A life-saving move: Alabama extends postpartum Medicaid coverage

Alabama is on its way to reducing maternal mortality and improving health for families across the state ‒ but we can’t stop here.

Lawmakers and Gov. Kay Ivey last month enacted a budget that extends postpartum Medicaid coverage to a full year after childbirth. That is up from the previous cutoff of only 60 days after birth. Alabama Arise and other members of the Cover Alabama Coalition will continue to work with the governor’s administration and legislators to ensure this program is sustainable and permanent.

Alabama has the nation’s third-worst maternal death rate. Each year, nearly 40 new mothers in the state die within one year after delivery. The toll on Black mothers is nearly three times that of white moms.

Research shows that outcomes improve when moms have access to high-quality, equitable and uninterrupted care. Extending the Medicaid postpartum coverage period is a big step to save lives and improve the health and well-being of families, communities and the entire state.

Arise story collection coordinator Whit Sides speaks at a March 9 rally in Montgomery to support extending postpartum Medicaid coverage. Arise joined the American Heart Association and other Cover Alabama partners at the event.

The work that remains

This is an exciting win, but we know that one year of coverage is, ultimately, not enough. And we know the solution: The most effective way to reduce maternal deaths is to make sure people giving birth have access to care before, during and after pregnancy. We need full Medicaid expansion, and we won’t stop until we get it.

Medicaid restrictions are not affecting only new parents. More than 220,000 Alabamians are caught in our health coverage gap, earning too much to qualify for Medicaid and too little to afford private insurance. And another 120,000 are stretching to pay for coverage they cannot afford. Expanding Medicaid would give these Alabamians the health care that they need to survive and deserve to thrive.

Postpartum Medicaid extension will be only the first of many wins toward creating a more equitable state health care system. It’s been a long fight, but I know we can do this.

Postpartum Medicaid extension brings a glimmer of hope for new mothers in Alabama

This story originally appeared on AL.com.

On Mother’s Day in 2014, I found out I was pregnant. For me, the existential dread set in just as deeply as the morning sickness.

Motherhood and its crushing weight had been drilled into me my entire life. I told myself it was too hard, that I just wasn’t strong enough to handle parenthood and all its pressures. And I feared that my family’s legacy would repeat itself.

Maude Wakefield, pictured with her husband, William (Andy) Ingle of Nauvoo, Ala. Maude is holding one of their 72 grandchildren. (Photo courtesy of Whit Sides)

One summer day in 1932, while pregnant with her 14th child, my great-grandmother Maude Wakefield finally reached her breaking point. She set off behind her home in Winston County and climbed high into a tree on my family’s land. She had been pregnant regularly since 1906 and decided enough was enough.

So she offered an ultimatum: She would return to her infinite load of daily household duties only if my great-grandfather would promise that this was it – no more babies. Not long after what would become her infamous last stand, she passed away due to a stroke worsened by postpartum hypertension. My grandmother was left to live without her mother at age 12.

Nearly a century later, during a routine blood pressure check, I was deemed high risk for the same life-threatening condition that killed my great-grandmother.

I didn’t want that same lonely future for my daughter.

The life-saving power of health coverage

Fortunately, I had health insurance. My blood pressure continued to rise to dangerous levels as my pregnancy progressed. After reviewing my family history, my doctor decided it was best for both me and the baby to deliver early under supervision to prevent preeclampsia, a condition that can lead to maternal death during or after delivery.

Because I had access to care, I was easily treated, and it ended up saving my life. Now, when I take my blood pressure pill every morning, I can’t help but think how things could have been different for my great-grandmother.

Hope can be hard to come by in Alabama. Stories like mine remind us how far we’ve come. But when you’re left without coverage, it’s never as simple as a pill and a copay.

Medicaid covers about half of all births in Alabama. And for many new moms, health coverage expires shortly after the baby is born.

Medicaid postpartum coverage extension is a step in the right direction

Some good news could be coming as soon as this fall. On April 7, Gov. Kay Ivey signed a new General Fund budget into law. It includes an extension of postpartum Medicaid coverage from 60 days of coverage to 12 months. This life-saving change will provide thousands of families consistency in care during the critical time after childbirth.

Alabama has the nation’s third-worst maternal death rate. Each year, roughly 40 new mothers in the state die within one year after delivery. Nearly 70% of those deaths are preventable, the state Maternal Mortality Review Committee found. And the toll on Black mothers is nearly three times that on white moms.

