MONTGOMERY, Ala. — Enrollment among Alabamians in Medicaid stabilized toward the end of fiscal year 2024 and into FY2025 after a year defined by Medicaid unwinding saw more than 264,000 lose coverage since July of 2023.
Medicaid unwinding refers to the process of Medicaid agencies across the country purging their rolls after the expiration of pandemic-related federal protections in early 2023 that prohibited states from removing enrollees, regardless of their eligibility status.
The Alabama Medicaid Agency began redetermining eligibility for its, at the time, 1.36 million enrollees after federal protections expired on March 31, 2023, and began purging its rolls in July that same year. The unwinding process took approximately 12 months, concluding in July of 2024 with 254,633 less enrollees.
As of September, the final month of FY2024, there were 1.09 million Alabamians enrolled in Medicaid, 10,837 less than the 1.1 million enrollees in July when Medicaid unwinding ended, suggesting enrollment in the program has largely stabilized since the end of the unwinding process.
For the month of October, the first month of FY2025, Medicaid enrollment increased when compared to the previous month by 749, further suggesting enrollment in the program has stabilized.
More than 94 million Americans are currently enrolled in Medicaid. As of September, roughly 25.2 million Americans lost coverage since Medicaid unwinding began.
When compared to other states, Alabama ranked 19th in its disenrollment rate, losing approximately 21% of its enrollees between March of 2023 and August of 2024. Losing 33% of its enrollees over the same time period, Montana saw the highest disenrollment rate in the nation, and North Carolina, which saw its enrollment actually increase by 18%, saw the lowest.
Alabama remains one of just ten states that has yet to expand its Medicaid program eligibility under the provisions outlined in the 2010 Affordable Care Act. The program’s eligibility requirements are among the strictest in the country.
Interest in expanding Medicaid’s eligibility in Alabama has grown over the past year. In January, House Speaker Nathaniel Ledbetter, R-Rainsville, floated the idea of expanding Medicaid under a private-public partnership model, similar to that of Arkansas. Other Republican state lawmakers showed an openness to Medicaid expansion after hearing from other state lawmakers from North Carolina and Arkansas on how Medicaid expansion benefitted their own states.
Blue Cross Blue Shield of Alabama and the Alabama Hospital Association have also aggressively promoted and endorsed a plan to expand Medicaid dubbed ALL Health, a private-public partnership model of expansion that involves private insurers. Under this proposal, an additional 113,000 Alabamaians would become eligible for Medicaid.
Gov. Kay Ivey, however, has remained skeptical of Medicaid expansion, with her office telling ADN in May that her concerns over long-term costs of Medicaid expansion remained unchanged.