Arise’s Akiesha Anderson welcomes everyone to the Alabama Legislature’s 2024 regular session. She talks about what we’ll be looking out for on our members’ legislative priorities and how you can stay engaged with us this year as we work to build a better, more inclusive Alabama.
Full video transcript:
Hi, everyone. My name is Akiesha Anderson, and I am the policy and advocacy director for Alabama Arise. I am here to give a brief update on the 2024 legislative session.
So if you are not aware, the 2024 legislative session will begin on Tuesday, Feb. 6. In the day prior to the beginning of the legislative session on Monday, Feb. 5, there will be budget hearings that will take place just about all day, and on Tuesday morning, those budget hearings will continue.
And then Tuesday afternoon, the legislative session will begin. This legislative session, we believe that there is a lot in store for Arise and our members and supporters, and we look forward to keeping you posted each week with the updates of what happened at the State House in the week prior.
And so for now, what we are anticipating before the start of the legislative session is that there will be a lot of hot topic issues that come up this session, some controversial issues that we may not be in support of. But we also are hopeful that our legislative priority issues — things related to maternal infant health criminal justice reform, death penalty reform, state budgets, tax reform, closing the health care coverage gap — all those things we hope will be up on the agenda of this session.
And so, again, we look forward to keeping you posted throughout legislative session about how things are progressing. And if you have any questions along the way, please don’t hesitate to reach out to our office.
But we especially look forward to making sure that you all stay engaged with the different action alerts that we send out, contacting your legislator and making sure that your voice is uplifted, to make sure that people at the State House understand and know what it is that you care about and what it is that you would like to see this session.
Diana Isom (right) smiles alongside her husband, Luke, and their son, Keenan. Diana, a resident of Athens, Ala., was uninsured during her pregnancy and struggled to find affordable options for the health care she needed. (Photo courtesy of Diana Isom)
When Diana Isom became pregnant with her first son, Keenan, back in 2021, it was what she’d always wanted.
“My husband and I had been trying for years. I was so happy, but immediately started thinking about timing,” Diana said.
Timing is always a big consideration for most first-time parents, but for Diana and her husband, Luke, things were a little more complicated. When Luke lost his job suddenly, he had to start training in a new technical field. This meant he lost the private health coverage they had previously.
Even though Diana was working full-time hours as a health care worker, she was paid hourly and offered no benefits. She faced a frightening new future: being pregnant with no health coverage.
“I knew I was fully on my own when the medicine I needed was $200 a month and I’m out here with no insurance. Zero options,” Diana said.
Diana, now 26 years old, was raised in Vestavia Hills. Her parents, native to Panama, moved to the United States more than two decades ago when she was 4 years old.
“When I was a child, my parents came to this country so I could have a better life and a better education. I was taught that America was freedom and happiness… and that hard work can get you whatever you want,” Diana said.
Building a life despite uncertainty
As she got older, Diana said she remained positive and worked hard so she could have opportunities her parents never did.
“When the DACA [Deferred Action for Childhood Arrivals] (policy) was passed in 2012, kids like me, who grew up here in America, qualified as ‘Dreamers.’ I was so excited to be able to get a work permit! I’ve been working ever since,” she said.
Under federal DACA provisions, Diana also could access her driver’s license, a Social Security card and other important documents. These documents could help her secure a job, a home or even just a doctor’s visit.
When Diana and Luke got married, she received a green card. But she decided she would begin the lengthy immigration process in 2017, to make everything “official.”
She grew up in Alabama and wanted to start her own family here. Even so, she had to spend five years – and thousands of dollars – to gain citizenship status.
“My life is here,” she said. “I don’t want to have to go back to Panama. My friends are here. My job and family are here.”
When she was growing up, Diana said, other kids bullied her about her status. Even though Alabama was all she had ever known, she still felt a gnawing sense of insecurity.
“In really bad times in my life, people would threaten to call immigration or ICE on my family,” Diana said. “So I jumped through all these hoops and saved up thousands of dollars to make sure that never happens again. Not for me, and not for my son.”
The stress of being uninsured during pregnancy
In 2021, the Isoms received the good news that Diana would finally receive her citizenship. There was only one hitch: It wouldn’t take effect until three months after her baby was due.
“I had horrible prenatal depression. No one talks about that. It’s awful,” Diana said. “All the stress of not having insurance and my husband working on a temp basis. He either gets hired on or he’s fired. Every time. That stress is crazy!”
Diana said finding the care she and her baby needed while pregnant became like a second job.
“It’s so mentally draining,” she said. “Ever since they rejected me from Medicaid, I’ve been crying and crying. I’m so numb with the whole process, but I couldn’t give up.”
When she realized the couple’s private insurance had lapsed and no other lifelines were in sight, she began researching resources. She went to a free primary care clinic serving mostly Hispanic patients. But she found it difficult to navigate materials provided in Spanish because her first language growing up was English. And the clinic couldn’t provide all the prenatal screenings she needed.
