Category: SCII State Profiles Tags: Arkansas, Disability Policy, Community Integration, Olmstead, HCBS, Disability Rights, SCII 2026, State Profile, Independent Living, Policy Analysis, Crisis Stabilization Units, IndependentChoices, Eighth Circuit
Introduction
Arkansas presents a study in contradiction: it was one of the earliest conservative states to expand Medicaid coverage, yet that coverage expansion has not translated into a modern HCBS infrastructure — the state has no current, binding Olmstead Plan, has not eliminated Section 14(c) subminimum-wage work, and pays no general state SSI supplement. At the same time, Arkansas has built a genuinely distinctive crisis-diversion architecture that state officials describe as a national model, even as county jails absorb hundreds of people who cannot get a psychiatric bed. The result is a state whose policy innovations are real but structurally under-resourced relative to need.
2026 SCII Score Card
| Composite Score | 35 / 100 |
| National Rank | Part of the 2026 rolling expansion — see the full ranking on the SCII Data Analysis page |
| Tier | 🔴 Tier 4 — Critical |
| Active DOJ Olmstead Action | None currently active; a 2010 DOJ lawsuit over the Human Development Centers was dismissed on the merits in 2011 with no consent decree |
| Olmstead Plan Status | No current, binding, publicly posted Olmstead Plan; only agency-level strategic plans identified |
| Judicial Posture | Neutral — Eighth Circuit, no narrowing precedent identified |
| Data Current As Of | 2026 (source data dated 1998–2026) |
Domain Scores
| Domain | Score | Notes |
|---|---|---|
| Institutional Population Burden | 8 / 20 | 36.8 state psychiatric beds/100,000 (below the 50/100,000 recommended minimum); ~500 people held in county jails awaiting a court-ordered evaluation or state hospital bed (April 2026); ~1,000 residents across five Human Development Centers |
| HCBS Infrastructure | 7 / 20 | I/DD waiver waitlist estimated at 1,900–2,345 people, with FY2026 budget cuts risking a return toward 14-year waits; pioneering IndependentChoices self-direction program since 2008; only 42.3% of Medicaid LTSS spending went to HCBS in 2021 |
| Olmstead Compliance | 3 / 15 | No current Olmstead Plan; 2010 DOJ lawsuit over Human Development Centers dismissed 2011, no consent decree; national DOJ opinion (2026) questioning the integration mandate’s binding force compounds the gap |
| Criminal Justice Diversion | 7 / 15 | Act 423 built four regional Crisis Stabilization Units described as a national-model partnership structure; 988 in-state answer rate ~58% (May 2025) to ~71% (2025 overall), below most states; Section 1115 Medicaid reentry demonstration on CMS’s list |
| Housing & Economic Self-Determination | 4 / 15 | Has not eliminated 14(c); no general SSI state supplement to community-dwelling recipients; lowest average direct-support-professional wage in the nation (2021 data) |
| Voice, Oversight & Civil Rights | 6 / 15 | Disability Rights Arkansas forced to stop accepting new clients for two months in 2025 amid a federal funding freeze; only four Centers for Independent Living statewide; Arkansas Civil Rights Act of 1993 covers employers with 9+ (vs. ADA’s 15+) with a private right of action |
Critical Population Counts
| Setting | Count | Source |
|---|---|---|
| Nursing facility residents under 65 | Not separately reported for Arkansas | — |
| State psychiatric hospital census | Arkansas State Hospital: 222 licensed beds statewide; 36.8 state psychiatric beds per 100,000 population; ~500 people held in county jails awaiting a bed/evaluation as of April 2026 | Arkansas Dept. of Human Services [3]; Treatment Advocacy Center [1][2]; Arkansas Advocate [4] |
| ICF/IID residents | State falls in the 26–90-per-100,000 band nationally (RISP FY2020); ~1,000 residents at the state’s five Human Development Centers alone | RISP, University of Minnesota [6]; Encyclopedia of Arkansas [7] |
| Estimated incarcerated adults with serious mental illness | Precise statewide count not verified; best proxy is the ~500 individuals in county jails awaiting evaluation or a bed | Arkansas Advocate [4] |
| Chronically homeless adults with disabilities | Statewide total not independently verified; two Arkansas Continuums of Care did not conduct an unsheltered count in 2024 | HUD AHAR 2024 Part 1 [9] |
| HCBS waiver waitlist (I/DD, CES/DDS) | Estimated 1,900–2,345 people (2026, secondary source, not independently corroborated against a primary state document) | Arkansas DHS [10]; Special Needs Trust By State [11] |
Three Strengths
1. A pioneering, still-operating self-direction infrastructure. Arkansas was one of the original Cash & Counseling demonstration states in the late 1990s, and its IndependentChoices program — which lets Medicaid beneficiaries or their representatives hire, train, and supervise their own attendant-care workers, including family members — became a permanent state-plan service under Section 1915(j) in 2008 [13][14].
2. A distinctive, state-county-law enforcement crisis diversion partnership. Act 423 built four regional Crisis Stabilization Units accessible 24/7 as alternatives to jail or the ER, paired with statewide Crisis Intervention Team training under the 2017 Behavioral Health Crisis Intervention Protocol Act [23][24][25] — described by state officials and justice-reform researchers as a first-of-its-kind partnership structure.
