Issue: Health

HB 89 and SB 102 would improve maternal health, save money and save lives in Alabama

By Jennifer Harris

Presumptive eligibility allows doctors and other providers to determine Medicaid eligibility for expectant mothers who are likely to be eligible. This allows women to begin receiving Medicaid coverage in the first trimester without having to wait for the agency’s official eligibility decision.

More than 50% of expectant mothers in Alabama are eligible for Medicaid coverage for prenatal medical care crucial for the health of both mother and child. Yet that care is regularly delayed because Alabama doesn’t have a timely procedure to allow many mothers to get prenatal care.

HB 89 by Rep. Marilyn Lands, D-Huntsville, and SB 102 by Sen. Linda Coleman-Madison, D-Birmingham, would allow expectant mothers to receive Medicaid coverage earlier in the pregnancy, when health care is essential for the mother and child. These bills would expand presumptive eligibility and reduce red-tape barriers to coverage.

Why do we need presumptive eligibility?

The wait for Medicaid’s official eligibility approval can prevent mothers from receiving care earlier in their pregnancy. Areas with a lack of maternal health care access compound this issue, increasing the cost of higher-risk pregnancies and deliveries.

Presumptive eligibility allows up to 60 days of Medicaid coverage for women who have not yet been formally approved for coverage but who submit proof of pregnancy and household income information to their maternity care provider. This would allow mothers to see a doctor, receive pregnancy verification and begin prenatal care while the Medicaid approval process is ongoing.

What are the benefits of presumptive eligibility? 

  • Alabama has some of the nation’s highest rates of infant mortality, maternal death and low birth weight. Maternal mortality is higher among patients with late or no prenatal care. 
  • More than 1 in 4 pregnant women (27%) do not receive prenatal care until the second trimester, according to the March of Dimes. This can lead to costlier care later in pregnancy or postpartum. 
  • Receiving prenatal care in the first trimester can improve outcomes and save millions of dollars by diagnosing and treating conditions that may worsen over time without medical attention, thereby reducing risk for maternal and infant death or severe complications. 
  • The state cost for presumptive eligibility – just $273,700, according to the fiscal note – is small compared to the potential savings, both in dollars and especially in lives.

What can the Legislature do to help?

Vote “yes” on HB 89 and SB 102 to improve maternal health, save money and save lives in Alabama.

Alabama at risk from threatened federal funding cuts

By Chris Sanders

Congress this week likely will begin considering budget resolutions that could set the stage for severe cuts to Medicaid, food assistance and other human services. These funding cuts would finance efforts to renew or expand tax cuts for wealthy people and highly profitable corporations. Alabama Arise executive director Robyn Hyden issued the following statement Monday in response:

“It’s wrong to hurt people who are struggling to help people who are already doing well. But Congress is expected to vote soon on budget and tax legislation that would do exactly that.

“Congress must decide this year whether to renew the 2017 federal tax cut law, which provided tax breaks that overwhelmingly benefited wealthy households and highly profitable corporations. To offset the cost of these tax giveaways, Congress would have to slash funding in other areas. And many of those proposed service cuts would make life worse for Alabamians who struggle to make ends meet.

“The damage could be severe for hundreds of thousands of people across our state. As many as 1 in 5 Alabamians enrolled in Medicaid could lose their health coverage due to cuts and onerous work reporting requirements. Many more people could see food assistance reduced or eliminated. Other potential targets for cuts include school meals, the Child Tax Credit and tax credits for Affordable Care Act coverage.

“These cuts could cause more economic harm in our state than in most others, because Alabama receives far more federal dollars than we pay in taxes to the federal government. In 2022, Alabamians got a return of $2.01 for every dollar in federal taxes paid per capita. That ranked Alabama as the nation’s seventh-highest beneficiary of federal funds.

“As Alabama Arise and 55 partner organizations wrote last month to Alabama’s congressional delegation, Congress should put the future and well-being of all of us ahead of tax cuts for the wealthy and well-connected. Our lawmakers should reject harmful service cuts for working people and tax giveaways to wealthy households. And they should focus instead on building an economy that works for everyone in Alabama and across our country.”

