While all 50 states plus Washington, D.C., provide Medicaid for their citizens, each state provides differently. Some states are right on the heels of the federal government, enacting new policies and expansion measures as soon as they’re passed, while others have stayed behind, preferring to make their own way in the health insurance industry. Alabama is one of the latter types.
Current State of Alabama Medicaid
As of March 2020, Alabama lawmakers have still chosen to not expand Medicaid under the Affordable Care Act (ACA). About 900,000 residents currently have access to healthcare under Alabama Medicaid, but another estimated 314,000 would gain access to it if Alabama did choose to expand coverage under the ACA. Of the 4.7 million people in Alabama, 36 percent are low-income (earning less than 200 percent of the federal poverty level) and 21 percent are covered by Medicaid/CHIP. An estimated 140,000 Alabama residents live in poverty but have no real access to healthcare.
As Alabama Medicaid policies currently stand, children making approximately 317 percent of the federal poverty level are eligible for Medicaid/CHIP. Pregnant women making 146 percent, seniors and individuals with disabilities making 74 percent and parents of caretaker relatives (POCRs) making 18 percent of the federal poverty level are eligible for Medicaid. No childless adults are currently eligible.
One of the most significant aspects to watch about Alabama Medicaid eligibility is its prospective work requirements policy. Back in early 2018, Alabama proposed a Medicaid waiver that, if approved, would set in place one of the most stringent work requirement policies in the nation. It would require POCRs, or non-disabled adults with children in their care, to work 20 to 35 hours a week depending on the ages of their children. This is a big difference from other states in which the maximum work requirement is 20 hours per week for childless adults, and in which adults with children have a full exemption from work requirements.
Since the current income standard of Alabama Medicaid for this part of the population is 18 percent or less of the federal poverty line, this work requirement would mean that any non-disabled adult with minor children who begins to work 35 hours a week at minimum wage ($7.25 in Alabama) would soon lose coverage, as they would be making more than the Medicaid eligibility limit.
These regulations and the proposed work requirements are still hotly contested and have not been passed yet, as of March 2020. Part of the reason that Medicaid is such a battleground in Alabama is that there are no other options available for low-income parents to receive healthcare, aside from attempting to enroll through the Marketplace. Additionally, even with 35 hours of work gathered from two part-time jobs, most adults would still not receive health insurance from their employers.
How DECO Can Help
Medicaid has been a difficult topic in the US government for years, and many healthcare organizations struggle to understand it, particularly due to its high rate of change and expansion. But we at DECO make it a priority to stay up-to-date on healthcare policies so we can help healthcare organizations get reimbursed for the care they have provided. We have even created a state-by-state Medicaid regulations guide to help determine eligibility. If you need help understanding Medicaid or any other part of the revenue cycle management process, contact us today!