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Alabama Medicaid enrollment dropped by nearly 170,000 since last summer

MONTGOMERY, Ala. — The number of Alabamians enrolled in the state’s Medicaid program dropped by 167,812 since last July, according to new data from the Alabama Medicaid Agency.

Like the rest of the country, the Alabama Medicaid agency has been sifting through its rolls to redetermine the eligibility of its more than 1.2 million recipients after federal protections that prohibited Americans from being booted from the low-income health care program during the pandemic expired last year.

Per the new report that analyzes enrollment data through the month of January, just over 1.2 million Alabamians remained enrolled in Medicaid, significantly down from its peak in June of almost 1.4 million.

More than 65,000 of the nearly 170,000 Alabamians that are no longer enrolled in Medicaid since July were children, the majority of which – nearly 48,300 – were between the ages of 1 and 12. Due to several Alabama-specific programs such as  ALL Kids, however, the rate of uninsured children remains low compared with other states at around 3%.

Between December and January alone, more than 21,600 Alabamians lost Medicaid coverage, for an average decrease in enrollment of 22,109 Alabamians per month since unwinding began last summer.

While the Alabama Medicaid Agency does not publish information on the specific cause for individuals losing Medicaid coverage, at least a sizable portion, according to Medicaid Division Director Felton Gretel, lost coverage due to procedural reasons, and could be reinstated were they do file the proper paperwork.

Other than procedural reasons, other causes for losing Medicaid coverage include individuals securing insurance through the private sector, moving out of state, or exceeding eligibility income caps.

Alabama’s Medicaid program has among the strictest eligibility requirements in the country, and only accepts individuals with certain qualifiers, including those who are pregnant, blind, have a disability, or are over 65 years of age.

In addition to the requirement of meeting the aforementioned qualifiers, eligibility is also determined by income, with Alabamians who seek to enroll in Medicaid through the federal Supplemental Security Income program only eligible if making below $964 a month, or $1,436 for couples.

Calls to expand eligibility for the state’s Medicaid program have grown in recent years. States that expand their Medicaid programs to cover those making up to 138% of the federal poverty level are entitled to receive significant federal financial assistance to cover costs under the 2010 Affordable Care Act.

This year, the U.S. Department of Health and Human Services calculated the federal poverty level to be an annual income of $15,060 and below for an individual, meaning, were Alabama to expand its Medicaid program, individuals making up to $20,783 would become eligible for the program, regardless of if they meet the disability qualifiers.

Alabama Democrats and a number of advocacy groups, including Voices for Alabama’s Children, the American Cancer Society and Alabama Arise, have all advocated for Medicaid expansion. 

State Republicans, however, have largely been opposed to the idea over cost concerns. Earlier this year, however, Republican House Speaker Nathaniel Ledbetter floated the idea of expanding Medicaid, albeit through a private-public partnership similar to that of Arkansas’ Medicaid expansion.

Many Republican state lawmakers were also briefed recently on a private-public Medicaid expansion plan developed by the Blue Cross and the Alabama Hospital Association, a plan that its creators said would not cost the state any money for at least five years, though likely ten, and extend coverage to an additional 260,000 Alabamians.

As of February, more than 16 million Americans have lost Medicaid coverage since the federal protections expired last spring. When including those who were booted from Medicaid and reinstated, however, the net loss to Medicaid enrollment nationwide, as of February, sits at around 9.5 million.

Health experts broke down last year who the close to 300,000 Alabamians were that would become eligible for Medicaid were the state to expand the program, finding that more than half of them were employed, the majority of whom worked in food service.

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