Medicaid Matters – Section 4: How can we make Alabama healthier?


What you need to know …

A woman holding an #IamMedicaid sign
(Photo: #IamMedicaid)
  • Medicaid expansion would help hundreds of thousands of Alabamians get the health care they need.
  • States that have expanded Medicaid have seen improvements in infant and maternal mortality and greater access to treatment for mental illness and substance use disorders.
  • Extending coverage would reduce Alabama’s racial health disparities.
  • Medicaid expansion would generate billions of dollars in economic activity and hundreds of millions of dollars in new tax revenues.
  • Expanding health coverage would boost efforts to make Alabama’s prison system more humane, restorative and cost-effective.
  • Medicaid expansion could save hundreds of lives in Alabama every year.

Closing the coverage gap would improve lives

Hundreds of thousands of Alabamians could get the health care they need to survive and thrive if Alabama raised the income limit for Medicaid and allowed coverage for adults who aren’t parents. Medicaid expansion improves lives across a range of health measures, a growing body of research shows. Those areas include better birth outcomes and maternal health, lower overdose rates and improved mental health. Expansion also would increase household financial security and reduce racial health disparities.

A bar graph showing Alabama's current Medicaid eligibilty and eligibility under expansion. Medicaid expansion would bring the eligibilty limit for all adults in Alabama up to 138% of the federal poverty level. Right now, the eligibility limit for parents is at 18% FPL, and the limit for seniors, people with blindness and other disabilites is at 76% FPL. Childless adults without a disability are not eligible right now.

Extending coverage would keep Alabamians healthier

  • Evidence from Medicaid expansion states shows that providing women continuous health coverage before, during and after pregnancy would make a life-saving difference for mothers and babies.
  • Extending Medicaid coverage to adults with low incomes would extend the benefits of ongoing Medicaid reforms to hundreds of thousands more Alabamians. This improvement would give us the tools we need to address the state’s chronic health challenges, making families and our workforce healthier in the process.
  • Research shows that Medicaid expansion increases access to treatment for substance use disorders and significantly strengthens responses to the opioid epidemic.

Medicaid expansion would promote racial equity

A circle graph that shows Alabama's racial/ethnic health coverage gap. 49% of uninsured Alabama residents with low incomes are people of color, while 34% of all Alabamians are people of color.

Alabama’s shameful legacy of segregation and racial discrimination has driven racial health disparities that continue today. Nearly half of uninsured Alabamians with low incomes are people of color, even though people of color make up just one-third of the state’s population. Medicaid expansion would reduce that coverage disparity and increase economic and health security for Alabamians of all racial and ethnic backgrounds.

Medicaid expansion would boost Alabama’s economy and budgets

In the first four years of Alabama’s Medicaid expansion, the federal government would spend $6.7 billion for new health coverage in our state. This direct investment would yield:

An infographic showing a direct investment of $6.7 billion for new health coverage in Alabama would yield $4.6 billion in indirect economic activity, $446 million in new state tax revenues and $270 million in new local tax revenues.Covering adults with low incomes also would save $316 million in current state health program costs. With all these gains, the net cost to the state would be:A bar graph showing that the net state cost of Medicaid expansion would be $168 million in year 1 and $25 million in year 2 and after. Sources: David J. Becker, "Medicaid Expansion in Alabama: Revisiting the Economic Case for Expansion," January 2019; Manatt, "Alabama Medicaid Expansion: Summary of Estimated Costs and Savings, SFYs 2020-2023," February 2019.


Medicaid expansion would support prison reform in Alabama

In 2019, the U.S. Department of Justice put Alabama on notice that prison violence and overcrowding will trigger federal intervention if we don’t get the problems under control. Medicaid expansion would make our corrections system more humane, restorative and cost-effective in three ways:

    1. Untreated mental illnesses and substance use disorders are major contributors to over-incarceration in Alabama. By strengthening support for these services, Medicaid expansion would reduce recidivism and help more people stay out of the criminal justice system in the first place.
    2. When a person leaves prison, it’s hard to get a job that offers health coverage. But to get and keep a job, you need to be healthy. Medicaid expansion would provide former inmates the health security they need to join and remain in the workforce.
    3. Federal funding would cover 90% of the cost of expansion. That would slash state costs for hospitalizing prisoners and free up funds for other needed investments in the corrections system.