How federal funding improves the quality of life in Alabama

Alabama receives a wide array of federal funding to support and maintain public infrastructure, programs and services. This funding is administered at the state, regional and local levels. Alabama benefited from more than $14.5 billion in federal funds in fiscal year (FY) 2024. Here are a few key examples:

  • $8.1 billion for health and human services, including Medicaid, the Children’s Health Insurance Program (known as ALL Kids in Alabama), Head Start, child care subsidies, child welfare and child protective services, HIV/AIDS prevention, opioid and substance use disorder treatment programs, and supportive services for older adults and people with disabilities.
  • $2.86 billion for nutrition and agriculture programs, including the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), school meal programs, emergency food assistance, cooperative extension services and agricultural research.
  • $1.4 billion for transportation, including funds for highways, railways, airports and bridges.
  • $1.35 billion for education, including Title I programs, Pell Grants, special education programs and 21st Century Community Learning Centers.
  • $318 million for housing and urban development programs, including homeownership programs, Community Development Block Grants and assistance for people facing homelessness.
  • $142.1 million for environmental protection, including grants to support clean water, clean air, pesticide management and enforcement of hazardous waste disposal.
  • $110 million for fish and wildlife programs and other programs supported by the Department of the Interior.
  • $92.4 million for the Tennessee Valley Authority.
  • $82 million for workforce development programs, including jobs programs for veterans, unemployment insurance and Workforce Innovation and Opportunity Act (WIOA) programs.
  • $23.8 million for Department of Justice programs, including sexual assault investigations, supports for crime victims and programs to prevent violence against women.
  • $12.6 million for homeland security.
  • $4.7 million for energy assistance and weatherization programs.
  • $2.1 million from the National Endowment for the Arts.
  • $1 million to support election administration.

More resources

View a full breakdown of federal funds that Alabama received in FY 2024.

Read the letter from Alabama Arise and 55 partner organizations urging Alabama’s congressional delegation to oppose further tax cuts for wealthy people.

Arise legislative update: Week of Feb. 3, 2025

By Matt Okarmus

Arise’s David Stout welcomes everyone to the Alabama Legislature’s 2025 regular session. Watch to see what to expect and learn about parental leave, school breakfast and other key issues where we hope to make progress this year.

Remember to sign up for our action alerts. And you can read more about our 2025 legislative priorities.

Full transcript below:

Hello, I’m David Stout, the legislative director for Alabama Arise, and I’m here to give you a brief look at the upcoming 2025 legislative session. The session begins Tuesday, Feb. 4, and the Constitution prescribes that the Legislature must meet over 105 days. There are actually 30 so-called working days where they meet, debate, and vote on bills in a session.

There are many issues that are very important to Arise members, and we need to be aware of them and be able to give our input as this session proceeds. During the first week, the budget presentations before the Legislature will occur on Feb. 5 and Feb. 6. These budget hearings, for the first time, are wrapped into the session and will include presentations by financial directors, state departments, education— a whole variety of departments in state government.

Especially important this year, and critical to making Alabama a better state, are three key issues that Arise will be working on. One is parental leave, which we hope will give parental leave for the first time in Alabama to state employees and educators. Secondly, we will be offering a plan to incentivize schools to provide breakfast for all students in public schools in Alabama. Lastly, we will continue our efforts to see that Alabama joins the majority of other states and expands Medicaid to give health coverage to over 200,000 Alabamians who do not have it.

Arise will also be working on a broad agenda in the Legislature, including criminal justice reform, seeking funds for public transportation, maternal and infant health care, voting rights, death penalty reform, and pushing to take more taxes off groceries.

We will keep you posted as we move through this session. It’s extremely important that you stay engaged, and the way to stay engaged is to be conscious of the Arise action alerts. We hope you participate, we hope you contact your legislators, and we think it’s important that you meet with your legislators personally. It’s going to be a difficult session, but Arise is working, we think, for the betterment of the people of Alabama.

Arise 2025: How we’re working to build a better Alabama

By Alabama Arise

Alabama Arise believes in dignity, equity and justice for all. We believe in an Alabama where everyone’s voice is heard and everyone has the opportunity to reach their full potential. And we believe better public policies are the key to building a brighter future for our state.

Below, we’ll share some details of that vision with you before the Alabama Legislature’s regular session begins Feb. 4. We’ll focus on the crucial legislative priorities on our 2025 roadmap to change.

Graphic listing Alabama Arise's 2025 legislative priorities: Arise's roadmap to a better Alabama. The priorities are untaxing groceries, Medicaid expansion, voting rights, criminal justice reform, maternal and infant health, public transportation and death penalty reform.

