How Arkansas pays for disability services

Waiver inventory

Arkansas has no 1915(i), no 1915(k)/Community First Choice, and no 1115 authority covering IDD. ARChoices in Homecare (0195) and Living Choices Assisted Living (0400) are aging and physical-disability waivers and are excluded.

State-only funded programs

None identified as a standalone state-only IDD service program. What I checked and what I found instead:

• The DHS Division of Medical Services FY2026 appropriation act (DFA budget manual, 0710 DHS-DMS) shows no state-only IDD services line. Human Development Centers appear inside "Public Nursing Home Care" ($217,529,350, FY2026), which is Medicaid-matched.
• DDS program inventory in the October 8, 2025 legislative presentation (Exhibit D) lists CES Waiver, Autism Waiver, Children's Special Services, and Early Intervention and Adult Day Treatment. All are Medicaid-financed except Children's Special Services care coordination, whose funding source is not stated in the document.
• Two dedicated state revenue streams are used as the state match rather than as separate programs: Tobacco Settlement funds (Act 50 of 2017, $8.5 million reallocated for 500 CES slots) and the PASSE premium tax, half of which is statutorily dedicated to reducing the CES waitlist (about $15 million per year funding 600 regular slots plus 100 DCFS slots as of December 1, 2020). Source: Bureau of Legislative Research, CES Waiver 1989-90 through 2020-21.

County / regional / local funding

None identified. Arkansas administers DDS centrally through DHS with a statewide single point of access (DDS Referral Intake, 501-683-5687). There are no county boards, county levies, or regional center allocations in the DDS structure described in the October 2025 DDS legislative presentation or in the CES waiver application. The only sub-state intermediaries are the PASSEs, which are private full-risk managed care entities with statewide, not geographic, enrollment.

Funding scale

• CES waiver spending, most recent published actuals: $307,290,409 in reporting year 2020-21, of which federal share $237,934,964 and state share $69,355,445. Average plan of care cost $61,804. BLR report, Table 3
• CES waiver projected spending, CMS-approved: $431,202,566 in waiver year 1 (6,983 participants, Factor D $61,750.33 per participant) rising to $593,868,833 in waiver year 5 (8,433 participants, Factor D $70,422.01). Waiver year 5 ends February 28, 2027. CES waiver application Appendix J
• ICF/IID appropriation: $217,529,350 for FY2026 for the five Human Development Centers plus thirty-one 15-bed-or-smaller programs. DFA 0710 DHS-DMS FY2026
• Total DHS Division of Medical Services appropriation FY2026: $10,565,248,296, including Hospital and Medical Services $8,336,005,717 within which waiver services sit. A consolidated all-funds IDD total for Arkansas was not found.
• FMAP: 69.23% for FY2026, declining from FY2025 by 1.91 percentage points; 70.52% for FY2027. CRS R43847 and KFF FMAP
• People served in DD waivers: CES 8,233 slots authorized per year as of October 2025; Autism Waiver 173 active children in program year 12 out of 180 slots.
• Waiting list, CES: approximately 1,900 people as of October 8, 2025, down from 3,241 on July 1, 2021 and a peak of 3,507 on July 1, 2020. Exhibit D, Oct 2025
• Waiting list, Autism Waiver: 103 children with completed applications waiting, 7 pending approval, and 381 families with incomplete packets, as of September 26, 2025. 13 waiting children plus 113 incomplete applicants are expected to turn 5 before a slot opens and will age out of eligibility. Autism Task Force presentation, Oct 8, 2025
• Average wait: not published as a statistic. Press reporting describes multi-year waits; no official average was found.

Residential funding detail

Supportive Living is the single CES residential service. It covers services and activities that help a person live in their own home, with family, in an apartment, or in a provider-owned group home. It is billed as a day unit. The CMS-approved cost model uses an average of 294 units per user per year at an average cost per unit of $270.16, applied to 5,364 users in waiver year 1 rising to 7,410 users in waiver year 5. Behavioral Prevention and Intervention Plans are the responsibility of the Supportive Living provider.

Acuity structure. Arkansas assigns people to Tier 2 (requires paid care or services less than 24 hours per day, seven days per week) or Tier 3 (requires paid care or services 24 hours per day, seven days per week) using an Independent Assessment performed by Optum. The tier drives both PASSE attribution and the risk and needs profile used for the capitation. A new assessment can be requested when circumstances change.