In Alabama, children living in households with low or middle incomes are widely eligible for coverage through Medicaid or ALL Kids, Alabama’s Children’s Health Insurance Program (CHIP). For adults, it is much harder to qualify for Medicaid. Just 17% of Medicaid participants in Alabama are adults under age 65 who do not have a disability.

Our state has some of the most stringent income limitations for Medicaid. For example, a single parent of two without a disability is ineligible if they make more than $346 a month. These harsh Medicaid eligibility limits mean affordable health insurance is simply not an option for many people in our state.

Medicaid expansion would ensure coverage for more than 340,000 Alabamians, including those left uninsured by these tight limits. These folks do not qualify for Medicaid, but they are unable to afford a marketplace plan or other private coverage. However, the new postpartum coverage extension means there will now be a brief inclusive window during and after pregnancy.

A lifeline in a time of need

Moms like my friend Brittany Kendrick of Blountsville call this coverage a lifeline.

Brittany lost her fiance, Dylan, in a car accident two months before her daughter Khaleesi was born. They had everything planned out, but her health insurance expired after Dylan’s death. Brittany turned to Medicaid to cover the costs.

Blountsville resident Brittany Kendrick holds her daughter Khaleesi. Medicaid was a lifeline for Brittany after her fiance, Dylan, died shortly before Khaleesi’s birth. (Photo courtesy of Brittany Kendrick)

Then, in August 2021, she made the hour-long drive to Children’s Hospital in Birmingham, where she found out her newborn had contracted COVID-19. After getting emergency care, her baby made a recovery. But as soon as they got home, Brittany tested positive and started to feel worse.

Being able to see a doctor and seek treatment quickly was just the blessing they needed during what Brittany calls the hardest year of her life.

“Medicaid paid for all of our hospital and doctor bills,” Brittany said. “It gave me a chance to use the money I had in savings for a safer car and a new apartment for me and the baby.”

Brittany hopes she will be among those eligible for the new postpartum extension. Having consistent care has brought balance to her life in more ways than one. “I can take medicine for anxiety and depression now. I need that, to stay strong for her,” she said.

Khaleesi Rider in April 2022. (Photo courtesy of Brittany Kendrick)

‘Why not offer this to all mothers?’

Extending Medicaid coverage doesn’t just support new or single parents.

Sarita Edwards of Madison is a mother of five and founder of the E.WE Foundation, a health care advocacy organization. She began her foundation after receiving a rare prenatal diagnosis of Edwards’ Syndrome (trisomy 18) for her son Elijah. The high mortality rate associated with her son’s diagnosis meant her family racked up thousands in medical debt before baby Elijah was even born.

Madison residents Kareem and Sarita Edwards hold their son Elijah. Sarita founded the E.WE Foundation after her son received a rare prenatal diagnosis. (Photo courtesy of Sarita Edwards)

Sarita says every day with Elijah has been a juggling act. Elijah’s condition is terminal, and his care can be exhausting and expensive. She now spends her time advocating for more equitable treatment and access in health care. She knows our leaders can do more, because she’s seen it firsthand.

“I know what our state can do when offering care to mothers and children with rare diseases,” Sarita said. “Why not offer this to all mothers?”

Elijah Edwards, age 5. (Photos courtesy of Sarita Edwards)

The new General Fund budget includes more than $8 million to extend Medicaid coverage for 12 months after childbirth. But the funding is guaranteed only for one year – on a trial basis.

This year marked another Mother’s Day when Alabama mothers are still dying from pregnancy and childbirth at twice the national rate. Reliable health coverage – and the access to care that comes with it – can prevent many of those deaths. Sarita sees no reason to hold off on making Medicaid’s postpartum coverage extension permanent.

“Our babies are taken care of, but what about the mothers?” Sarita asked. “I don’t know why it takes Alabama so long to do the right thing sometimes.”

About Alabama Arise and Cover Alabama

Whit Sides is the story collection coordinator for Alabama Arise, a statewide, member-led 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. Email: .

Arise is a founding member of the Cover Alabama Coalition. Cover Alabama is a nonpartisan alliance of more than 115 advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations advocating for Alabama to provide quality, affordable health coverage to its residents and implement a sustainable health care system.

Arise legislative recap: April 4, 2022

Arise’s Jane Adams shares the good news that next year’s General Fund budget includes a provision that would extend Medicaid postpartum coverage to one year after childbirth, up from the current 60 days. The budget has passed both the Alabama House and Senate and has gone to the governor.