It’s time to close Alabama’s health coverage gap

For more than a decade, Alabama has been outside looking in on a good deal. While hundreds of thousands of Alabamians continue to struggle without health insurance, state leaders have failed to expand Medicaid. A few loud voices have politicized an issue that never should have been political. And our state has paid the price in lost dollars, lost jobs and lost lives.

Alabama is one of 10 states that has yet to expand Medicaid. That inaction has left hundreds of thousands of Alabamians in a health coverage gap. We’re advocating to make this the year when our state closes that gap.

READ MORE – An Alabama solution: Closing the health coverage gap

Finish removing the state grocery tax

Alabama’s state sales tax on groceries is a cruel tax on survival, and Arise is committed to eliminating it. We were thrilled to see lawmakers pass legislation in 2023 to cut the state grocery tax in half after decades of persistent advocacy by our members. And we’ll continue advocating to remove the rest of the tax sustainably and responsibly. We’re grateful to serve on a state commission that is studying policy pathways to end the state grocery tax while protecting vital funding for public schools.

WATCH – The path forward in Alabama Arise’s work to untax groceries

Fund public transportation to improve life for all Alabamians

Alabama’s labor force participation rate is among the nation’s lowest. Only 58% of working-age adults reported they were actively working or looking for jobs as of November 2024. Our state also has nearly 100,000 more job openings than workers available to fill them. Yet 31% of Alabama job seekers cite transportation issues as the reason they are unemployed or underemployed, according to a study commissioned by the governor’s office.

Unfortunately, Alabama is one of only three states that has no state funding set aside to support public transportation. Alabama Arise will advocate for that to change during this legislative session.

READ MORE – Fund public transportation to improve life for all Alabamians

Expand voting rights to right past wrongs and safeguard democracy in Alabama

Voting rights are the foundation of our democracy, and we should do everything we can to protect them. However, since the U.S. Supreme Court stripped away federal preclearance of voting law changes in 2013, the Legislature has passed several harmful laws to create unnecessary barriers to voting rights in Alabama. This included 2024’s SB 1, which created a chilling effect for people trying in good faith to help Alabamians with absentee voting. Arise will advocate instead for positive steps to support voting rights, including passage of the Alabama Voting Rights Act, which would protect absentee voting and clarify voting procedures. Additionally, lawmakers will introduce bills to remove barriers to voting rights restoration for citizens released from incarceration.

READ MORE – Expand voting rights to right past wrongs and safeguard democracy in Alabama

It’s time for Alabama to prove we care about mothers and children

Healthy parents and healthy children mean a healthier future for Alabama. Comprehensive maternal and infant health care investments are crucial to ensure the health and safety of both infants and Alabamians of child-bearing age, especially postpartum mothers, pregnant women and future mothers. Lawmakers have numerous policy options to increase the number of health care providers and extend health coverage to more parents.

READ MORE – The Alabama Maternal Health Toolkit

School breakfast for all: What Alabama can do to help feed all of our kids

School breakfast for all would help reduce child hunger in Alabama, and it would go a long way toward the goal of guaranteeing a morning meal for every child in our state. School breakfast’s benefits are wide-ranging: It helps address chronic absenteeism, improves adolescent mental health, alleviates behavioral problems and improves test scores. Alabama Arise is pushing for a $16 million appropriation from the Education Trust Fund to ensure every district can pull down the maximum federal funding, and to give local schools the opportunity to offer no-cost breakfast for all Alabama children.

READ MORE – School breakfast for all: What Alabama can do to help feed all of our kids

Alabama’s death penalty practices remain unjust and unusually cruel

Americans increasingly oppose the death penalty. Gallup found that opposition to the death penalty more than doubled in the past 25 years. This may result from disturbingly high error rates in the system. For every 10 people executed since 1976, one innocent person on death row has been set free.

Alabama took an important step toward death penalty reform in 2017 by banning judicial overrides of juries’ sentencing decisions, and we will aim to work this session to make that ban retroactive. But the state’s death penalty scheme also remains broken in many other ways.

READ MORE – Alabama’s death penalty practices remain unjust and unusually cruel

Alabama’s parole system is still broken. How can we fix it?

The state’s parole system is a failure in both its design and in application of its own rules. We need to increase parole board oversight and eliminate racial disparities in parole. People also deserve to be able to attend their own parole hearings.

Arise’s suggested changes would be an important step in the direction of a more just Alabama, and they would mitigate some of the problems plaguing our state’s prison system overall.

READ MORE – Alabama’s parole system is still broken. How can we fix it?