The experience left Diana lonely and struggling to bond with her child throughout her pregnancy.
“Most people get regular ultrasounds. Without insurance, the hospital I went to only offered me the bare minimum. I got to see my baby two times: at the beginning and at the end. That was it,” she said.
‘I shouldn’t have ever been left behind’
Diana’s local hospital was her only option. As she continued to be billed for more than $1,500 a visit, she said she spent many nights wondering how her new family could afford it all.
“You do what you have to do, and I made it all work for my child because that’s what my parents did for me,” she said. “I shouldn’t have ever been left behind, and now neither should my baby.”
After a 19-hour complicated labor and delivery, baby Keenan was born in early 2022. Three months later, Diana joined him in gaining full American citizenship.
Diana thought her citizenship ceremony would lift her spirits and give her family the celebration they needed after a stressful pregnancy, but the process proved a bit impersonal and underwhelming.
“We drove nearly four hours to the immigration office. When I sat down, there was just an officer calling in on Zoom. I was looking at an iPad screen when I ‘became an American,’” she said.
Diana said she is grateful for her new status, but her time as an uninsured mother was a stark reminder that the playing field is not equal for everyone who lives in Alabama.
“People like me who have been in this country for so long… we pay taxes,” she said. “You’re telling me I pay into it, but not benefit from it?”
Though most undocumented immigrants live in a family with a full-time worker, they have limited access to employer-sponsored coverage,a Kaiser Family Foundation report found. And while they pay the same taxes as citizens, they often are employed in low-wage jobs and industries that are less likely to offer employer-sponsored coverage, like Diana is.
Medicaid expansion is the path to a healthier future for Alabama parents
Diana was ineligible for Medicaid after her pregnancy, both because she was not yet a citizen and because Alabama had not yet extended postpartum coverage to one year.
She would now qualify for Medicaid coverage during and immediately after future pregnancies if she met the income eligibility standards.
Alabama remains one of 10 states yet to expand Medicaid. That means tens of thousands of Alabama parents still have no affordable long-term path to the health care they need as they seek to provide for their families.
Hundreds of thousands of Alabamians stand to gain access to health coverage if our state expands Medicaid. In the Huntsville metro area where Diana and her family live, that includes more than 11,000 people in Madison County and nearly 3,000 people in Limestone County.
Diana said her difficult journey has turned her into a fierce advocate for Alabama mothers.
“Medicaid expansion is a given,” she said. “The stuff I had to deal with in my pregnancy; the days I had to cry myself to sleep. I was always thinking, ‘Today is gonna be the day that something bad happens to my baby.’”
The Isoms’ new son, Keenan, is now insured under Alabama’s Medicaid program. Diana recently returned to work, and her husband was hired on full time after completing workforce training. They soon will be covered by his health insurance.
Diana said having coverage for both baby and mom has been such a relief to their family.
“I’ve been able to let go of so many things I was worried about before: being deported and away from my child, or how I was going to be able to go to the doctor, even just sleeping at night,” she said. “No one should have to go through what I did. No one.”
About Alabama Arise and Cover Alabama
Whit Sides is the Cover Alabama storyteller 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: whit@alarise.org.
Arise is a founding member of the Cover Alabama coalition. Cover Alabama is a nonpartisan alliance of 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.
By Debbie Smith, Cover Alabama campaign director at Alabama Arise, and Whit Sides, Cover Alabama storyteller at Alabama Arise
Medicaid expansion would empower nearly 300,000 uninsured and underinsured Alabamians to access the health care they need to survive and thrive. Alabama Arise and Cover Alabama were proud to attend a Nov. 6 community discussion in Birmingham titled “Closing the Healthcare Coverage Gap in Alabama.”
The panelists – including Dr. Khalilah Brown, vice president of medical affairs and patient advocacy at Southern Research, and Jane Adams, government relations director at the American Cancer Society Cancer Action Network – discussed how expanding Medicaid would bring federal funding into Alabama. They also spoke about how closing the coverage gap would create jobs in health care and related sectors, bolstering local economies and reducing uncompensated care costs for hospitals and providers. Both speakers made a compelling economic and budgetary case for why Alabama should expand Medicaid as soon as possible.
The need to center people when discussing Alabama’s health coverage gap
That’s why we’re glad that personal stories of directly impacted people were featured heavily throughout the MDC event. Personal stories, like those shared through the Cover Alabama coalition, break down walls that keep policymakers and the public away from seeing the real experiences of people affected by our state’s failing health care policies.
These lived experiences are powerful. They help people understand and empathize, going beyond just talking about money and instead seeing how the coverage gap affects real lives.
For example, Kenneth King shared during the panel discussion about his experience living in the health coverage gap. Kenneth is an underemployed resident of Birmingham, where he lives with his wife and daughter. He chooses the term “underemployed” carefully, as a testament to the difficulty of finding and keeping work in the face of chronic health challenges, some life-threatening.
