MONTGOMERY, Ala. — The Alabama Medicaid Agency continues its post-COVID “unwinding” of its rolls and more than 34,000 Alabamians were removed from the health care coverage program between March and April, according to a new report from the agency.
Medicaid unwinding refers to the process in which states have reevaluated the eligibility of their Medicaid recipients following the expiration of pandemic-era federal protections, and subsequently began removing from their rolls those no longer eligible.
Adopted with the passage of the 2021 American Rescue Plan Act, those protections prevented states from removing people from the Medicaid rolls, regardless of whether or not recipients had become ineligible for the program due to increases in pay or other factors.
Since that process began last summer, Alabama Medicaid enrollment dropped from its peak of 1.38 million in June of 2023, to 1.15 million in April of this year, representing a loss of Medicaid coverage for at least 228,594 Alabamians, a nearly 17% cut in enrollment.
On average, roughly 23,000 Alabamians have lost Medicaid coverage every month since last June, though enrollment loss had slowed in recent months.
The AMA does not disclose why recipients were removed from Medicaid. While a significant amount may be due to recipients no longer being eligible for the program, a sizable portion may also be due to procedural reasons, including failures to file the proper paperwork.
Medicaid is the state’s largest General Fund budget expense, with a record $955 million allocated for fiscal 2025, up more than $91 million from this year. The agency received a total of $9.2 billion for fiscal 2024, most of it coming from federal sources.
From October to March, the monthly loss in enrollment saw four consecutive months of decline, with March having the lowest monthly purge since unwinding began, with just 9,869 losing enrollment.
Stephanie Azar, AMA commissioner, had previously projected the unwinding process to take roughly a year, however, suggesting that AMA enrollment figures should stabilize after the agency’s next monthly report.
Of the 34,026 Alabamians that lost Medicaid between March and April, 19,636 of them were women, and 13,485 were men, which tracks with the breakdown of Medicaid recipients in Alabama, roughly 60% of them being women.
When broken down by ethnicity, black Alabamians, who make up roughly 27% of the state’s population but nearly 38% of Medicaid recipients, represented roughly 35% of those who lost Medicaid coverage between March and April.
White Alabamians represented 48% of those who lost Medicaid coverage in April, whereas Hispanic Alabamians made up just under 4%.
In total, 7,351 of the 34,026 Alabamians that lost Medicaid coverage were between the ages of 22 and 39. The age range with the next-highest loss of coverage were those aged 19 to 21, who represented 6,829 of the 34,026 that lost coverage.
More than 23 million people nationwide have lost Medicaid coverage during the unwinding process, with there being a wide variation in disenrollment rates across the country, ranging from 56% in Utah to 13% in North Carolina.
Alabama remains one of ten states to have not expanded Medicaid to extend coverage to those making up to 138% of the federal poverty level, which as of this year, would be an annual salary of $20,783 for an individual, or $43,056 for a family of four.
As it stands today, Alabama has among the strictest Medicaid eligibility criteria in the nation, and is available only to those who meet certain qualifiers such as being pregnant, blind or having a disability. Furthermore, those with a qualifying condition must still adhere to strict income caps.
Alabama state lawmakers are currently exploring the idea of expanding Medicaid in the state, albeit through a private-public model similar to that of Arkansas’ Medicaid expansion.
The ultimate decision rests with the governor, however, with Gov. Ivey’s office telling Alabama Daily News in May that she remains skeptical on the idea of Medicaid expansion, citing concerns related to long-term costs.