March 2022 newsletter

On Feb. 15, dozens of well-wishers gathered for an online retirement party for outgoing Arise policy director Jim Carnes. We salute Jim for his 18 years of service at Arise and his lifelong dedication to building a better world. Thank you, Jim!

Grocery tax, health care key Arise focuses this year

By Chris Sanders, communications director

Untax groceries. Expand health coverage. Make the criminal justice system more just. Those are a few of Alabama Arise’s major priorities during the Legislature’s 2022 regular session. And we’re making real progress toward turning those goals into realities.

Untaxing groceries

Ending the state’s regressive sales tax on groceries has been a longtime Arise priority. It was the centerpiece of Alabama Arise Action’s online Legislative Day on Feb. 15, which attracted nearly 200 advocates from across the state. It also will be the focus of a March 15 rally in Montgomery.

Legislative Day attendees heard from two lawmakers working to untax groceries: Sen. Andrew Jones, R-Centre, and Rep. Penni McClammy, D-Montgomery. Jones’ and McClammy’s bills reflect growing support for untaxing groceries while protecting funding for public schools.

McClammy said the grocery tax is a policy concern that transcends political lines. “It’s important that we stand together united as one and show the citizens that we all care about what’s going on in our homes,” she said.

Jones expressed optimism that lawmakers are nearing a breakthrough on the grocery tax. “This is not a partisan issue,” he said. “Montgomery is not Washington, D.C., so we get a lot of bipartisan work done here.”

Nearly 200 advocates from across Alabama attended Arise’s virtual 2022 Legislative Day on Feb. 15. Supporters gathered to learn more about our issue priorities and get updates on where things stand legislatively on them. Sen. Andrew Jones, R-Centre (top right), and Rep. Penni McClammy, D-Montgomery (bottom left), joined us for a discussion of their bills to untax groceries.

Expanding health coverage

The COVID-19 pandemic has underscored a cruel fact: Hundreds of thousands of Alabamians can’t afford the health care they need. Gov. Kay Ivey can remove that financial barrier by expanding Medicaid to cover nearly 300,000 adults with low incomes. Arise and our Cover Alabama campaign are working hard to make that happen.

Public support for Medicaid expansion is strong and growing. More than seven in 10 Alabamians support expansion, according to a statewide Arise poll conducted in January. Expansion would create more than 20,000 jobs and save the state almost $400 million annually, a recent report estimated.

Extending Alabama Medicaid’s postpartum coverage to one year (up from the current 60 days) is another key goal this year. Nearly 70% of Alabama’s maternal deaths in 2016 were preventable, one study found. That’s why Arise is working hard to ensure legislators fund this life-saving coverage extension in the General Fund budget.

Advancing justice

Numerous reforms of Alabama’s criminal justice system are moving in the Legislature this year. Arise supports two bills – HB 200 by Rep. Merika Coleman, D-Birmingham, and SB 117 by Sen. Will Barfoot, R-Montgomery – to end driver’s license suspensions for failure to pay fines and fees. Arise also backs HB 57 by Rep. Chris England, D-Tuscaloosa, and SB 215 by Sen. Bobby Singleton, D-Greensboro, which would increase transparency in parole decisions.

Together, we can make a difference. Subscribe to our email list for timely alerts on these bills and others. And visit the Bills of Interest page to track legislation throughout the year.

Join us for the Untax Groceries Rally on March 15!

By Matt Okarmus, communications associate

Join Arise in Montgomery to tell lawmakers that now is the time to untax groceries! We can’t miss this opportunity to help families make ends meet.

The Untax Groceries Rally will be from noon to 1 p.m. on Tuesday, March 15. We will gather outside the State House steps. In the case of inclement weather, we have a backup plan for those who feel safe to gather inside.

Visit untaxgroceries.org today to register for the event. Please note that we will observe COVID-19 safety precautions should we gather indoors. Masks will be required for rally participation.

We see you, Alabama, and we’re with you

By Robyn Hyden, executive director

As I think about each of you receiving and reading these updates, in the midst of a hectic and uncertain time, I’m amazed by the strength and resilience of the people like you who make up Arise’s membership and our community.

The single parent who has been holding it together during COVID-19 child care closures and home schooling, all while trying to keep their family safe.

The college student who isn’t sure what the future holds but just wants to make the world a better place.

The full-time essential worker who goes home and works a second shift as a community organizer, caregiver or volunteer, keeping the threads of society woven together.