After facing health issues while uninsured, Kenneth has been left with more than $100,000 in medical debt. As a contractor, Kenneth hasn’t been able to get employer-provided health insurance. He makes too much for Medicaid but can’t afford coverage through the Health Insurance Marketplace. (In Alabama, a parent in a family of three only qualifies for Medicaid coverage if their annual income is below 18% of the federal poverty level. That’s just $4,475 a year.)
How the coverage gap harms Alabamians with cancer
Jenny Fine, originally from Enterprise, Alabama, also shared how the coverage gap hit home for her. Jenny recently lost her sister to pancreatic cancer. Navigating care can be hard even in the best of times for those with a cancer diagnosis. But Jenny’s sister also faced long waits to see a doctor and a lack of treatment options when their local hospital became overwhelmed.
Smaller regional hospitals bear the brunt of uncompensated care, adding up to $13.4 million in 2021 in Coffee County, where Jenny’s family calls home. Expanding Medicaid would reduce that county’s adult uninsured rate by nearly half (42%), and it would add $68.2 million to the local economy in the first year alone. That would mean nearly 2,000 people like Jenny’s sister in that county alone would gain the life-saving coverage they need under expansion.
One of the most powerful moments of the event came when attendee Callie Greer shared the story of her daughter Venus. Venus was in the coverage gap and received her breast cancer diagnosis too late because she did not have access to the preventive care she needed. Venus only received help after countless expensive visits to the emergency room.
Callie told the audience that on one of Venus’ final desperate ER visits, a doctor walked in the room and asked, “What’s that smell in here?” Venus replied, “It’s my breast!” Her breast was literally rotting away from cancer. She went through a radical mastectomy and started chemo, then radiation. The treatment helped for a few months, but it proved too late to save her life.
The path to making Medicaid expansion a reality in Alabama
Personal stories like these, paired with grassroots action, are ultimately how Medicaid expansion is going to become a reality in Alabama. Finally closing the coverage gap depends on highlighting these stories of real Alabamians and working together to push our state leaders for change. As we reflect on these poignant stories shared at the MDC event, it’s crystal clear that Medicaid expansion isn’t just a policy discussion. It’s about lives, families and communities.
The time to act is now. Together, we can urge policymakers to listen to these stories, to recognize the human cost of inaction and to take the necessary steps to close Alabama’s health coverage gap. You can help us: Contact your legislators, share your story and join the Cover Alabama campaign.
Let’s ensure that no one else suffers the tragic consequences of being left in the coverage gap. Join us in demanding a healthier, more equitable future for all Alabamians.
Debbie Smith is the campaign director of Alabama Arise’s Cover Alabama campaign. Whit Sides is the storyteller for Alabama Arise’s Cover Alabama campaign. Visit coveralabama.org for more information on how you can get involved.
In April, Medicaid ended a continuous coverage eligibility period brought on by the public health emergency during the COVID-19 pandemic. What followed was a return to traditional eligibility requirements. This return to normal rules is called “unwinding.” Coverage losses have begun, and tens of thousands of Alabamians likely will lose their Medicaid coverage by June 2024.
A little more than halfway through the unwinding process, Alabama Medicaid members have a renewal rate of 68%. Only 4% of Medicaid members have been determined to be ineligible, while 27% of members lost coverage for procedural reasons.
From this information, we know more than 70% of Medicaid members have responded to requests for eligibility information from Alabama Medicaid. This response rate can be credited to Alabama Medicaid having a clear and concise communication plan. It also is a testament to the strong support of health care advocates in communities across Alabama.
But this does leave many thousands of people who are disenrolled for procedural reasons. And these losses are especially harsh for those who still may be eligible for coverage. When coverage loss occurs for procedural reasons, enrollees may need to submit further information to keep or maintain coverage. To prevent unnecessary coverage loss, please return any application materials to Alabama Medicaid, even if you do not think you are eligible. Only Alabama Medicaid can determine eligibility status.
If you have lost coverage, you may reapply with Alabama Medicaid. You also can contact Enroll Alabama for information on options for Marketplace insurance under the Affordable Care Act. If you feel that Medicaid terminated your coverage in error, you may appeal that decision. Call our partners at ADAP at 800-826-1675 for help.
Alabama Arise reached a new milestone in October when more than 500 members voted to determine Arise’s 2024 legislative priorities after our Annual Meeting. Nearly 100 members attended the meeting in person at the Equal Justice Initiative’s Legacy Institute in Montgomery, while almost 250 attended virtually. Outgoing board president Kathy Vincent led the meeting, which featured presentations from Arise staff and member group representatives.