Medicaid expansion’s biggest win: saving lives

Across the country, Medicaid expansion saved the lives of at least 19,200 Americans aged 55 to 64 over the four-year period from 2014 to 2017. During the same period, 768 older Alabamians with low incomes lost their lives because they lacked health insurance. (Source: National Bureau of Economic Research, 2019)

If all states expanded Medicaid, the lives saved each year among older adults would nearly equal those of all ages saved by seatbelts.

A bar graph showing Medicaid expansion could save nearly as many lives among older adults as seatbelts save among people of all ages. In 2017, 14,955 lives of all ages were saved by seatbelts. 13,330 lives of people ages 55-64 would have been saved by full Medicaid expansion in every state in 2017. 7,500 lives were saved in expansion states, and 5,830 more lives would have been saved in non-expansion states. Source: National Highway and Transportation Safety Administration and Miller et al., "Medicaid and Mortality," 2019.


Meet Formeeca Tripp

A photo of Formeeca Tripp with her two children.
Formeeca Tripp of Auburn knows firsthand the tough decisions that come with living and working in the coverage gap. (Photo: Julie Bennett)

Formeeca Tripp watched her parents struggle with diabetes and heart disease. She has made efforts to follow a new path. But it hasn’t been easy.

“I have been conditioned to put my health on pause to make sure my children are up to date with all of their health care and mental health needs,” she says.

Formeeca lives in Auburn and is the mother of two children, one of whom was diagnosed with autism. She works full-time as a behavior specialist and part-time as an Uber driver to provide them both with medication they need, sometimes at a great cost to herself. For a long stretch, she fell into the coverage gap. With all her “extra” money spent on her children’s health care needs, Formeeca found herself reporting to work with ailments such as tooth infections and pink eye.

Recently, she gained coverage through her employer’s plan, but many people she knows are not so fortunate. Speaking from her own experience, Formeeca says Alabamians who can’t afford health insurance often work in public-facing jobs.

“It’s the people who are working with the sick and elderly, working with your babies,” she said. “It’s us, out here, hands on, making food, cleaning houses — it’s that gap of people, very important people. People who come into contact with thousands of other people. And you don’t want them to be healthy?”

Medicaid Matters (Main Section)
How does Medicaid work in Alabama? (Section 1)
How is Medicaid improving coverage? (Section 2)
Who’s still left out of health coverage? (Section 3)

Medicaid expansion would improve life for all Alabamians, new Arise report shows

Expanding Medicaid to cover adults with low incomes would build on the program’s successes and save hundreds of lives every year, according to a new report that Alabama Arise released Wednesday.

Arise’s report, Medicaid Matters: Charting the Course to a Healthier Alabama, illustrates why Medicaid expansion is so critical for the state at this moment in history. Through data, colorful graphics and personal profiles, the report explores Medicaid’s crucial role in Alabama’s health care system. And it reveals how Medicaid expansion would promote racial equity and leave communities better equipped to fight the COVID-19 pandemic.

“Expanding Medicaid would save thousands of lives, create tens of thousands of jobs and help hospitals and clinics across Alabama,” Alabama Arise policy director Jim Carnes said. “As our state continues to struggle with COVID-19, it’s more important than ever for the governor and lawmakers to step up and prove they value the health and well-being of all of our residents.”

Front cover of Alabama Arise's Medicaid Matters report

Medicaid is a health care lifeline for one in four Alabamians and an economic engine for the entire state. Medicaid Matters explains the Medicaid coverage available to more than 1 million children, seniors, and people with disabilities in Alabama. It highlights improvements that new Medicaid changes are promoting in key areas like infant mortality, obesity and substance use disorders. And it shines a spotlight on more than 340,000 uninsured and underinsured Alabamians who would be covered under Medicaid expansion.

Medicaid expansion would save and transform lives across Alabama

So far, 36 states – including Arkansas, Kentucky and Louisiana – have expanded Medicaid to cover adults with low incomes. But Alabama is one of just 14 states that have not. That remains the case even though the state would get $9 in federal money for every $1 of state funding.

Medicaid expansion would bring peace of mind to thousands of Alabamians who recently lost their jobs and health insurance. And it would make life better for many uninsured people who are working on the front lines of the pandemic. This includes workers at grocery stores, hospitals, child care facilities and other essential businesses.

Formeeca Tripp, a behavior specialist who lives in Auburn, explains in Arise’s report how the health of any Alabamian is linked to the health of every Alabamian.

