But before Arkansas Gov. Mike Beebe (D) and the federal government can move forward, the state legislature needs to approve the Medicaid expansion—and we're likely to learn Monday whether that will happen.
The Arkansas House of Representatives is likely to vote Monday on whether to fund the legislation that would allow the private Medicaid expansion. We don't know whether it will pass.
There was another important vote Thursday, where the House voted 62-37 in favor of enabling legislation for the Medicaid expansion. While that is a solid majority, passing the bill to appropriate funds to the program has a higher bar: It needs 75 votes to pass.
There are a few signs that the decision may not go in the Medicaid expansion's favor. Legislators were initially scheduled for a Friday vote, but delayed action until Monday so they could have the weekend to talk the issue through with constituents. There are some reports of House Speaker John Boehner (R-Ohio) becoming involved with Arkansas legislators, urging them to vote down the legislation.
If the Arkansas legislation fails, that does not preclude other states from pursuing the same Medicaid expansion framework. Any state can ask the Department of Health and Human Services for this type of flexibility and work out an agreement.
Still, not having Arkansas on board would likely prove a pretty big setback. State legislators and health policy experts I talk to were waiting on Arkansas as the litmus test. It's supposed to show states whether such an arrangement is possible with the federal government.
If it doesn't move forward, that means another state would need to take its place in forging an initial deal. Whether anyone would, at this point, remains an unknown.