Association of Arkansas's section 1115 Medicaid waiver with health insurance coverage

Jim P. Stimpson, Sungchul Park, Fernando A. Wilson

Research output: Contribution to journalArticlepeer-review


Objective Evaluate how the use of a Section 1115 waiver in Arkansas was associated with health insurance coverage compared to Medicaid expansion states that did not use a waiver. Methods Difference in difference analysis was conducted of 1,320,790 adults aged 19-64 with family incomes at or below 138% of the federal poverty level from the 2010-2017 American Community Survey. Arkansas was compared to states that expanded without a waiver in calendar year 2014. States that expanded Medicaid with an approved Section 1115 waiver during the study period or expanded without a waiver after 2014 or did not expand Medicaid were excluded from the analysis. The outcome measures were no health insurance coverage, Medicaid coverage, employer sponsored private insurance, and non-group direct purchase private insurance. Results Arkansas's use of a waiver to expand Medicaid was associated with a lower uninsured rate (-3.7%, p< 0.001), a higher Medicaid coverage rate (2.0%, p< 0.001), and a higher nongroup, direct purchase private insurance coverage rate (2.9%, p< 0.001) compared to states that expanded Medicaid in 2014 without a waiver. Conclusion Compared to states that implemented traditional Medicaid expansion, we found that Arkansas's waiver was associated with increases in health insurance coverage rates.

Original languageEnglish (US)
Article numbere0231417
JournalPloS one
Issue number4
StatePublished - Apr 2020
Externally publishedYes

ASJC Scopus subject areas

  • General Biochemistry, Genetics and Molecular Biology
  • General Agricultural and Biological Sciences
  • General


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