Payment structure. All CES waiver services are paid under a capitated per member per month methodology. DHS pays each PASSE a prospective PMPM; the PASSE then negotiates rates with HCBS providers and must contract broadly enough to serve all enrolled members statewide. DHS and DDS review encounter claims quarterly. There is no state fee schedule that fixes the Supportive Living per diem. Waiver application Appendix I-2 states this explicitly.

ICF/IID. The five Human Development Centers and the community ICF/IID programs are paid on a cost-based per diem set under the Manual of Cost Reimbursement Rules for Long-Term Care Facilities. HDC services are explicitly carved out of the PASSE capitation.

Room and board. Room and board is not a covered CES waiver service and is not state-funded. Community Transition Services provides a one-time package (approved model: 1.05 packages per user at $3,254.05) for set-up expenses when a person moves from an institution or provider-operated setting to a private home where the person or guardian is directly responsible for living expenses. Ongoing rent, utilities, and food fall to the person's own income, principally SSI.

Host home and shared living are not separately named CES services. They are subsumed within Supportive Living.

Comparable service rates

Ancillary CES model values from the same source: Specialized Medical Supplies $79.48 per month; Adaptive Equipment $4,350.00 per package; Personal Emergency Response System $29.25 per month; Consultation $102.96 per hour; Environmental Modifications $444.96 per package; Supplemental Support $1,251.83 per month; Community Transition Services $3,254.05 per package. These are approved average cost per unit figures used to build Factor D, not a published provider fee schedule.

Official rate schedule links

• DMS fee schedule landing page (no CES or ICF/IID schedule is posted here): humanservices.arkansas.gov
• CES waiver application with Appendix I-2 rate methodology and Appendix J cost per unit tables: humanservices.arkansas.gov
• CMS waiver record with the approved application download: medicaid.gov
• ICF/IID and long-term care cost reimbursement rules: humanservices.arkansas.gov
• CES waiver minimum certification standards for providers: humanservices.arkansas.gov
• Arkansas Total Care PASSE waiver provider manual, showing how a PASSE administers waiver services: arkansastotalcare.com
• CES waiver provider list: humanservices.arkansas.gov

Notable features and flags

• Mar 1, 2022: CES waiver renewal 0188.R06.00 approved effective Mar 1, 2022 through Feb 28, 2027, adding 3,204 slots over three years plus 200 more foster care slots, removing Crisis Intervention as duplicative of PASSE benefits, removing restrictions on who may receive respite and where, and making direct support professional training requirements permanent in place of the one-year experience requirement.
• Oct 8, 2025: DDS reported 8,233 CES slots per year and roughly 1,900 people on the waitlist, down from 3,241 in July 2021. This is the largest reduction in the program's history and traces to the PASSE premium tax and Tobacco Settlement slot purchases.
• Oct 8, 2025: Autism Waiver capacity is frozen at 180 point-in-time slots against 4,556 cumulative applications since 2012. DDS told the Legislative Task Force on Autism that 13 children on the waiting list and 113 with incomplete applications will likely age out at the 5th birthday before a slot opens.
• 2025-2026 DDS Strategic Plan: DDS is leading development of a new Acquired Brain Injury (ABI) Waiver, updating the CES waiver, transferring Autism and ICF 704 determinations to DDS, and revising the OT, PT, and speech manuals. Strategic plan
• Provider rate adequacy is an unresolved policy dispute. Public comment on the 2022 slot increase argued that adding slots "is not the answer. Adequate rates are." DHS responded by pointing to providers negotiating rates with PASSEs, which is the structural consequence of full-risk capitation. There is no state rate floor published for CES services.
• Feb 28, 2027: the current CES waiver expires. A renewal application will be required during calendar 2026.

Confidence

Solid: waiver authorities and CMS numbers, the PASSE capitation structure and the absence of a published CES fee schedule (stated directly in Appendix I-2 of the approved application), the FY2026 DMS appropriation, the October 2025 slot and waitlist counts, Autism Waiver enrollment and waitlist, and the full historical enrollment and expenditure series through 2020-21. Estimated or dated: all per-unit dollar figures are CMS-approved average cost per unit from the 2022 waiver application cost model, not provider payment rates, and actual PASSE-negotiated rates will differ; the most recent audited waiver expenditure total is 2020-21. Could not find: current-year CES waiver expenditures, a consolidated all-funds Arkansas IDD spending total, Human Development Center per diems or census, an average waiting-list wait time, and any published Arkansas fee schedule for CES or ICF/IID services. The DHS fee schedule server returns 403 to automated retrieval, so I cannot rule out that a schedule exists behind that page.