MONTGOMERY, Ala. — A total of 251,734 Alabamians have been removed from Medicaid since last summer following the expiration of pandemic-era federal protections according to a new report from the Alabama Medicaid Agency.
Based on Medicaid enrollment in May, the new report shows roughly 1.1 million Alabamians were still enrolled in the low-income health care program, down by more than a quarter million when compared to the program’s peak enrollment of nearly 1.4 million in June 2023.
May’s report also represents a decline in enrollment of 22,140 when compared to the month prior, for an average monthly enrollment decrease of around 22,500 since last summer. In total, enrollment saw a nearly 18.3% cut from its peak last year.
Similar to other states, Alabama’s Medicaid enrollment has steadily declined since last summer due to the expiration of federal protections that were established under the 2021 American Rescue Plan Act, a process referred to as Medicaid unwinding.
Under those protections, states were prohibited from booting people off of their Medicaid programs regardless of eligibility changes.
Once those protections expired last summer, however, Medicaid agencies across the country have been sifting through their rolls to redetermine eligibility, and removing those whose income or other changes make them no longer eligible.
In total, 24.6 million Americans have lost Medicaid coverage since last summer.
While the Alabama Medicaid Agency does not disclose why enrollees were removed from its rolls, it’s typically done because either a recipient was no longer eligible for the program, or due to procedural reasons, such as failing to file the proper paperwork.
Of the 22,140 that lost Medicaid coverage between April and May, 12,948 of them were women, and 8,328 were men, tracking closely with the demographics of Medicaid recipients in Alabama, roughly 60% of which are women.
White Alabamians made up the largest share of those who lost Medicaid coverage between April and May at 43%, however, black Alabamians, who make up around 27% of the state’s population, made up 37% of those who lost coverage during that period.
Hispanic Alabamians represented just under 4% of those who lost Medicaid coverage between April and May.
In terms of age, adults made up the majority who lost Medicaid coverage between April and May at 14,129, or 64%, whereas there were 8,011 children who lost coverage during that period. However, Alabama has among the lowest rates of uninsured children due to alternative state programs like ALL Kids, which as of May covered nearly 89,000 children.
Alabama’s shrinking Medicaid rolls, as well as the state’s strict eligibility criteria, among the strictest in the nation, has led to continued calls from some Democratic lawmakers and advocates for the state to expand its Medicaid program.
Expanding Medicaid under the provisions of the 2010 Affordable Care Act, of which Alabama remains one of ten states that has yet to do so, would expand eligibility to those making up to 138% of the federal poverty level, which currently would be a salary of $20,783 for an individual.
State lawmakers have begun to explore the idea of expanding Medicaid in the state through a private-public model, however, Gov. Kay Ivey, whose office holds the authority to expand Medicaid, has remained skeptical at the prospect of expansion, citing concerns over costs.
The Alabama Medicaid Agency remains the state’s largest General Fund budget expense, with a record $955 million being allocated for fiscal year 2025, an increase of $91 million from the current year.