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Alabama starts removing people off Medicaid, but won’t yet say how many

The Alabama Medicaid Agency could remove as many as 120,000 Alabamians from the state health care program in the coming months as states purge enrollment for the first time since the COVID-19 pandemic.

The agency won’t say how many people have been removed since the eligibility review began in the spring.

During the onset of the COVID-19 pandemic, the federal government prohibited states from removing people off of Medicaid, even if individuals’ life situation changed to where they no longer met the financial eligibility criteria. The federal provision expired on March 31, however, and the agency is now checking the eligibility of the more than one million people enrolled in the program.

While the AMA has published its eligibility statistics for April, it has not made termination statistics public since the March 31 end of continuous enrollment. Alabama Daily News requested that data from the AMA recently.

“The Alabama Medicaid Agency is not publishing termination statistics at this time since we are in the first month of terminations now,” wrote Melanie Cleveland, communications director for AMA. “These recipients have 90 days from their termination to reinstate their coverage if they are still eligible.”

Alabama has among the strictest Medicaid eligibility requirements in the country. For children and pregnant women to qualify for Medicaid, a family of four this year has to earn $43,800 or less. But in order for a caregiver of a child on Medicaid to qualify for care, their income has to be much less, about $5,400 a year in a family of four.

Nearly 1.4 million Alabamians were eligible to receive Medicaid as of April, 2023, with approximately 1.2 million enrolled in the program in March. Those enrollment numbers, however, could fall over the next 12 months, with more than a million already losing Medicaid coverage across the country. Medicaid leaders previously said the “unwinding process” will take about a year in Alabama. 

Even with the current record-high Medicaid enrollment in the state, Alabama has among some of the poorest health outcomes in the country.

A recent report from Georgetown University Health Policy Institute found that one in six women aged 18-44 lacked health care coverage, the fifth-highest uninsured rate in the country. The state also has the third-highest maternal mortality rate according to data spanning from 2018 – 2020, and 29 of the state’s 54 rural counties lost hospital obstetric care providers between 1980 – 2019.

Alabama lawmakers have made some progress in addressing the state’s poor health outcomes and barriers to health care, with the Legislature last year extending postpartum coverage through Medicaid from 60 days to a full year.

For some groups, however, such as the Medicaid expansion advocacy group Cover Alabama, steps like that aren’t sufficient.

“State leaders showed they’re willing to address Alabama’s maternal health crisis when they extended Medicaid postpartum coverage last year,” said Debbie Smith, Cover Alabama campaign director. 

“However, these findings show that this step alone is not enough to help mothers and families stay healthy. Alabama should take the next logical step to protect women’s health and expand Medicaid coverage for adults with low incomes. We urge Gov. Kay Ivey and legislators to make Alabama a better place for parents and babies by expanding Medicaid.”

Medicaid expansion has been pushed by Democrats in the Alabama Legislature for years, to little success in the Republican-controlled House and Senate. Opponents to expansion routinely point to costs as a reason to not expand the program, whereas proponents argue the majority of the costs are offset by federal funding that’s awarded to states for expanding Medicaid.

Medicaid expansion bills had been carried for years by former Rep. John Knight of Montgomery. After Knight left office in 2018, Medicaid expansion bills have been carried every year by Rep. Mary Moore, D-Birmingham, who told Alabama Daily News she intends to continue to carry Medicaid expansion bills every year.

“The number of counties that don’t have prenatal care… it’s just staggering in this state, and then people will refuse Medicaid expansion when the health care is so needed,” Moore said. “And it would help with job development; companies don’t want to invest in many areas of Alabama because we don’t have health care.”

For now, Blue Cross and Blue Shield of Alabama, the state’s largest private insurance provider, is urging those being removed from Medicaid to check their eligibility status.

“More than 120,000 Alabamians are at risk of losing Medicaid, and approximately 61,000 Alabamians unfortunately may not have access to any other type of coverage,” the provider said in a statement late last month. However, as many as 69,000 will be eligible for coverage either under an Affordable Care Act health plan, employer coverage, or a Medicare plan, BCBS said.

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