Paid parental leave improves life for Alabama workers

Like any employer, our state should ensure its workers have jobs that support their ability to care for their families. The teachers, social workers and many other state employees who help look after our children and who build up Alabama for all the families in the state should be able to create and grow their own families without scrambling to pay the bills.

Paid parental leave is a common-sense policy that helps workers care for their families while maintaining their careers and financial well-being. State officials often have said Alabama is pro-family. Ensuring that teachers and state employees have paid parental leave is an important step to prove it.

READ MORE – Paid parental leave improves life for Alabama workers

School breakfast for all: What Alabama can do to help feed all of our kids

By Alabama Arise

By Carol Gundlach, senior policy analyst, and LaTrell Clifford Wood, hunger policy advocate | January 2025

Overview

Alabama can and should do more to equip our children and our schools for success. One big step would be to provide school breakfast for all our children. And our lawmakers can make major progress toward that goal this year with a modest allocation from the Education Trust Fund (ETF) budget.

Alabama Arise is recommending an ETF appropriation of $16 million to support public schools, including public charter schools, that wish to provide breakfast to all their students. 

From this amount, each of the 1,459 Alabama schools participating in the National School Lunch Program would be eligible to receive a $5,000 base grant to upgrade their food service capacities.

The remaining $8.7 million could be distributed to eligible schools to bring their breakfast service reimbursements to the maximum possible federal level.

The benefits of school breakfast

Children who start the day with breakfast learn better, participate more in class and are less likely to skip school than are kids who don’t get breakfast. But tight family budgets, busy mornings and before-daylight bus routes can mean many children arrive at school hungry. School districts across the country have found that breakfast for all children, served after the first bell, reduces hunger and helps kids learn.

It’s time for Alabama’s school districts to join their peers nationwide in feeding breakfast to all of our kids. Here are just a few of the benefits:

School breakfast reduces child hunger across our state. In Alabama, 23% of school-age children are food insecure, meaning they do not always have enough to eat or know when they will get their next meal. That rate is even higher among children of color. School breakfast could guarantee a morning meal for all Alabama children during the school day. School breakfast for all kids also allows schools to experiment with food delivery services like grab-and-go kiosks or breakfast in the classroom that increase participation and make sure kids are ready to start the day.

School breakfast reduces chronic absenteeism. Nearly 1 in 5 Alabama children have been chronically absent from school, and 53% of Alabama schools have high absenteeism rates. Research has shown that students who get breakfast at school have improved attendance and decreased tardiness, according to the Food Research and Action Center. 

School breakfast improves standardized testing and math scores. Alabama ranks 48th in average math ACT scores. Academic achievement improves, especially for math, when breakfast is available for school-age children.

School breakfast reduces behavioral problems. Child hunger contributes to impulsivity, hyperactivity, irritability, aggression, anxiety and substance abuse, according to the National Institutes of Health. Reducing hunger would reduce these behaviors.

How Alabama lawmakers can help feed children

The Alabama Legislature can help schools offer school breakfast for all children.  The Legislature can help feed Alabama’s schoolchildren by appropriating ETF dollars to match federal funds for school breakfast. Schools that choose to offer breakfast to all their children can use these matching funds to give all their students breakfast at the start of the school day. Thirty-five other states are considering similar legislation, and eight states have approved some form of school meals for every child.

How is school breakfast funded now? Many schools already provide breakfast for all children, but other schools need state help. Some Alabama schools offer breakfast to income-eligible children under the traditional federal School Breakfast Program, administered by the Alabama State Department of Education. 

Schools with a significant number of low-income children can receive the maximum federal reimbursement for all meals served. But some Alabama schools can’t make the federal reimbursement rate work for them without additional state or local dollars. And some Alabama schools would like to offer breakfast for all their children but don’t want to deal with federal regulations that might impact their Title 1 distribution to local schools.

Bottom line

Providing school breakfast at all public schools would be an important step to improve child nutrition and student success. An ETF budget appropriation of approximately $16 million would allow Alabama schools to be made whole if they can’t receive the maximum federal reimbursement for these meals. This support for school breakfast for all would help children grow, thrive and learn across Alabama.

‘It shouldn’t be like this’

By Whit Sides
Standing, posed photo of Florence Dutch
(Photo by Whit Sides)

Florence Dortch, 60, of Vredenburgh (Monroe County)

Florence has been uninsured for 22 years. Lately, she’s been receiving care from a rural health clinic in Monroeville, where she pays out of pocket for help with her arthritis, high blood pressure and monitoring her prediabetes. She has trouble affording her medications but is able to continue taking her prescriptions for now with help from her sister. 

