Medicaid Expansion Through Premium Assistance: Arkansas and Iowa’s Section 1115 Demonstration Waiver Applications Compared

Arkansas and Iowa recently released for public comment draft demonstration waiver applications proposing to implement the ACA’s Medicaid expansion by using Medicaid funds as premium assistance to purchase coverage for some or all newly eligible Medicaid beneficiaries in Marketplace (formerly called Exchange) Qualified Health Plans (QHPs). Arkansas and Iowa seek demonstration waiver authority primarily because they propose to make premium assistance enrollment mandatory for affected beneficiaries. Iowa also proposes to waive its obligation to provide wrap-around benefits. This fact sheet compares the two proposals.