3. A disability civil rights statute that exceeds the ADA’s floor. The Arkansas Civil Rights Act of 1993 covers employers with 9 or more employees, well below the ADA Title I threshold of 15, and gives Arkansans a private right of action in state court [42].
Three Critical Gaps
1. Section 14(c) subminimum wage remains fully intact. Unlike the roughly 17 states that have statutorily ended subminimum-wage certificates, Arkansas has taken no such action; active certificate holders continue to operate with roughly 450 subminimum-wage workers in southwest Arkansas alone [30][31].
2. No current Olmstead Plan and no active federal enforcement backstop. Arkansas’s only substantive brush with Olmstead accountability — the 2010 DOJ lawsuit over the Human Development Centers — ended in dismissal in 2011 with no consent decree [17][18][19][44].
3. A protection-and-advocacy and independent-living network that is thin and increasingly precarious. Disability Rights Arkansas operates on roughly $2 million annually, almost entirely federal money, and was forced to stop accepting new clients for two months in 2025 amid a federal funding freeze [37][38] — while only four Centers for Independent Living serve the entire state [39][40].
Key Insight
Arkansas’s disability policy landscape is defined less by outright hostility to community integration than by a persistent gap between stated commitments and funded infrastructure: a state that expanded Medicaid early and pioneered self-directed care has nonetheless allowed its Olmstead Plan to lapse, left Section 14(c) untouched, declined to supplement SSI, and left its flagship crisis-diversion system so under-resourced downstream that hundreds of people cycle through county jails awaiting a psychiatric bed instead of receiving community-based treatment. The pattern that emerges is one of episodic, often innovative program design — Cash & Counseling, Crisis Stabilization Units, a broader civil rights act — undermined by chronic underinvestment in the capacity needed to make those programs function at the scale the state’s population requires.
References
[1] Treatment Advocacy Center. Arkansas state resource page. https://www.tac.org/map_directory/arkansas/
[2] Treatment Advocacy Center. (2024). Estimating Psychiatric Bed Need in the United States (ORPA Research Summary). https://www.tac.org/wp-content/uploads/2024/03/TAC_ORPA_ResearchSummary1.24.pdf
[3] Arkansas Department of Human Services. Arkansas State Hospital. https://humanservices.arkansas.gov/divisions-shared-services/shared-services/office-of-substance-abuse-and-mental-health/arkansas-state-hospital/
[4] Arkansas Advocate. (2026, April 1). Survey of Arkansas jails reveals strained, costly health care system. https://arkansasadvocate.com/2026/04/01/survey-of-arkansas-jails-reveals-strained-costly-health-care-system/
[5] KLRT Fox16. Arkansas State Hospital kicks off pilot program with 16 new beds for people waiting on mental evaluations. https://www.fox16.com/news/state-news/arkansas-state-hospital-kicks-off-pilot-program-with-16-news-beds-for-people-waiting-on-mental-evaluations/
[6] Residential Information Systems Project (RISP), University of Minnesota Institute on Community Integration. ICF/IID recipients per 100,000 by state. https://publications.ici.umn.edu/risp/infographics/how-many-people-with-intellectual-or-developmental-disabilities-get-medicaid-icfiid-supports
[7] Encyclopedia of Arkansas. Human Development Centers. https://encyclopediaofarkansas.net/entries/human-development-centers-6929/
[8] CareListings. Intellectual Disability Care — Arkansas ICF/IID facility listing. https://carelistings.com/find/intellectual-disability-care
[9] HUD USER. (2024). The 2024 Annual Homelessness Assessment Report (AHAR) to Congress, Part 1. https://www.huduser.gov/portal/sites/default/files/pdf/2024-AHAR-Part-1.pdf
[10] Arkansas Department of Human Services. Governor Addressing Waitlist for Services for Arkansans with Developmental Disabilities. https://humanservices.arkansas.gov/news/governor-addressing-waitlist-for-services-for-arkansans-with-developmental-disabilities/
[11] Special Needs Trust by State. (2026). Medicaid DD Waiver Waitlists by State. https://specialneedstrustbystate.com/medicaid-waiver-waitlists/
[12] Mathematica Inc. / Medicaid.gov. Trends in the Use of and Spending for Home and Community-Based Services (LTSS Rebalancing Brief). https://www.medicaid.gov/medicaid/long-term-services-supports/downloads/ltss-rebalancing-brief.pdf
[13] Office of the Assistant Secretary for Planning and Evaluation, HHS. Moving to IndependentChoices: The Implementation of the Cash and Counseling Demonstration in Arkansas. https://aspe.hhs.gov/basic-report/moving-independentchoices-implementation-cash-and-counseling-demonstration-arkansas
[14] Arkansas Department of Human Services. Self-Direction/IndependentChoices. https://humanservices.arkansas.gov/divisions-shared-services/aging-adult-behavioral-health-services/self-direction-independent-choices/