Alabama Arise was excited to have a record number of members voting on our legislative priorities this year! Above: Arise staff members pose for a group photo after our Annual Meeting on Sept. 30, 2023, in Montgomery. (Photo by Julie Bennett)
Six of the seven priorities are returning from our 2023 agenda:
A safer and healthier Alabama for parents and children
A notable newcomer to our roster is a comprehensive approach to maternal and infant health care, which was proposed by ACLU of Alabama. This priority certainly aligns with our ongoing work to expand Medicaid and close Alabama’s health coverage gap. And our members decided it was critical for this to become a named priority in its own right. We are starting off strong by hiring a maternal health fellow to support our work to protect coverage during the Medicaid unwinding period.
Advocates have a long road ahead on this issue. Alabama has the highest maternal mortality rate in the nation. And according to the March of Dimes, more than one-third of Alabama’s counties are “maternal care deserts.”
Alabama Arise members Victoria Jenkins and Tem Samuel speak during the closing moments of our Annual Meeting on Sept. 30, 2023, in Montgomery. (Photo by Julie Bennett)
A safer Alabama for mothers will include access to high-quality maternal health care where patients live, removal of criminal penalties for doctors providing necessary care, and more freestanding maternal care centers across the state.
Alabama’s mothers and babies deserve so much better. Arise is committed to creating a safer and healthier state that will give parents, children and every Alabamian the chance to thrive and achieve their full potential.
This situation gives Alabama workers increased power to negotiate better wages, benefits and working conditions. It also leaves state leaders and employers scratching their heads. Aren’t we supposed to be among the most “business-friendly” states in the country? How can we attract and retain industry if businesses can’t hire workers? And why aren’t more people applying for openings as the cost of living continues to increase?
Consistent barriers to workforce participation
If you want to know why people are leaving the workforce, you need to ask them. Thankfully, we have data to understand what is happening.
Workers who are underemployed or dropped out of the workforce cited three major, consistent concerns, according to multiple recent surveys from the Governor’s Office of Education and Workforce Transformation:
No transportation.
Inadequate pay or work schedule. (Workers are looking for full-time work or higher pay.)
Illness or disability prevented them from working. (Indeed, disability is one of the main driving forces in Alabama’s extremely low workforce participation rates.)
One would hope we would see more of this data informing the conversation about the workforce. But unfortunately, it appears many lawmakers still haven’t seen the data.
Alabama Arise worker policy advocate Dev Wakeley participated in a recent discussion with lawmakers about barriers to workforce entry. He shared Arise’s policy prescription to address this issue, based on clear and direct feedback we’ve heard from workers.
1. Fund the Public Transportation Trust Fund to help workers get to jobs.
Alabama is one of only three states that has no state funding set aside to support public transportation. The Bipartisan Infrastructure Law of 2021 made massive federal boosts in public transit money available across the country. But with no local or state resources to match, cities and counties across Alabama cannot harness those federal matching funds.
Multiple survey groups cited transit access as their top barrier. It’s time for Alabama to join the rest of our Southeastern neighbors by boosting public transportation investments.
2. Stop incentivizing employers who fail to deliver on promises to provide good-paying jobs.
Alabama lawmakers passed “The Game Plan” earlier this year to renew several key economic incentive packages for large employers. Legislators also strengthened some reporting requirements via the Enhancing Transparency Act. These enhancements were critical, as Alabama still ranks among the least transparent states when it comes to economic incentives and tax expenditures.
We applaud efforts to hold businesses accountable for the promises they make when applying for these major tax breaks. But lawmakers must do more to enforce accountability and ensure the investment is paying off. While our state defers millions of dollars in tax revenue for vague incentives with unclear deliverables, many workers are still struggling to access the promised jobs because we have failed to invest in the necessary state infrastructure. And too often, the jobs simply don’t measure up to the promised wages and hiring goals.
3. Expand Medicaid to keep working-age adults healthy and in the workforce.
Investing in Alabama’s health care infrastructure is not just an avenue to create more health care jobs. It’s also a way to keep workers healthy and in the workforce.
Nearly 300,000 working Alabamians fall into the health coverage gap. Many are employed in high-demand but low-paying industries including service, retail, personal care or construction jobs. Consistent health care for low-wage workers can help prevent or control chronic disabling conditions. It also can give workers a lifeline when they are struggling with addiction, substance use disorders or mental illness.
Workers ideally would find good-paying jobs that provide flexible and inclusive family benefits. But they also should retain access to health coverage if they have to take a break from work to handle caregiving duties, manage a health or family crisis, go back to school or start their own business.
Temporarily losing a job with health coverage should not spiral further into permanent, preventable disability or untreated illness. Medicaid expansion would ensure many Alabamians still can get the health care they need during difficult times.
A prescription for a stronger workforce
We applaud House Speaker Nathaniel Ledbetter and the House Commission on Labor Shortage for expressing an interest in looking more deeply into the data around labor force participation. We were also glad to hear multiple lawmakers cite issues including affordable housing, wages and child care. All of these are critical supports to empower people to obtain and maintain employment.