“I make it work because I have to. I try not to think about how long I’ve been living like this, because it’s not great. It’ll get you down. I rely on a lot of help from the community, but it shouldn’t be like this, because I’m not the only one.”

Florence has a few more years until she’s eligible for Medicare. Because she works, she doesn’t meet Alabama’s stringent income eligibility requirements for Medicaid.

“If working people could get the coverage they deserve, we wouldn’t even be where we are now. Here in the Black Belt, or anywhere else.”

‘I just want to go to the doctor’

By Whit Sides

Standing, posed photo of Kiana George

Kiana George, 29, of Camden

“I felt like with Medicaid, I got the best care I’ve ever had, and I could afford the copays. I didn’t have to worry about racking up debt just for going to the doctor.”

Kiana is a child care provider working in Camden. She recently lost Medicaid coverage during the state’s “unwinding” period after learning she was “earning too much” at the day care center, leaving her in Alabama’s health coverage gap.

After she sought urgent care for polycystic ovarian syndrome, out-of-pocket bills for diagnostic labs and imaging left her with thousands of dollars in medical debt.

“I get these bills in the mail, and it’s so much stress. I don’t like owing people money. So I just don’t get help even when I’m in pain.”

Kiana visits free clinics offered at local health fairs but says the care is limited. She’s worried about needing care when she’s not close to home, or facing another medical emergency and collecting even more medical debt.

“I really wish Alabama would expand Medicaid. I just want to go to the doctor. I feel like without coverage, by the time I do get to the doctor, it is too late, and everything is way out of hand.”

‘Coverage needs to be affordable for everyone’

By Whit Sides
A standing, posed photo of Valerie Cochran.
(Photo by Whit Sides)

Valerie Cochran, 61, of Camden

“We’re all gonna get sick. That’s life. But coverage needs to be affordable for everyone.”

Valerie is disabled, living without health coverage in rural Wilcox County. After 30 surgeries, she’s got thousands of dollars in medical debt.

During a routine colonoscopy, doctors removed a tumor in Valerie’s stomach. After receiving the hospital bill, she became so worried about the cost of follow-up care at the cancer center that she chose to delay treatment. Valerie hopes to get Medicare coverage through SSDI after she turns 62 later this year. Until then, her options are limited.

“Medicaid expansion would make a world of difference for me, and other people like me. With my issues, I should be taking care of my health, not living in fear of how much it’s going to cost to take care of myself.”

The Alabama Maternal Health Toolkit

By Alabama Arise

 

A black and white photo of a pregnant woman holding her stomach. Above is a dark blue background with an Alabama Arise logo and white text reading "The Alabama Maternal Health Toolkit: Birthing Better Outcomes in Alabama, January 2025."

 

“To improve maternal health, we have to focus on improving all women’s health and access to care – not just during labor and delivery, but before and after pregnancy, and throughout our lives.” – Dr. Leana S. Wen

Download a full PDF copy of The Alabama Maternal Health Toolkit here. You also can access the PDF by clicking the “Download” button at the top of the page.

Table of contents

Introduction

Welcome to The Alabama Maternal Health Toolkit! Alabama Arise created this resource with one primary goal: to support and empower you as you navigate the complexities of maternal health care in Alabama. Whether you’re a new mom, an expectant mother or a health care advocate, this toolkit is designed to provide you with critical information on maternal health, Medicaid coverage, health care access and community resources.

Our hope is that this guide will help you understand available health care options and provide the confidence you need to take the next steps in securing and maintaining necessary care. We are committed to improving maternal health outcomes and supporting families across our state. We’re here to help guide you through every step of the way.

We encourage you to share this toolkit with others who may benefit. Together, we can build a healthier future for all Alabama mothers and their families.

Background

Maternal health in Alabama faces serious challenges. Alabama has some of the highest rates of maternal mortality and preterm births in the United States. Limited access to comprehensive health care worsens these disparities, especially for women in underserved and rural communities. Medicaid plays a critical role in addressing these gaps by covering more than half of all births in Alabama. However, many women still lack the continuous care they need.

Key statistics

  • Alabama has the third highest rate of maternal mortality in the nation.
  • 1 in 2 births are covered by Medicaid in Alabama.
  • Black women are three times more likely to die from pregnancy complications.