The person living with disability or mental illness, struggling to find dignity, care and inclusion.

I see you. Alabamians. United in our belief that our state can be better. We’ll make it happen together.

Untaxing groceries is the right path for Alabama

By Carol Gundlach, senior policy analyst

Alabama’s sales tax on groceries is a cruel tax on survival, particularly in times of economic insecurity. It increases hunger rates and drives struggling Alabamians deeper into poverty.

Three bills in the 2022 regular session – SB 43 by Sen. Andrew Jones, R-Centre; HB 173 by Rep. Mike Holmes, R-Wetumpka; and a forthcoming bill by Rep. Penni McClammy, D-Montgomery – would end the state grocery tax while protecting funding for public schools.

Why and how to end the state grocery tax in Alabama

Alabama lawmakers have a real opportunity this year to untax groceries responsibly. Here’s why it needs to happen this year – and how the state can do it:

  • Alabama is one of only three states with no tax break on groceries.
  • The state grocery tax is 4%, equal to two weeks’ worth of groceries each year.
  • Alabama can untax groceries and protect education funding by limiting its state income tax deduction for federal income taxes (FIT). The FIT deduction is a skewed tax loophole that overwhelmingly benefits rich households.

All three bills would end the state grocery tax and protect education funding by capping the FIT deduction for individuals. McClammy’s bill also would remove the state sales tax on over-the-counter medicines. All of the bills would require voter approval of a constitutional amendment. The graph below shows how millions of Alabamians would benefit.

Under SB 43 and HB 173, the FIT deduction cap for Alabamians who file as single, head of household or married filing separately would be $4,000 annually. For married couples filing jointly, the limit would be $8,000 a year. Under McClammy’s bill, those annual caps would be $3,500 and $7,000, respectively.

Both sales tax revenue and individual income tax revenue go to the Education Trust Fund. By capping the FIT deduction, these bills would allow Alabama to untax groceries without cutting school funding. This plan would be a significant tax cut for nearly all Alabamians, and the largest benefit would go to people with low and middle incomes who need it most. The Legislature should pass this proposal this year and send it to voters for final approval.

Bottom line

Untaxing groceries quickly and responsibly would boost economic and food security for all Alabamians. By ending the state grocery tax and capping the FIT loophole, lawmakers could protect funding for public schools and make life better for families across our state.

You are the strong force behind Arise’s advocacy

By McKenzie Burton, development associate

Your support holds lawmakers accountable during this legislative session. Will you donate to Alabama Arise today?

Right now in Montgomery, elected officials from across Alabama are proposing laws that would infringe on our constitutional right to protest, limit our children’s access to a quality, well-rounded education and increase barriers to receiving unemployment insurance benefits, even as the pandemic rages on.

There is so much at stake. But our members are the strong force behind our sustained advocacy at the State House – and we are already seeing progress. Lawmakers are willing to hear our concerns, and we need your help to ensure they listen. Your donation will strengthen our calls to stop this harmful legislation and pass laws that ensure all Alabamians have the opportunity to live happy and productive lives.

Will you join or renew your Arise membership today to demand our elected officials promote fair policies to alleviate poverty?

Together, we can make a difference in the lives of our children and neighbors. You can donate online at al-arise.local/donate, or send a check to P.O. Box 1188, Montgomery, AL 36101.

Welcome, Rebecca!

Photo of Rebecca HowardRebecca Howard joined Arise as our new policy and advocacy director in January. She is an Alabama native who grew up in Alexander City. She earned a B.A. in political science from the University of Alabama and an M.A. in European public policy from King’s College London. Before joining Arise, Rebecca worked for former U.S. Sen. Doug Jones, serving as his legislative policy adviser on education and agriculture policy, among other issues. She most recently worked as a federal policy adviser at the Learning Policy Institute in Washington, D.C., where she worked on teacher shortages, early childhood education and school discipline issues.

Grocery tax, health care key Arise focuses this year

Untax groceries. Expand health coverage. Make the criminal justice system more just. Those are a few of Alabama Arise’s major priorities during the Legislature’s 2022 regular session. And we’re making real progress toward turning those goals into realities.

Untaxing groceries

Ending the state’s regressive sales tax on groceries has been a longtime Arise priority. It was the centerpiece of Alabama Arise Action’s online Legislative Day on Feb. 15, which attracted nearly 200 advocates from across the state. It also will be the focus of a March 15 rally in Montgomery.