To us, the message is clear: Investing more in work supports like public transportation and health care while ensuring more transparency and accountability for workforce incentives is a key, data-supported strategy to keep more Alabamians working and thriving.
Expanding Medicaid and ending the state sales tax on groceries will remain top goals on Alabama Arise’s 2024 legislative agenda. The group also will pursue a multifaceted approach to improving maternal and infant health in Alabama.
More than 500 members voted to determine Arise’s legislative priorities in recent days after the organization’s annual meeting Saturday. The seven priorities chosen were:
Adequate budgets for human services, including expanding Medicaid to make health coverage affordable for all Alabamians and protecting public education funding for all students.
Tax reform to build a more just and sustainable revenue system, including eliminating the rest of Alabama’s state sales tax on groceries and replacing the revenue equitably.
Voting rights, including no-excuse early voting, removal of barriers to voting rights restoration for disenfranchised Alabamians, and other policies to protect and expand multiracial democracy.
Criminal justice reform, including legislation to reform punitive sentencing laws and efforts to reduce overreliance on exorbitant fines and fees as a revenue source.
Death penalty reform, including a law to require juries to be unanimous in any decision to impose a death sentence.
“Arise believes in dignity, equity and justice for everyone,” Alabama Arise executive director Robyn Hyden said. “Our 2024 legislative priorities reflect our members’ embrace of those values, and they underscore the need to enact policies that empower Alabamians of every race, income and background to reach their full potential. Together, we’re working to build a healthier, more just and more inclusive Alabama for all.”
The time is right to close Alabama’s health coverage gap
One essential step toward a healthier future for Alabama is to ensure everyone can afford the health care they need. Arise members believe Medicaid expansion is a policy path to that destination, and research provides strong support for that position.
“Medicaid expansion would boost our economy and improve the lives of hundreds of thousands of Alabamians,” Hyden said. “It’s time for Alabama’s policymakers to make this life-saving and job-creating investment in the people of our state. Ensuring Alabamians’ health and well-being now will help our state flourish for decades to come.”
Alabama became one of only 10 states yet to expand Medicaid after North Carolina enacted expansion in March. Medicaid expansion would ensure health coverage for nearly 300,000 Alabamians caught in the coverage gap. Most of these residents earn too much to qualify for the state’s bare-bones Medicaid program but too little to afford private plans.
How Medicaid expansion would improve maternal and infant health
Medicaid expansion also would bolster health care access for Alabamians before, during and after pregnancies. This would be a critical life-saving move in Alabama, which has the nation’s worst maternal mortality rate. Those rates are even higher for Black women, who are twice as likely to die during birth as white women. Adding to the problem, more than two-thirds of Alabama counties offer little or no maternity care or obstetrical services.
“Alabama took an important step to help families stay healthy by extending Medicaid postpartum coverage last year,” Hyden said. “However, that step alone was not enough to meet our state’s numerous health care needs. Policymakers should pursue numerous solutions to make Alabama a better place for parents and babies. At the top of that list should be expanding Medicaid to ensure Alabamians of all ages can stay healthy before, during and after conception.”
New to Arise’s agenda this year is a comprehensive policy approach to safeguarding and expanding access to maternal and infant health care in Alabama. In addition to Medicaid expansion, this approach would promote seamless continuity of care between home and clinical settings. It would include coverage for contraception and midwifery services. And it would eliminate the specter of criminal penalties for doctors who provide care to pregnant people who are experiencing life-threatening complications.
Finish the job: Alabama should remove the rest of the state grocery tax
Arise advocacy got results this year when legislators voted unanimously to reduce Alabama’s state sales tax on groceries by half. The new law reduced the state grocery tax from 4 cents to 3 cents on Sept. 1. Another 1-cent reduction will occur in 2024 or the first subsequent year when education revenues grow by at least 3.5%.
Arise’s members have advocated for decades to untax groceries, and they renewed their commitment to continue that work in 2024. Ending the state grocery tax remains a core Arise priority because the tax makes it harder for people with low incomes to make ends meet. The tax adds hundreds of dollars a year to the cost of a basic necessity for families. And most states have abandoned it: Alabama is one of only 12 states that still tax groceries.
The state grocery tax brought in roughly 7% of the Education Trust Fund’s revenue in the last budget year. But lawmakers have options to remove the other half of the state grocery tax while protecting funding for public schools. Arise will continue to support legislation to untax groceries and replace the revenue by capping or eliminating the state income tax deduction for federal income taxes. This deduction is a tax break that overwhelmingly benefits the richest households.
“Reducing the state grocery tax was an important step toward righting the wrongs of Alabama’s upside-down tax system,” Hyden said. “By untaxing groceries and reining in the federal income tax deduction, lawmakers can do even more to empower families to keep food on the table. Closing this skewed loophole is an opportunity to protect funding for our children’s public schools and ensure Alabama can afford to end the state grocery tax forever.”