Maternity care access in Alabama

Alabama has one of the United States’ highest rates of maternity care deserts, defined as areas where access to maternity care is limited or absent. This leaves many women in rural areas without access to necessary obstetrical services. The ongoing closure of maternity wards, specifically in rural areas, further limits access to prenatal care, safe deliveries and postpartum services.

Statistics

  • 16 of the 55 Alabama counties considered rural have hospitals providing obstetrical services today, compared to 45 of the 55 counties in 1980.
  • On average, Alabama women travel 17.4 miles and 23.5 minutes to their nearest birthing hospital.
  • Hospitals are closing or reducing services due to financial strain. This is a situation worsened by Alabama’s lack of Medicaid expansion.
  • 8.9% of all Alabama births occur in maternity care deserts.

Medicaid benefits and coverage

Medicaid offers a comprehensive range of services to support maternal health during preconception, pregnancy and postpartum periods.

Preconception

Plan First Program

The Medicaid Plan First Program offers family planning services to women ages 19 through 55 in Alabama. For women, the program includes coverage for essential exams, birth control and planning assistance.

SERVICES COVERED BY MEDICAID PLAN FIRST

  • Yearly family planning exam 
  • Access to birth control (including pills, IUDs, diaphragms, shots and implants)
  • Tubal ligation (and vasectomies for men)
  • Lab work for pregnancy
  • Testing for sexually transmitted infections
  • Assistance in planning when to have a baby
  • Tobacco cessation

Pregnancy

Health coverage during pregnancy ensures access to prenatal care, which is critical for monitoring the health of both mother and baby.

SERVICES COVERED BY MEDICAID 

  • Regular prenatal checkups
  • Prenatal vitamins
  • Diagnostic tests like ultrasounds
  • Health education (such as childbirth preparation classes)
  • Dental services
  • Nurse-Family Partnership (NFP) services (See page 13 for more)
  • Alabama Coordinated Health Network (ACHN) care management services (Patients must register with an ACHN before scheduling their first prenatal appointment)

Postpartum

Postpartum care is essential for both mother and baby. Extended coverage after birth helps ensure proper recovery, mental health support and access to necessary infant care. Postpartum coverage is available for one full year after childbirth or pregnancy loss.

SERVICES COVERED BY MEDICAID 

  • Postpartum checkups
  • Mental health counseling to address postpartum depression and other conditions
  • Family planning services to assist with birth spacing
  • Dental services (until 60 days after birth)
  • Infant care, including vaccinations, regular checkups and developmental screenings

Maternity Medicaid enrollment

There is no open enrollment period for Maternity Medicaid. People may apply and enroll at any time.

Medicaid coverage may be used alongside private insurance coverage. If a woman has a private, non-Marketplace insurance plan, she also may enroll in Maternity Medicaid if she meets the income and eligibility requirements. A child born to a woman enrolled in Medicaid at the time of the birth is eligible for what is known as “deemed newborn coverage.” This is coverage that begins at birth and lasts for one year, regardless of any changes in household income during that period.

How can Alabama moms get coverage?

Medicaid is a vital resource for pregnant women and new mothers in Alabama. Understanding how to qualify and enroll in Medicaid is essential for ensuring access to health care during pregnancy and after childbirth.

Eligibility criteria

  1. Age
    • Pregnant Alabama women of any age can receive full Medicaid coverage if they meet all eligibility requirements. Pregnant women under age 19 also may receive full coverage if their parents’ income is counted and they meet the income guidelines for a child.
  2. Income
    • The household income limit for pregnant women is 146% of the federal poverty level (FPL). See page 10 for more.
  3. Citizenship
    • Pregnant women must be a U.S. citizen or have satisfactory immigration status to qualify.
  4. Residency
    • Pregnant women must reside in Alabama to receive Alabama Medicaid benefits.

Eligibility help

2024 income guidelines

Household size includes the pregnant woman and the unborn child. It also may include the spouse, father and/or other children under age 19, depending on who is living in the home and how taxes are filed.

Financial eligibility

Medicaid financial eligibility is based on Modified Adjusted Gross Income (MAGI), which starts with a person’s Adjusted Gross Income (AGI). AGI is the total income earned in a year after certain deductions like retirement contributions or student loan interest. To determine MAGI, applicants should add untaxed foreign income, non-taxable Social Security benefits or tax-exempt interest (if any) to their AGI. For many applicants, AGI and MAGI are the same. For Medicaid, the household income is calculated by adding up the MAGI of each person in the household, whether they file taxes or not.