Legislative Day attendees heard from two lawmakers working to untax groceries: Sen. Andrew Jones, R-Centre, and Rep. Penni McClammy, D-Montgomery. Jones’ and McClammy’s bills reflect growing support for untaxing groceries while protecting funding for public schools.

McClammy said the grocery tax is a policy concern that transcends political lines. “It’s important that we stand together united as one and show the citizens that we all care about what’s going on in our homes,” she said.

Jones expressed optimism that lawmakers are nearing a breakthrough on the grocery tax. “This is not a partisan issue,” he said. “This is something that really meets the full criteria of being a bipartisan issue.”

Nearly 200 advocates from across Alabama attended Arise’s virtual 2022 Legislative Day on Feb. 15. Supporters gathered to learn more about our issue priorities and get updates on where things stand legislatively on them. Sen. Andrew Jones, R-Centre (top right), and Rep. Penni McClammy, D-Montgomery (bottom left), joined us for a discussion of their bills to untax groceries.

Expanding health coverage

The COVID-19 pandemic has underscored a cruel fact: Hundreds of thousands of Alabamians can’t afford the health care they need. Gov. Kay Ivey can remove that financial barrier by expanding Medicaid to cover nearly 300,000 adults with low incomes. Arise and our Cover Alabama campaign are working hard to make that happen.

Public support for Medicaid expansion is strong and growing. More than seven in 10 Alabamians support expansion, according to a statewide Arise poll conducted in January. Expansion would create more than 20,000 jobs and save the state almost $400 million annually, a recent report estimated.

Extending Alabama Medicaid’s postpartum coverage to one year (up from the current 60 days) is another key goal this year. Nearly 70% of Alabama’s maternal deaths in 2016 were preventable, one study found. That’s why Arise is working hard to ensure legislators fund this life-saving coverage extension in the General Fund budget.

Advancing justice

Numerous reforms of Alabama’s criminal justice system are moving in the Legislature this year. Arise supports two bills – HB 200 by Rep. Merika Coleman, D-Birmingham, and SB 117 by Sen. Will Barfoot, R-Montgomery – to end driver’s license suspensions for failure to pay fines and fees. Arise also backs HB 57 by Rep. Chris England, D-Tuscaloosa, and SB 215 by Sen. Bobby Singleton, D-Greensboro, which would increase transparency in parole decisions.

Together, we can make a difference. Subscribe to our email list for timely alerts on these bills and others. And visit the Bills of Interest page to track legislation throughout the year.

New poll: More than 7 in 10 Alabamians support Medicaid expansion

More than seven in 10 Alabamians (71.5%), including 65.8% of Republican voters, support expanding Medicaid when told about arguments in support of the idea, according to a new poll commissioned by Alabama Arise. The poll also showed robust bipartisan support for using a portion of the state’s funding under the American Rescue Plan Act (ARPA) to support Medicaid expansion.

Participants responded strongly when informed that expanding Medicaid would create an average of 20,000 new jobs per year over the next six years and have an economic impact of $1.8 billion per year. Nearly 69% of respondents, including 61.8% of Republican voters, supported using a portion of the state’s $2 billion in ARPA funds to expand access to Medicaid in Alabama.

Jane Adams, Cover Alabama campaign director at Alabama Arise, said the poll results underscore Alabama’s urgent need for Medicaid expansion.

“Voters support Medicaid expansion because it is a tremendous opportunity to create jobs, protect rural hospitals and provide life-saving care,” Adams said. “This poll shows Medicaid expansion is no longer a partisan issue and that most Alabamians support expanding Medicaid coverage to adults with low incomes.”

Support for Medicaid expansion grows across Alabama

The overwhelming polling support reflects an ever-growing group of individuals, organizations, veterans, faith leaders, medical professionals and businesses that support expanding Medicaid in Alabama. This group includes the Alabama Hospital Association, Alabama Chapter of the American Academy of Pediatrics, the Alabama Department of Public Health’s Maternal Mortality Review Committee and the Medical Association of the State of Alabama, as well as more than 100 nonprofits, faith-based groups and medical advocacy organizations in the Cover Alabama Coalition.

Alabama Arise commissioned the poll, which the Montgomery-based firm Cygnal conducted in January. The poll surveyed 631 likely voters across Alabama and has a margin of error of +/- 3.85%. Interviews of known registered voters occurred via live phone calls, online panel, texts and email invitation.

Click here for Arise’s poll results on Medicaid expansion in Alabama.