Alabama Arise listens because we deeply value the input we get from members, partners and most importantly, those directly affected by the work we do together. We depend on what we hear to help guide our issue work and our strategies.
We held three statewide online events this summer: two Town Hall Tuesdays and one public transportation listening session. And we facilitated eight additional listening sessions around the state, engaging a total of about 375 people.
The town halls happened on July 18 and Aug. 8, and the public transit event was Aug. 9. Other meetings took place throughout the summer. This year we are sharing the direct notes and highlights from each of the meetings as recorded during the sessions.
Town Hall Tuesdays & Public Transportation Listening Session
Building on our vision:We had three breakout rooms during this session. We asked folks in each group to discuss their thoughts on current issues and to share other priorities they had. Here’s what we heard:
Group One: Participants generally thought Arise should continue working on the current issues. They noted that the issues are interconnected, and that makes it hard to prioritize. Concerns about criminal justice conviction practices were raised, along with the need for continued work on voting rights and Medicaid expansion. Other issues raised were the need for more affordable housing, paying a living wage versus a minimum wage, and the need to discuss the impact of the opioid epidemic on grandparents now raising children because their parents suffer with addiction. Participants also raised reapportionment as an important issue.
Group Two: Participants strongly believed all of the Arise priority issues are important and that we should continue to work on them. Some of the specific issues lifted up were transportation, voting rights, payday lending and Medicaid expansion. Some issues that are not current Arise priorities raised were housing, disability, mental health access and accountability and prison reform.
Group Three: Medicaid expansion received the most support for continued work. Several people voiced prisons and criminal justice as a concern, including the need for prison reform and bail reform. Voting rights and the concern about the many voter suppression bills was a high-priority topic. Participants discussed passionate concern about payday loans, and the group supported the present slate of issues.
Building on our hope:We had three breakout rooms during this session. We asked folks in each group to discuss what motivates them to act on issues and how Arise supports their actions. We also asked them to indicate their priority issues. Here’s what we heard:
Group One:
The discussion in the group was hot and heavy concerning voting rights and specifically the absentee ballot application. The group concluded that a no-excuse absentee ballot should be the norm and should be an Arise issue for 2024.
The group felt strongly that the 2023 Arise slate of issues should all remain on the 2024 list of Arise priority issues. Medicaid is an issue we need to keep fighting for, they said.
This group had a primary focus and lengthy discussion around voting rights.
Group Two:
All members of the group strongly believe all the Arise priority issues are important and that we should continue to work on them.
Members also strongly believe affordable housing and public transportation should receive a strong voice like Medicaid expansion.
Members said that to further our support of advocacy work, Arise can help unite nonprofits and grassroots organizations across the state to work together toward shared goals as opposed to working separately toward shared goals.
Members lifted up our education and lobbying work as essential to connecting the people to those who represent them in the Legislature.
Group Three: Voting rights emerged as a strong theme from this group’s discussion. Participants stressed the importance of voter education and folks making the connection between voting and the policies elected officials make that impact their lives. Other voting themes included restoration of voting rights and engaging younger and BIPOC voters. Other issues raised were around public transportation and the need to fund mental health services. One participant expressed appreciation for the storytelling work Arise does related to Medicaid expansion and urged similar storytelling to help move elected officials around other Arise issues.
Public Transportation Listening Session:We had three breakout rooms during this session. We asked folks in each group to discuss what’s needed to improve public transit in Alabama, what strategies are needed to move the issue forward and how public transit impacts quality of life in their communities.
Group One:
Private companies like Uber and Lyft are not equipped to serve the disability community, group members said. This is very important when talking about transportation for the disability community wherever they may be, rural or urban. In other words, the private companies are not a viable resource, participants said.
Rural linkage: Many rural counties have transportation-on-demand systems, but they only serve the county boundaries. Many health services reside in urban centers, and the rider needs to get from Blount County to UAB or Children’s Hospital in Birmingham. These riders are out of luck. Transfer hubs for rural to urban systems do not exist.
A state transportation planning system is needed to coordinate all the existing public systems, rural and urban. Participants hoped Arise’s forthcoming transit study will shine some light on the need for a statewide public transportation planning entity.
The group felt a need for massive public education around the benefits of public transportation. Somehow, Arise or a group of organizations should seek funding for an advertising budget, participants said.
The real cost of owning a car versus using public transportation. This kind of information should be available to the public.
The fact that public transportation is good for business development throughout the state should be targeted to legislators and local business councils and chambers of commerce.
Group Two:
This group believes public transportation is essential.
There is a need for more hubs and covered stops for locations that already have public transportation in place.
There is a need for more routes with more frequent buses each hour, as well as drivers who are paid livable wages.
Specific strategies discussed included working with for-profits, chambers of commerce, small businesses and corporations to improve transportation for their employees. Participants also suggested surveying the need for transportation by including a question on applications to ask if transportation is needed.
