Almost 200K Alabamians removed from Medicaid

MONTGOMERY — As the Alabama Medicaid Agency continues its unwinding process of redetermining the eligibility of the state's more than 1.1 million Medicaid recipients, nearly 186,000 Alabamians have been removed from the low-income health insurance program since last summer.

The latest figures come from a new report from the agency on enrollment in February, which shows 17,887 fewer Alabamians enrolled in the program when compared to January.

On average, more than 20,000 Alabamians have lost Medicaid coverage each month since last June.

Like other states, Alabama Medicaid has been sifting through its rolls since last summer after the expiration of COVID-related federal protections that prohibited states from booting people from their Medicaid programs.

Since the expiration of those protections, more than 20 million Americans have lost coverage, nearly a quarter of which remain uninsured, per a survey from The Kaiser Family Foundation released last Friday.

The AMA does not publish why individual recipients were removed from the program, though reasons can be procedural, such as failing to file the proper paperwork, or exceeding income eligibility caps, which in Alabama are among the strictest in the country.

Only those with certain qualifiers, such as being pregnant, blind or having a disability, are eligible for Medicaid coverage in Alabama. Furthermore, recipients must not exceed strict income caps, which for an individual is $964 a month, or $1,436 for couples.

Other causes for losing Medicaid coverage include individuals securing insurance through the private sector, moving out of state, or exceeding eligibility income caps.

In Jefferson County, Alabama's most populated county, 2,154 residents lost Medicaid coverage between January and February, per the new report, and 23,973 residents since last June.

In Mobile County, 1,610 lost coverage between January and February, and 980 lost coverage in that same time frame in Montgomery County.

While the average monthly decrease in enrollment of more than 20,000 has remained steady, AMA Commissioner Stephanie Azar has projected the unwinding process to take roughly a year, meaning the monthly purge of around 20,000 Medicaid recipients is expected to slow sometime in the coming months.

Of the 17,887 that lost Medicaid coverage between January and February, 10,910 of them — approximately 61% — were women, who, at Alabama's peak in Medicaid enrollment last June, made up about 59% of all Medicaid recipients.

Black Alabamians also made up a disproportionate number of those who lost coverage between January and February. While Black Alabamians make up approximately 27% of the state's population, they made up almost 38% of those who lost coverage during that period.

A frequently called-for solution to the state's growing population of uninsured residents has been for the state to expand its Medicaid program, with Alabama remaining just one of 10 states having yet to do so under the 2010 Affordable Care Act, commonly referred to as Obamacare.

Were Alabama to expand its Medicaid program under the requirements of the ACA, individuals making up to $20,783 would become eligible for the program and would not be required to meet the state's disability qualifiers.

Medicaid expansion in Alabama is estimated to cover an additional 300,000 Alabamians.

Lawmakers were briefed earlier this year on a proposal to expand Medicaid through a private-public partnership model, a proposal that House Speaker Nathaniel Ledbetter, R-Rainsville, suggested he might be in support of.

Developed by Blue Cross and the Alabama Hospital Association, the Medicaid expansion proposal was projected to not require any state spending for a minimum of five years, though likely 10, given the significant federal financial assistance provided to states that expand their Medicaid programs.