New report highlights economic benefits of Medicaid expansion

A recent report from the nonprofit Public Affairs Research Council of Alabama (PARCA) shows how Medicaid expansion would create jobs and boost local economies across the state. “Expanding Medicaid coverage in Alabama could save the state almost $400 million per year over the next six years – more than enough to cover the cost of expansion – and have an average positive economic impact of $1.89 billion per year over that same time frame,” the report found.

Medicaid expansion in Alabama would cost an average of $225.4 million per year, according to the PARCA report. But the report also found that expansion would lead to the federal government covering $379.9 million in annual expenses now paid by the state. “As a result, the state could expand coverage, and at the same time, reduce or reinvest the amount paid to support health care for low-income Alabamians by $172 million annually,” PARCA found.

The economic impact of Medicaid expansion. Medicaid covers approximately 925,000 Alabamians -- the majority are children. Alabama is 1 of 12 states that have not expanded Medicaid. Over the next six years, research by PARCA and Jacksonville State University shows Medicaid expansion in Alabama could save the state more than $400 million a year, increase Medicaid enrollment by as many as 283,636 people, drop the uninsured rate by 43%, create an average of 20,083 new jobs per year, cost an average of $225.4 million above current expenditures and yield average annual savings of $397.8 million. Recent polling by Cygnal shows more than 7 in 10 Alabama voters would like to expand Medicaid so more people can access health care. 71.5% of voters support Medicaid expansion, including 65.8% of Republicans. 50.2% strongly support expansion, while only 17.5% overall and only 20.6% of Republicans oppose expansion.

Adams said ARPA funding and other federal incentives make Medicaid expansion an opportunity too good for Alabama to pass up.

“Governor Ivey and leaders in Montgomery have said the obstacle to expanding Medicaid in Alabama is the cost. But with the American Rescue Plan Act funding, Alabama can expand Medicaid and could reinvest more than $170 million in state funding to provide more access to care,” Adams said.

“Public support is strong, and the report and polling data show there is no financial barrier or obstacle to overcome. We urge Governor Ivey and leaders in Montgomery to put forward a Medicaid expansion plan that is tailored to the needs of Alabamians.”

Six ways Alabama should use ARPA funds to build a better, more inclusive future

The Alabama Legislature’s 2022 regular session, which began Tuesday, will be unusual in one important way. For the first time in many years, Alabama has more than enough revenue to maintain its bare-bones public services. That means instead of scrambling to avoid cuts, the legislative focus can be on strengthening investments in our state’s future.

Both the Education Trust Fund (ETF) budget and the General Fund (GF) budget, which funds non-education programs, have seen tax revenues rise more than 10% in the last year. ETF revenues actually increased 16% in 2021. In addition, Alabama has about $1.6 billion of federal relief funds remaining under the American Rescue Plan Act (ARPA). President Joe Biden signed ARPA into law in March 2021.

Alabama lawmakers already allocated $480 million of the state’s ARPA money last year. Of that amount, $400 million went toward prison construction and $80 million went to hospitals and nursing homes.

Budget growth faces sustainability challenges

State budget officials have steadily cautioned lawmakers to consider the one-time nature of both relief money and the bump in tax revenues. Recent revenue growth almost certainly will not be sustained in future years, budget officials warn. And one-time ARPA funds are by definition only temporary.

Alabama’s budget officials have strongly recommended that both ARPA funds and increased state revenues be invested in programs and services that won’t require regular, recurring revenue but that still meet critical needs for the people of the state. Alabama Arise questions whether the new revenue is as unsustainable as budget officials predict. But Arise agrees that this money needs to fund big ideas that will benefit the state for years to come.

Areas for investment

If spent wisely, ARPA funds could create vital long-term improvements for Alabamians. Alabama Arise has numerous specific suggestions for what those big ideas, and investments, could be.

Serve underserved communities

ARPA investments should focus on the most underserved areas and most underserved Alabamians. Communities of color and communities with low incomes, particularly in the Black Belt, have long-festering unmet infrastructure needs. The lack of wastewater treatment, accessible broadband internet, affordable housing and public transportation has held these communities back for decades.

In deciding where to spend new one-time dollars, the most historically neglected parts of Alabama should come first. An urgent public health need in many rural Black Belt counties is for sewer and other water treatment systems. These should be a top priority.

