announcing the new program. “It costs us more than $2.2 billion each year, and growing. Of those recipients, estimates show that nearly 90,000 have no job.”

Unlike Arkansas’ previous Medicaid work requirement that was blocked by a federal judge, the new proposal plans to use automated data matching to track compliance and offer “success coaching” for those struggling to meet requirements. Also, rather than terminating coverage for non-compliance, benefits would be temporarily suspended until recipients get back “on track.”

“Lessons learned” from the failed plan include the “importance of providing clear communications through multiple means, simplicity in design and the need for personal interaction rather than over-reliance on technology,” according to the waiver document.

The new program will assess individuals as either “on track” or “not on track” through automated activity tracking. Those deemed off-track will be offered the success coaching and help developing a personal plan for achieving economic independence. The state plans to leverage existing resources through health plans, workforce services and community partners to provide these services.

Sanders said at the news conference that she is confident the new order will be upheld in court due to the data compliance aspect and the new federal administration, but largely because the program will only suspend coverage.

“We are confident that the revised waiver will be approved by the [Centers for Medicare & Medicaid Services] and upheld in court, and that we can get to implementing it quickly,” Sanders said during the press conference.

Department of Human Services Secretary Kristi Putnam said at the conference that the program aligns with existing work requirements in other assistance programs like SNAP and TANF.

“The goal should be for Medicaid to be a safety net, and we should routinely see healthy adults moving from government dependence to economic independence, improving their health in the process,” Putnam said, stating that the program is “not punitive. It is about purpose.”

The proposal must still go through a 30-day public comment period before submission to the Centers for Medicare & Medicaid Services.

The waiver document states that Arkansas aims to implement the program in January 2026, pending federal approval.

Officials project it could generate more than $165 million in savings over five years through a combination of temporary benefit suspensions and participants transitioning to other coverage options as their incomes increase. Total costs for the program are estimated to be $42.8 million over the five-year period, leading to $122.8 million in net savings.