Public transportation impacts the quality of life across the board: health, food, employment, education, leisure, etc.
People have a right to comfort, dignity, pride and independence that public transportation can provide.
One member said reaching out to people who do not need or use public transportation is important to educate them that they can still benefit from it. It helps reduce traffic and road congestion, decreases likelihood of drinking and driving, and helps people out of desperate situations, which can help decrease poverty and crime.
A member of the Alabama Institute for the Deaf and Blind shared how losing the ability to drive caused depression. But oppression is felt when there are no options for transportation other than relying on friends or family if you have them, or simply being unable to go to doctor’s appointments, shop for groceries or pick up medications when needed.
Some members suggested a public Lyft/Uber service.
Group Three:
Needs: Money/state funding, alternative models, transit-oriented development at local levels, accessibility, buy-in from agencies like ALDOT, changed perception of public transit.
Strategies/tactics: Collect public transit stories, share statistics on earning power with vs. without good public transit and other data relevant to workforce development, and highlight workforce development as a theme for legislative lobbying. Participants discussed a license plate fee, tire fee or special license plate (like public schools have, for example).
Quality of life: A visually impaired participant described how a trip to the grocery store or polling place only a couple miles away is a $25 Uber ride one way. Another participant who works with clients described how their lack of access to public transit affects not just work but health appointments, visiting DHR to secure SNAP, applications for housing, etc. They also mentioned that even “low-cost” transit can be a barrier to low-income folks who may not have a dollar for a ride.
Additional listening sessions
Following are the brief notes/summaries from eight other sessions our organizers held during the summer. In general, all participants strongly affirmed Arise’s work on the current issue priorities. They also highlighted some other issues of concern.
Cullman, July 26 (Stan Johnson) – This was a well-informed group with a lot of comments and questions concerning criminal justice, public transportation, death penalty and new prison construction.
Opelika, July 26 (Formeeca Tripp) – This group discussed issues surrounding housing, transportation, food insecurity, health care and the legal system. Housing was a top issue.
Zoom, Aug. 3 (Formeeca) – A death penalty group discussed issues related to recent executions in Alabama, as well as upcoming executions nationwide. Participants said more attention and connections are necessary to bring more awareness to death penalty reform.
Tuscaloosa, Aug. 7 (Stan) – The most passionate suggestion from this meeting was the need for legislative action to provide funding for mental health.
Opelika, Aug. 17 (Formeeca) – Arise conducted listening sessions in the form of a series of small group meetings.
Group 1: Predominantly parents, people of the community and law enforcement. They supported all current issues but wanted to focus on housing and transportation.
Group 2: Predominantly school staff, counselors, superintendents, principals, resource providers, etc. They wanted resources for non-English-speaking families, housing, transportation and effective mental health services.
Group 3: Predominantly youth, teenagers and support staff. They wanted to learn more about their representatives and how to lift up their own voices, as well as better wages and job opportunities.
Montgomery, Aug. 17 (Formeeca) – This group discussed their strategic plan to add to the existing public transportation priority issue. They want to add a $1 fee to license plates to fund the Public Transportation Trust Fund.
Birmingham, Sept. 10 (Stan) – This group showed special interest in fair housing and criminal justice reform. Voting rights also was a concern to the group, specifically absentee voting bills that may be reintroduced in the upcoming session.
Auburn, Sept. 21 (Formeeca) – Students from an Auburn University class filled out a 2024 issue proposal survey form asking them to rank issues of priority. The top three issues that seemed to rank the highest were public transportation, voting rights and criminal justice reform.
Medicaid expansion is a proven solution to help people join and stay in the workforce, a new report from Community Catalyst spotlights. States that have expanded Medicaid have seen a greater increase in labor force participation among people with incomes below 138% of the poverty line than states – like Alabama – that have not expanded.
“Every Alabamian should be able to get the medical care they need to survive and thrive,” said Debbie Smith, Alabama Arise’s Cover Alabama campaign director. “Removing financial barriers to health care would make our workforce more robust and more productive. It’s time for Alabama policymakers to close the health coverage gap and invest in a healthier future for our state and for our people.”
Nearly half of Alabama workers do not get employer-sponsored health insurance, the Catalyst report finds. This forces tens of thousands of Alabama families to make tough decisions, either to forgo needed health care or take on thousands of dollars of medical debt. When Alabamians are delaying the care and treatment they need, that hurts their productivity and their well-being.
The need for expansion is especially urgent right now as state officials unwind COVID-19 pandemic-era Medicaid policies, leaving about 61,000 Alabamians at risk of losing their Medicaid. Without Medicaid expansion in the state, many more individuals and families will be left with no options for affordable health coverage.
Closing Alabama’s coverage gap could create an average of 20,083 new jobs per year and have an estimated positive economic impact of $11.36 billion over the next six years. Medicaid expansion would be one key solution to improving workforce participation across the state.