Modernize state technology

A major lesson from the COVID-19 recession was that Alabama’s technology infrastructure is totally inadequate for remote access to services. Suddenly unemployed people desperately tried to apply for unemployment insurance (UI) benefits, food assistance, COVID-19 tests and other services on overwhelmed state computer and telephone systems. People who had never before applied for public assistance couldn’t find one-stop sources of information about services for which they might be eligible. And when new federal programs were created, they were hard to implement. That’s because Alabama’s computer systems didn’t talk to each other and couldn’t share information needed to help people get assistance.

Modernizing the state’s computer systems would be a great investment to increase efficiency and prepare us for the next crisis. This would allow for integrated eligibility and data sharing systems across state agencies. And it would be an opportunity to modernize and upgrade the state’s UI application and payment process.

Expand Medicaid and strengthen public health

Alabama has failed for decades to invest adequately in our health care infrastructure, including Medicaid. The devastating toll of the COVID-19 pandemic has made the consequences of that failure apparent to everyone in the state. We need to invest now in a health care infrastructure that will improve the delivery of health services to underserved individuals and communities.

Medicaid expansion to cover adults with low incomes is an essential step to strengthen Alabama’s health care system. Other investments should include more funding for mobile health services and telehealth services. Alabama also should provide additional resources for our local and state public health departments.

Reduce hunger and promote healthier communities

Hunger was already a large and perpetual problem across Alabama even before the pandemic. But the COVID-19 recession and its aftermath exacerbated this problem by fueling a rapid, major increase in food insecurity. Sudden income loss, rising prices and occasional shortages have made it much more difficult for many people to feed their children and families.

The Supplemental Nutrition Assistance Program (SNAP) and various child nutrition programs are essential standing resources to fight hunger in Alabama. But the state can and should do more to support our food infrastructure. Alabama should provide healthy food financing grants to expand community groceries, farmers markets and mobile markets. This would improve access to healthy foods in communities without ready access to fresh foods, especially fruits and vegetables.

Invest in affordable housing

The COVID-19 recession has caused a wave of evictions and foreclosures across Alabama. This has occurred as the cost of housing has been driven up amid supply chain issues and fewer available workers.

Alabama could help address its housing shortage and resulting homelessness by providing $25 million for the state Housing Trust Fund. This investment would create and support jobs across the state. And it would reduce Alabama’s shortfall of more than 73,000 affordable homes for people with incomes below the federal poverty level.

Fund public transportation

Alabama’s elected leaders, including Gov. Kay Ivey in her State of the State address, have celebrated the state’s low unemployment rate. But they also are bemoaning our state’s associated low rate of labor force participation. For more Alabamians to return to work during and after the pandemic, the state must ensure they have essential work supports. Not the least of these is transportation to and from a job or school.

Lawmakers can help people reenter the job market by investing $20 million in ARPA funds and $10 million in GF dollars in the state Public Transportation Trust Fund. These dollars would go a long way toward ensuring that people, especially those in rural areas, can get to a job and to job training. They also would help Alabama match other federal transportation dollars that can benefit the entire state.

It’s time to expand Medicaid and close Alabama’s health coverage gap

For years, Gov. Kay Ivey and legislators have said cost is the barrier to covering Alabamians with low incomes through Medicaid. Thanks to federal COVID-19 relief funding with incentives for Medicaid expansion, any concerns about that barrier are gone. Now more than ever before, we have the opportunity to ensure no Alabamian has to choose between going to the doctor and putting food on the table.

Nearly 70% of Alabamians support Medicaid expansion, including 64% of Republican voters, according to a January 2021 poll. As we continue to struggle with the COVID-19 pandemic, extending Medicaid coverage to adults with low incomes is the single biggest step Alabama can take to restore health, save our rural hospitals and boost our state’s economic recovery.

Who would gain coverage under Medicaid expansion?

Medicaid expansion would ensure coverage for more than 340,000 Alabamians, including:

  • People who work low-wage jobs and can’t afford private coverage
  • Workers who are between jobs
  • Adults who are caring for children or older family members at home
  • People who have disabilities and are awaiting SSI determinations
  • Adult college students
  • Uninsured veterans

How would Medicaid expansion keep people healthier?

Medicaid expansion would help Alabamians stay healthy by ensuring pathways to:

  • Regular primary care and preventive checkups
  • Earlier detection and treatment of serious health problems
  • Regular OB/GYN visits without referral
  • Less dependence on costly emergency care
  • Better health and greater financial peace of mind

How would Medicaid expansion reduce health disparities?

