Months after becoming the first state to offer health care coverage to lower-income residents through a “private option” rather than Medicaid expansion under the Affordable Care Act, Arkansas finally agreed to extend this closely watched political compromise.

Matt Salo, executive director of the National Association of Medicaid Directors, describes it as a groundbreaking, albeit complex, plan for many other states to ponder – noting how it took “an enormous amount of time” to work through the logistics so that both the executive and legislative branches of government would be on board. His sense is that most states that have turned down Medicaid expansion funds would like to find a way to get to the ‘yes’ column, noting that the Arkansas model is one way to accomplish this goal.

The Arkansas initiative mirrors activity in other states where conservative Republicans were uneasy about federal expansion of Medicaid. While Iowa and Ohio reportedly have adopted similar plans, others are being considered in Pennsylvania, Tennessee and Utah. Twenty states have opted out of such funding since a 2012 U.S. Supreme Court ruling allowed them to do so.

Mike Beebe, Arkansas’s Democratic governor, recently signed into law a measure that includes $915 million in Medicaid-expansion dollars in his proposed $5 billion state budget for the coming fiscal year toward an alternative way of funding coverage for as many as 218,000 uninsured residents. Nearly 100,000 Arkansans will be able to continue participating in the program, which was approved only days before the Oct. 1 rollout.

State senators approved the plan in February, but it took several votes in the 100-member Arkansas General Assembly, where it passed by a razor-thin margin under legislative rules. Beebe had cautioned lawmakers that drastic cuts in services would have been necessary had they not approved the plan, which was projected to save the state $89 million.

One staunch GOP opponent, State Rep. Nate Bell from Mena, Ark., had proposed eliminating advertising and marketing funds from the private option, which he and others thought was too expensive and represented an unnecessary expansion of government.

Bruce Shutan is a Los Angeles freelance writer.

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