Alabamians at every income level should be able to get the health care they need to survive and thrive. Medicaid plays a vital role toward meeting that goal, providing health coverage for more than 1 million Alabamians with low incomes. But tens of thousands of Alabamians may lose their Medicaid coverage by June 2024 in a process called “unwinding.”
Alabama Arise is working to minimize coverage losses during this period. As part of those efforts, we created this toolkit to explain the Medicaid unwinding and help connect people with other affordable coverage options for which they may be eligible.
Below is a table of contents for the resources in this Medicaid unwinding toolkit. Email info@alarise.org if you have any questions or recommendations for additional resources.
On April 1, 2023, Medicaid ended a continuous coverage eligibility period brought on by the public health emergency during the COVID-19 pandemic. What followed was a return to traditional eligibility requirements. This return to normal rules is called “unwinding.”
Current Medicaid members will receive mailings to their home addresses from Alabama Medicaid discussing these changes. Enrollees should ensure their most current and up-to-date information is on file by visiting the recipient portal here.
Click here to make sure Medicaid has your current contact information. Answers to some common questions about the unwinding period are below.
(1) How will I know it is time to renew my Medicaid application?
Medicaid enrollees will receive a recorded phone message, text message and/or email when it is time to renew – if you have provided that contact information to the Alabama Medicaid Agency. These automated messages will not ask for a response.
Please call Medicaid directly at 800-362-1504 if you have questions or need assistance.
(2) How will I get my renewal packet?
Medicaid enrollees will receive a renewal packet by mail prior to their renewal month. Click here to find out your renewal month.
(3) What do I do when I receive my renewal packet?
Please complete your form and follow instructions to return it to Alabama Medicaid. If you need assistance, call Medicaid at 800-362-1504 or go in person to a local Medicaid office.
(4) How will I know if I keep my Medicaid benefits?
Alabama Medicaid will make a determination on your eligibility. The agency also may ask for more information if needed. You will receive a decision on your eligibility directly from Alabama Medicaid.
(5) Do I need to fill out the renewal form if I know I don’t qualify for Medicaid anymore?
You should fill out the renewal form – even if you think you don’t qualify anymore. You can fill out the paper form or go online to submit the information. Or you can call the Medicaid office in your area to renew. Once you submit your information, you will be considered for any of the Medicaid programs for which you are eligible.
(6) Where can I find some helpful unwinding resources from Alabama Medicaid?
Alabama Medicaid will make an eligibility determination and notify you of that decision. This notification will have a termination date if your benefits are ending.
(1) What if I received notice that I am no longer eligible for Medicaid?
(2) What if I want to stay on Medicaid but need to update my information?
Click here to reapply to Medicaid with your updated information.
(3) What If I believe the termination notice from Medicaid is incorrect?
The first step that you can take is to request a review of Medicaid’s decision or a conference to discuss your case. You or someone helping you must contact a Medicaid district office and request a review or conference. You may be asked to provide more information to Medicaid. A conference may be helpful when additional information is needed to support your eligibility claim.
(4) What do I do if Medicaid does not find me eligible after my review or conference?
The next step is to request a fair hearing. You must make your request in writing no later than 60 days from the date of your termination letter or 60 days from the decision of your review or conference. You must mail your request for a hearing to the following address:
Medicaid Agency – Central Office Alabama Medicaid Agency P.O. Box 5624 Montgomery, AL 36103-5624
Call Alabama Medicaid at 334-242-5741 for information on a fair hearing request.
Where to look for new coverage
Did you or someone you know lose health coverage due to the Medicaid unwinding? Other affordable coverage options may be available.
ContactEnroll Alabama for more information on enrolling in a plan through the Health Insurance Marketplace at healthcare.gov. Many Alabamians are eligible for Marketplace coverage at little or no cost thanks to subsidies under the Affordable Care Act.
How has the Medicaid unwinding affected you?
Alabama can protect families and make health coverage more affordable by expanding Medicaid to cover adults with low incomes. Your personal story can help influence legislators and inspire advocates to take action.
You’re not alone. Nearly 300,000 Alabamians who are uninsured or struggling to afford coverage would benefit from Medicaid expansion. When you share your story, you help make the issue real for people. And you help show what’s at stake if we don’t close Alabama’s health coverage gap.
Arise’s Cover Alabama storyteller Whit Sides is gathering and telling the stories of Alabamians living in the coverage gap. Click here to share your story.
Unwinding in the news
AL.com: Status of 129,000 Alabama Medicaid enrollees uncertain after post-pandemic emergency
Alabama Daily News: Alabama starts removing people off Medicaid, but won’t yet say how many
Alabama Reflector: Post COVID-emergency, Alabama not reporting how many people lost Medicaid coverage
CNN: Medicaid eligibility: More than a million people have lost their Medicaid coverage already. It’s far from over
