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Medicaid unwinding in Alabama slows down as total removed from program surpasses 195K

MONTGOMERY, Ala. — Medicaid enrollment in Alabama dropped by nearly 10,000 between February and March of this year according to the latest monthly report from the Alabama Medicaid Agency.

In total, 195,568 Alabamians have lost Medicaid coverage since June of 2023, the program’s peak enrollment before the agency began purging its rolls after the expiration of COVID-related federal protections, often referred to as the unwinding process.

On average, more than 20,000 Alabamians were removed from Medicaid every month since June, making March’s nearly 10,000 drop in enrollment the lowest monthly purge since unwinding began last summer, signaling an end to the unwinding process in the state.

At the onset of the COVID pandemic, federal rules prohibited Medicaid recipients from being removed from the low-income health care program, regardless of income or employment changes that would have otherwise made recipients ineligible.

Once those federal protections expired in the spring of 2023, states across the country began purging their Medicaid rolls of those who were no longer eligible do to employment and income status. That has led to more than 22.3 million Americans no longer having Medicaid coverage as of May.

Of the 9,869 Alabamians that lost Medicaid coverage between February and March, 7,073 were men and 2,147 were women, an inverse of recent months’ trends given that nearly 60% of Medicaid recipients in Alabama are women.

The majority of those who lost Medicaid coverage between February and March were white, representing 5,455 of the 9,869 booted from Medicaid. Black recipients represented 22.6% of those who lost coverage in March, and Hispanics, .08%.

However, Black Alabamians represent a disproportionate number of those enrolled in the program relative to their population in the state, representing 37.7% of Medicaid recipients as of February, despite representing 28% of the state’s population.

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.

Alabama remains among ten states in the country not to have expanded its Medicaid program to cover those making up to 138% of the federal poverty level, a threshold that would entitle the state to significant federal funding under the 2010 Affordable Care Act.

While Alabama Democratic lawmakers have long advocated for Medicaid expansion, Republican state lawmakers, who historically have been opposed to Medicaid expansion over cost concerns, have recently expressed an openness to the idea after attending a Medicaid expansion briefing with lawmakers from South Carolina and Arkansas in April.

Expanding Medicaid in Alabama would make close to 300,000 Alabamians eligible for the program, extending coverage to those making up to $20,783 a year.

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