Documentation examples

  • Income verification
    • Recent pay stubs
    • Tax returns
    • Unemployment insurance or Social Security benefits statements
  • Proof of identity and citizenship
    • Driver’s license or state-issued ID card
    • U.S. birth certificate or passport
    • Permanent Resident Card (Green Card)
  • Pregnancy confirmation
    • Doctor’s note or verification from a health care provider
    • Ultrasound report
  • Proof of Alabama residency
    • Utility bill (electricity, water, gas)
    • Lease agreement or mortgage statement
    • Voter registration card

Steps to enroll

Check eligibility

Be sure your income meets the requirements for your household size (which includes you, dependents and your unborn child). Review the eligibility checklist and income limits table in this toolkit to confirm eligibility.

Gather required documentation

Before applying, gather the required documentation:

  • Income verification
  • Pregnancy confirmation
  • Proof of identity and citizenship
  • Proof of Alabama residency

Apply

Online

Apply online at insurealabama.adph.state.al.us

By mail

Download, complete and mail the Medicaid application to:

Medicaid, P.O. Box 5624

Montgomery, AL 36103-5624

Confirm and wait

After applying, you should receive a confirmation letter within a few weeks. Be sure all your information is accurate. If you don’t hear back, follow up with the Medicaid office to check on your application status.

Need help?

Call the Medicaid helpline if you need assistance with the application process or renewing your coverage.

Medicaid helpline: 888-362-1504

Monday-Friday, 8 a.m. to 4:30 p.m.

How Alabama is improving outcomes

Despite the challenges, numerous programs and initiatives across Alabama are working to improve maternal health outcomes. Here are a few of them.

ALABAMA 211 CONNECTS

Alabama 211 is a statewide helpline that connects residents to essential health care, maternal health and social services. It acts as a central resource for navigating local support options during pregnancy and the postpartum period. Individuals can simply dial 2-1-1 to access a wide range of services.

ALABAMA MARCH OF DIMES

The March of Dimes is a nonprofit organization that supports research, advocacy and programs to improve maternal and infant health. In Alabama, it focuses on preventing birth defects, premature births and maternal health disparities. This organization offers prenatal education and support to expectant mothers, especially those in vulnerable communities.

ALABAMA MATERNAL HEALTH TASK FORCE

The Alabama Maternal Health Task Force (ALMHTF) works to address the state’s maternal health challenges by coordinating efforts across various stakeholders. Its goal is to improve health outcomes by reducing maternal mortality and morbidity through policy development, collaboration and health care quality improvement initiatives.

ALABAMA MATERNAL MORTALITY REVIEW COMMITTEE

The Alabama Maternal Mortality Review Committee (MMRC) investigates maternal deaths across the state to identify the causes and determine preventable factors. By reviewing these cases, the committee provides recommendations to health care providers and policymakers to improve maternal health care and reduce maternal mortality rates.

ALABAMA PERINATAL QUALITY COLLABORATIVE

The Alabama Perinatal Quality Collaborative (ALPQC) is a statewide initiative that brings together health care providers, hospitals and public health experts to improve the quality of perinatal care. Its focus is on reducing infant mortality and maternal health complications by implementing best practices in care delivery.

BIRMINGHAM HEALTHY START PLUS

Birmingham Healthy Start Plus provides community-based services to reduce infant mortality and improve maternal health in Birmingham’s most underserved neighborhoods. The program offers prenatal and postpartum support, education and resources to ensure healthy pregnancies and safe deliveries for vulnerable families.

BIRTHWELL PARTNERS

Birthwell Partners is a nonprofit organization that trains and provides doulas to support women, particularly in underserved and rural areas of Alabama. Their services help improve birth outcomes by offering emotional, physical and informational support throughout pregnancy, labor and postpartum recovery.

COVER ALABAMA

The Cover Alabama coalition advocates for the expansion of Medicaid coverage to ensure more Alabamians, especially pregnant women and families, have access to affordable health care. By pushing to close Alabama’s health coverage gap, the coalition aims to reduce maternal mortality rates and improve overall maternal and infant health.

GIFT OF LIFE FOUNDATION

The Gift of Life Foundation supports maternal and child health by offering prenatal education, health care access and early intervention services. Their programs are designed to reduce infant mortality and ensure that mothers receive comprehensive care during and after pregnancy.