Medicaid expansion would promote health equity in Alabama by:

  • Reducing the racial/ethnic disparities in health coverage
  • Lowering the high rate of Black infant deaths
  • Lowering the high rate of Black maternal deaths
  • Covering chronic health conditions that disproportionately affect people of color and make them more vulnerable to COVID-19 complications

How would Medicaid expansion boost the economy?

Medicaid expansion would bring our federal tax dollars home to support:

  • Healthier families, workers and communities
  • Stronger rural hospitals and clinics
  • Stronger community mental health and substance use disorder services
  • A needed boost in jobs and revenue for state and local economies

Bottom line

Medicaid expansion would save lives, create jobs and strengthen Alabama’s health care system. Closing the health coverage gap is one of the biggest policy changes available to move our state forward. The governor and the Legislature should embrace this opportunity to build a brighter, healthier future for Alabama.

Join our Cover Alabama campaign!

An end to Alabama’s coverage gap is within reach. Through our Cover Alabama campaign, Alabama Arise is working to ensure that every Alabamian can afford to get the health care they need when they need it. Visit coveralabama.org to learn more and add your name to our ever-growing list of supporters.

Funding surge is a path for Alabama to untax groceries, expand Medicaid

Alabama’s broken tax system usually starves our state of money to fund education, public health and other basic responsibilities adequately. But 2022 may be different. Record tax revenues and a surge of federal recovery dollars could allow lawmakers to address longstanding state needs and inequities – if they have the political courage:

  • Tax revenues for our schools and universities went up more than 16% in 2021.
  • Tax revenues for services not related to education grew more than 11% in 2021.
  • Alabama still has more than $1.6 billion in federal recovery funds that must be budgeted in 2022 and 2023, with more on the way.

Arise’s proposed uses for federal recovery dollars can be found at al-arise.local/rescueplan. Here are a few of our recommendations for budgeting state revenue increases:

  • Untax groceries. Alabamians with low and moderate incomes already pay a disproportionate share of their income in state taxes. Ending or rebating the state grocery tax while protecting education funding would help them make ends meet.
  • Raise the income tax threshold. Alabama should help people with low incomes by creating or increasing individual and child deductions or credits.
  • Expand Medicaid. Federal recovery dollars can’t be spent directly on expansion, but they can be spent on other needs. This will free up state money to expand Medicaid.
  • Make the criminal justice system more just. Lawmakers should increase funding for reentry services and for alternatives to incarceration like specialized courts and community correction programs.

Bottom line

This year’s budget landscape offers an opportunity to make Alabama better for generations to come. Thoughtful, transformative funding choices can bring that vision to life.

Funding boosts bring opportunity to invest in Alabama’s future

Alabama’s broken tax system usually starves our state of money to fund basic responsibilities adequately. But 2022 may be different. Record tax revenues and a surge of federal recovery dollars could allow lawmakers to address longstanding state needs and inequities – if they have the political courage.

State revenues that pay for our schools, including income taxes earmarked for teacher salaries, went up 16% in 2021, according to the Legislative Services Agency. Internet sales taxes and other revenues for non-education programs grew more than 11% in 2021. Alabama also has received federal funds under the American Rescue Plan Act (ARPA) to aid recovery from the COVID-19 recession. Alabama has $580 million remaining in 2021 ARPA funds, plus another $1.06 billion coming in 2022.

Coming fast behind ARPA are federal infrastructure dollars for roads, bridges and public transportation. And if the U.S. Senate passes it, the Build Back Better Act will include new funds for child care, health care and senior services.

Transformative changes for a better Alabama

Legislators already have begun talking about how to spend this money. Alabama Arise believes wise use of these funds can make Alabama a better place for generations to come. Many of our recommendations are in our statement of principles for spending recovery dollars. A few key Arise recommendations include:

  • Untax groceries. Tax cuts should help struggling Alabamians who already pay a disproportionate share of state taxes. Ending the state grocery tax is a good place to start.
  • Expand Medicaid. Federal recovery dollars can help free up state money for Medicaid expansion. This would save hundreds of lives and ensure affordable health coverage for more than 340,000 Alabamians every year.
  • Make the criminal justice system more just. Legislators just made a misguided decision to spend $400 million of ARPA money on new prison construction. They now should invest in meaningful policy changes like sentencing reform and other alternatives to incarceration.

Alabama lawmakers have a chance to make far-reaching and lasting changes in 2022. Arise and our members will work hard to ensure they seize this opportunity.