Despite jobs boom, no decline on Alabama Medicaid rolls

Oct. 03--A booming economy hasn't brought a decline in Alabama's Medicaid rolls, leading some advocates to speculate that the economic recovery is still leaving some Alabamians behind.

"Entry-level jobs just don't pay enough to bump a family's kids off Medicaid," said Jim Carnes, a spokesman for Alabama Arise, an organization that advocates for people in poverty.

Alabama was home to 1,021,951 Medicaid patients in August, Alabama Medicaid Agency spokeswoman Robin Rawls said Tuesday.

Medicaid enrollment first topped 1 million in June 2014. At the time, unemployment statewide was around 7 percent and a post-recession surge in Medicaid enrollment was a source of continuous alarm among state budget officials. The program had fewer than 800,000 people in its rolls before the 2008 recession, but the cost of the program surged as more people joined the Medicaid rolls.

Medicaid is a joint state-and-federal program that provides health care coverage for low-income people, most of them children, people with disabilities or nursing home residents. In Alabama, single adults almost never qualify for Medicaid, though children living below the poverty line do, and in some cases their mothers qualify as well.

Throughout the post-recession budget crises, lawmakers often said they hoped for an economic boom that would move many of Medicaid clients out of the program. Statewide unemployment in August was 4.1 percent. Except for a brief dip below 1 million in recent years, Medicaid remains where it was in 2014. One in five Alabamians uses the program.

"Our numbers are basically flat," said Rawls, the Medicaid spokeswoman.

That's not a huge surprise to Robin Rudowitz, an analyst for the Kaiser Family Foundation, a nonprofit that studies health care policy.

Rudowitz said Medicaid enrollment typically grows during recessions, with growth stopping or slowing -- often not reversing -- in better economic times.

Rising population accounts for some of that growth, she said. The Affordable Care Act, which offers uninsured people a chance to look at their options through health care exchanges, brought out new people who otherwise wouldn't have known they were eligible.

And there's a group of eligible persons, working but poor, with children, who may not see their wages rise enough to leave the program.

"They're cashiers, home health aides, servers and other people whose jobs may not offer health insurance," Rudowitz said.

Carnes, the Arise organizer, said the state might have seen better results had it raised the minimum wage. Minimum wage here is currently set at the federal minimum of $7.25 per hour, and state lawmakers have shot down efforts by local governments to raise the local minimum higher.

It's hard to say whether minimum wage laws affected enrollment in other states. All but 14 states have expanded Medicaid eligibility under the Affordable Care Act, causing enrollment to swell. Alabama didn't approve expansion. Most non-expansion states, like Alabama, also have no state-set minimum wage.

Rawls, in an email to The Star, said there could be a lag in the system's response to low unemployment because the program allows a 12-month transition off Medicaid for some people who've found employment.

"We haven't seen any dramatic shifts in the economic situation of our patients, but then, we talk mostly about their health," said Dr. Wes Stubblefield, president of the Alabama Association of Pediatricians.

Lawmakers years ago devised a new managed care system to try to stem the rising cost of Medicaid -- then abandoned the plan after realizing the state couldn't afford to set it up. Stubblefield said pediatricians are waiting anxiously to see what the replacement for the managed care plan will look like.

"We're sort of looking, watching and waiting," he said.

The state has proposed adding a work requirement for adults who are on Medicaid. That plan got a poor reception in public meetings earlier this year, where critics noted that the program covers mostly poor children. The state has sent the plan to federal officials for approval.

Asked if the work requirement would trim back the Medicaid roll significantly, Rawls said, "That is unknown at this time."

Capitol & statewide reporter Tim Lockette: 256-294-4193. On Twitter @TLockette_Star.

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