ARKids First

ARKids First is a state-run health insurance program for needy children. The program, which is an expansion of Medicaid, provides health insurance coverage for children whose parents’ income was too much to allow them to qualify for Medicaid but who still had significant needs. Since its creation, the program has proven popular and successful.

The program had its genesis in an early 1996 state study of Medicaid costs with an eye toward reducing spending. Task force member Amy Rossi, who was director of Arkansas Advocates for Children and Families, proposed to Governor Mike Huckabee that the state increase Medicaid spending to allow children whose parents’ incomes were too high to qualify but too low to afford private insurance to visit doctors on a regular basis. While recognizing that the proposed increase did not match up with the governor’s expressed intention, Rossi supported her proposal by noting that sick children meant more missed school days, which not only had a negative impact on a child’s educational development but also resulted in more missed work days by parents. She noted that sick children often become sicker, ultimately requiring even more expensive treatments. In addition, Rossi informed the governor that one in four Arkansas children had no health insurance. Gov. Huckabee said he would consider it, later talking directly with Rossi about the situation. Subsequently, when Huckabee presented his budget in December 1996, it included funding for ARKids First, a new initiative that provided coverage for children whose parents earned up to 200 percent of the federal poverty level. The legislation establishing the program was passed the following spring with Huckabee signing the new law—in crayon—surrounded by children.

The initial program called for free healthcare for children who qualified, but as representatives of the Arkansas Department of Human Services traveled the state to make people aware of the program and to encourage eligible participants to enroll, they were met with resistance from people who wanted to pay their fair share. So strong was this sentiment that the state decided to ask for a federal waiver to allow for a $10 co-pay for doctor visits and $5 for medications. The request was controversial, given that Medicaid services are free, but after the request went all the way to the White House, the waiver was granted so long as a safety net was established that would cover those for whom the co-pay was too costly.

With the adoption of the program, Arkansas became the third state in the nation, and the first in the South, to expand its Medicaid eligibility to 200 percent of the federal poverty level. Later, state leaders noted that Arkansas was a pioneer in offering such coverage even before the start of the federally funded State Children’s Health Insurance Program (originally called SCHIP, but now known as CHIP—Children’s Health Insurance Program), which specifically seeks to help children who fall between 133 and 200 percent above the federal poverty level.

In its first year, ARKids First enrolled an estimated 30,000 children. By early 2017, the expanded ARKids First brand (called ARKids A), which included Medicaid and served children up to nineteen whose parents’ income is at or below 138 percent of the federal poverty level, and the CHIP-funded expansion known as ARKids B had an estimated enrollment of more than 381,000, a figure that represented nearly half of all Arkansas children. (Part of the reason for bringing everything under the ARKids First label was to remove the stigma that went with Medicaid and its association of poverty.) By 2017, the percentage of Arkansas children who did not have health insurance, a figure that before ARKids First was almost twenty-five percent and near the top of the national rankings, had fallen to 4.9 percent, a figure that puts it below the national average.

Central to the continued survival of ARKids First is the reauthorization by Congress of CHIP, which, along with Medicaid, provides funds for ARKids First.

For additional information:
ARKids First. (accessed January 24, 2018).

Kenda, Ann. “20 Years, Thousands of Kids, One Great Idea: ARKids First Marks 20 Years.” Arkansas Public Media, March 9, 2017. (accessed January 24, 2018).

Peacock, Leslie Newell. “ARKids Turns 20.” Arkansas Times, March 23, 2017, pp. 14–20. Online at (accessed January 24, 2018).

William H. Pruden III
Ravenscroft School


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