NURSE-FAMILY PARTNERSHIP

The Nurse-Family Partnership (NFP) is a national program implemented in Alabama to improve maternal and child health by connecting first-time, low-income mothers with specially trained nurses. These nurses provide home visits during pregnancy and the first two years of the child’s life, focusing on health, parenting skills and economic self-sufficiency.

PREGNANCY RISK ASSESSMENT MONITORING PROGRAM

Pregnancy Risk Assessment Monitoring Program (PRAMS) is a CDC initiative in collaboration with the Alabama Department of Public Health, aimed at collecting data on maternal attitudes and experiences before, during and after pregnancy. This information helps shape policies and programs designed to improve maternal and infant health outcomes across the state.

Medicaid expansion

Alabama is one of only 10 states yet to expand Medicaid, leaving tens of thousands of women in the health coverage gap. Expanding Medicaid would help ensure that more women receive health care before, during and after pregnancy, leading to lower maternal and infant mortality rates.

Statistics

  • 10 states have not expanded Medicaid
  • Nearly 200,000 Alabamians are caught in the health coverage gap
  • States that have expanded Medicaid have seen fewer maternal and infant deaths compared to non-expansion states.
  • Medicaid expansion could help prevent further hospital closures and increase access to maternal care in rural areas.

States

  • Alabama
  • Florida
  • Georgia
  • Kansas
  • Mississippi
  • South Carolina
  • Tennessee
  • Texas
  • Wisconsin
  • Wyoming

Conclusion

Ensuring better maternal health in Alabama is a collective effort that requires continuous support, access to care and well-informed decision-making. The Alabama Maternal Health Toolkit is a resource designed to help inform and guide women, families and health care providers in accessing the resources available through Medicaid and other maternal health programs. By ensuring every mother has access to essential prenatal, delivery and postpartum care, we can work toward reducing maternal mortality, addressing disparities and improving the health of both mothers and babies across our state. Together, we can strive to birth better outcomes for families across Alabama.

Alabama Arise is a statewide, member-led nonprofit organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Learn more about Arise at alarise.org. Follow @AlabamaArise on Facebook, Instagram and Twitter/X.

Las prioridades legislativas de Alabama Arise para 2025

By Alabama Arise

Más de 150 grupos miembros de Alabama Arise y más de 1,500 miembros individuales eligen todos los años nuestras prioridades legislativas. Este proceso garantiza que los habitantes de Alabama más afectados por la pobreza participen de las decisiones. A continuación se enumeran las prioridades que nuestros miembros eligieron para 2025.

Para obtener una versión de este documento en PDF, haga clic aquí o en el botón de “Descargar” (Download) arriba.

Reforma impositiva – Un sistema impositivo más equitativo puede ayudar a la gente con problemas a llegar a fin de mes. Alabama debería quitar el impuesto a los alimentos y asegurar financiación justa y sostenible para servicios esenciales. 

Presupuestos estatales adecuados – Los servicios públicos fuertes amplían las oportunidades para todos. Alabama debe ampliar Medicaid y proteger los fondos para las escuelas públicas. También debe reducir el hambre y las dificultades respaldando el desayuno gratuito universal en las escuelas públicas.

Derecho al voto – Todos merecen su voz en nuestra democracia. Alabama debe aprobar el voto temprano sin excusas y eliminar barreras para la restauración del derecho al voto para quienes no lo tienen. 

Reforma de justicia penal – Nuestro sistema de justicia debe asegurar la justicia y la equidad para todos. Alabama debe mejorar el sistema de libertad condicional, reformar las leyes de sentencias punitivas y reducir la dependencia de multas y tarifas como fuente de ingresos. 

Atención médica maternoinfantil – La salud y seguridad de las familias es de suma importancia. Alabama debe mejorar el acceso a atención médica de alta calidad, asegurar que no se criminalice la atención vital durante el embarazo y extender la licencia prenatal para empleados y maestros en el estado.

Transporte público – La conexión comunitaria es esencial. Alabama debe financiar el Fondo Fiduciario de Transporte Público para que todos puedan llegar al trabajo, la escuela, la atención médica y más.

Reforma de pena de muerte – Todos en Alabama merecen la misma justicia según la ley. Un paso clave en esta dirección sería aplicar la prohibición de Alabama de anulación judicial de veredictos de jurado de manera retroactiva, para aplicarla a personas sentenciadas bajo esta política, ahora ilegal.