[15] Arkansas Department of Human Services. ARChoices Detailed Fact Sheet. https://humanservices.arkansas.gov/wp-content/uploads/ARChoices-Detailed-Overview.pdf
[17] National Disability Rights Network. Docket of Cases Related to Enforcement of the ADA Title II Integration Mandate. https://www.ndrn.org/wp-content/uploads/2019/03/Docket_of_Olmstead_Cases_updated_8_23_18.pdf
[18] Arkansas Department of Human Services. DDS Strategic Initiatives Plan 2025-2026. https://humanservices.arkansas.gov/wp-content/uploads/DDS-Strategic-Initiatives-Plan-2025-2026.pdf
[19] Arkansas Department of Human Services. OSAMH Strategic Initiatives Plan 2024-2025. https://humanservices.arkansas.gov/wp-content/uploads/OSAMH-Strategic-Initiatives-Plan-2024-2025.pdf
[20] CBS News. States aren’t required to provide community-based care for people with disabilities, new DOJ opinion claims. https://www.cbsnews.com/news/doj-disability-opinion-community-care/
[21] The Arc. DOJ Opinion on Olmstead Threatens the Right of People with Disabilities to Live in the Community. https://thearc.org/blog/doj-opinion-on-olmstead-threatens-the-right-of-people-with-disabilities-to-live-in-the-community/
[23] Council of State Governments Justice Center. (2019). Arkansas Crisis Stabilization Units Are Keeping People Out of Jail. https://csgjusticecenter.org/2019/09/24/arkansas-crisis-stabilization-units-are-keeping-people-out-of-jail/
[24] Association of Arkansas Counties. Behavioral Health in Arkansas: Where we have been and where we are heading. https://www.arcounties.org/media/articles/behavioral-health-in-arkansas-where-we-have-been-and-where-we-are-heading/
[25] Justia. Arkansas Code § 20-47-805, Behavioral Health Crisis Intervention Protocol Act of 2017. https://law.justia.com/codes/arkansas/title-20/subtitle-3/chapter-47/subchapter-8/section-20-47-805/
[26] Axios NW Arkansas. (2025, June 16). Arkansas lags in 988 mental health hotline use. https://www.axios.com/local/nw-arkansas/2025/06/16/988-hotline-use-low-arkansas-suicide
[28] Arkansas Judiciary. Mental Health Court, Specialty Court Programs. https://arcourts.gov/courts/circuit-courts/specialty-court-programs/mental-health-court
[29] Medicaid.gov. Arkansas Opportunities to Test Transition-Related Strategies to Support Community Reentry from Institutions for Mental Disease (Section 1115 demonstration). https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/160061
[30] Texarkana Today. Cotton bill would drop pre-employment requirements for young adults entering subminimum wage jobs; Texarkana nonprofit backs the change. https://txktoday.com/news/cotton-bill-would-drop-pre-employment-requirements-for-young-adults-entering-subminimum-wage-jobs-texarkana-nonprofit-backs-the-change/
[31] Akerman LLP. DOL Proposes End of Program Allowing Employers to Pay Disabled Employees Subminimum Wage. https://www.akerman.com/en/perspectives/hrdef-dol-proposes-end-of-program-allowing-employers-to-pay-disabled-employees-subminimum-wage.html
[33] Institute on Disability, University of New Hampshire (RRTC). 2023 State Report for County-Level Data: Employment — Arkansas. https://iodrrtc.sr.unh.edu/compendium/2023-state-report-for-county-level-data-employment/AR
[34] American Disability Action Group. How Much Is Disability Benefits In Arkansas? https://www.americandisabilityactiongroup.com/how-much-is-disability-benefits-in-arkansas/
[36] Arkansas Department of Human Services. Supported Housing Units for Adults (ARPA HCBS grant funding). https://humanservices.arkansas.gov/newsroom/hcbs/arpa-grant-funding-opportunities-for-arkansas-medicaid-providers/supported-housing-units-for-adults/
[37] Arkansas Times. (2025, April 29). Trump funding freeze hits Arkansas disability advocacy group. https://arktimes.com/arkansas-blog/2025/04/29/trump-funding-freeze-hits-arkansas-disability-advocacy-group
[38] KARK. Disability Rights Arkansas not taking new clients due to federal funds hold up. https://www.kark.com/news/state-news/disability-rights-arkansas-not-taking-new-clients-due-to-federal-funds-hold-up/
[39] Independent Living Research Utilization (ILRU). Directory of Centers for Independent Living — Arkansas. https://www.ilru.org/projects/cil-net/cil-center-and-association-directory-results/AR
[40] Arkansas State Independent Living Council (ARSILC). About. https://arsilc.org/about/
[41] Arkansas Long-Term Care Ombudsman Program. (2012). Annual Report. https://cdm16039.contentdm.oclc.org/digital/api/collection/p266101coll7/id/28970/download
[42] LegalClarity. Disability Rights in Arkansas Explained (Arkansas Civil Rights Act of 1993). https://legalclarity.org/disability-rights-in-arkansas-explained/
[44] ADA.gov Archive (U.S. Department of Justice, Civil Rights Division). Olmstead: Community Integration for Everyone — Enforcement Page. https://archive.ada.gov/olmstead/olmstead_enforcement.htm
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