A photo of Formeeca Tripp with her two children.
Formeeca Tripp of Auburn knows firsthand the tough decisions that come with living and working in the coverage gap. (Photo: Julie Bennett)

“It’s the people who are working with the sick and elderly, working with your babies,” Tripp said. “It’s us, out here, hands on, making food, cleaning houses – it’s that gap of people, very important people. People who come into contact with thousands of other people. And you don’t want them to be healthy?”

Click here to read Arise’s full report. Links to each section of the report are below.

Medicaid Matters (Main Section)
How does Medicaid work in Alabama? (Section 1)
How is Medicaid improving coverage? (Section 2)
Who’s still left out of health coverage? (Section 3)
How can we make Alabama healthier? (Section 4)

You’re invited to Arise’s Town Hall Tuesdays!

Arise’s statewide online summer listening sessions are a chance to hear what’s happening on key state policy issues and share your vision for our 2021 policy agenda. Register now to help identify emerging issues and inform our work to build a better Alabama.

We’d love to see you at any or all of these sessions! Registration is required, so please register at the link under each description.

June 23rd, 6 p.m. Money talks

How can we strengthen education, health care, child care and other services that help Alabamians make ends meet? And how can we fund those services more equitably? Click here to register for this session.

July 7th, 6 p.m. Justice for all

We’ll discuss Alabama’s unjust criminal justice system – and how to fix it. Click here to register for this session.

July 21st, 6 p.m. Getting civic

How can we protect voting rights and boost Census responses during a pandemic? Click here to register for this session.

August 4th, 6 p.m. Shared prosperity

Policy solutions can boost opportunity and protect families from economic exploitation. Click here to register for this session.

August 18th, 6 p.m. Feeding our families

How can we increase household food security during and after the recession? Click here to register for this session.

September 1st, 6 p.m. Closing the coverage gap

Join the Cover Alabama Coalition to discuss how you can help expand Medicaid. Click here to register for this session.

Alabama must tear down the legacies of slavery and segregation

The monument stood in Birmingham for decades as a twisted tribute to Alabama’s original sins: slavery and white supremacy. It “honored” a violent rebellion that sought to protect the enslavement of human beings. During segregation and Jim Crow and civil rights protests and into the 21st century, it served as a daily 52-foot-tall reminder of the systemic oppression and persecution of Black Alabamians.

That monument is finally gone now. After protests, the city pulled it down June 1, on a state holiday named for the political leader of the rebellion it commemorated. Removing physical symbols of slavery and segregation is an important step toward healing and recovery, but it’s not enough. We also must tear down prejudices, disparities and injustices that trace their roots to these oppressive and racist practices. To do that, Alabama must enact public policies that undermine white supremacy and promote dignity, equity and justice for everyone.

The need for racial justice

For more than 30 years, Alabama Arise has worked to make life better for struggling Alabamians through better public policy. It’s impossible to do that work effectively without acknowledging and challenging our state’s historical and ongoing racial inequities. There can be no economic or social justice without racial justice. And as scholar Ibram X. Kendi said, policy cannot be merely non-racist; it must be anti-racist. That’s why we’re committed to placing racial equity and inclusion at the core of our work.

Black Alabamians have battled generation after generation of discriminatory barriers to education, jobs, housing and voting. Compounding those barriers is a criminal justice system that polices Black people more heavily, arrests them more often and condemns them to harsher sentences in dangerously overcrowded prisons and jails.

For centuries, Black people have suffered from police brutality and unequal treatment from law enforcement. This history has fueled protests across the country and around the world over the last week. Arise stands in solidarity with calls to stop killing Black people and start building a world that’s safe for everyone.

All of these systemic failures have added together to produce a series of terrible, ongoing disparities. Black people in our state face higher rates of poverty and hunger, lower life expectancies and lower rates of employment and health insurance coverage.

Policy changes to break down harmful barriers

These are institutional failures that require policy solutions. Here a few ways lawmakers can help break down barriers to opportunity and justice:

  • Expand Medicaid to cover adults with low incomes. Expansion would ensure health coverage for more than 340,000 Alabamians who are uninsured or barely paying for insurance they can’t really afford. It also would attack a fundamental injustice: People of color make up about 34% of our state’s population, but nearly half of all uninsured Alabamians with low incomes are people of color. Lack of affordable health coverage deprives Black people of timely care for cancer, diabetes, heart disease and other serious conditions. As the disproportionately high share of coronavirus deaths among Black Alabamians shows, health care access is literally a matter of life or death.
  • Invest more in public education. Alabama’s state funding for K-12 and higher education, adjusted for inflation, is lower today than it was in 2008. This chronic underfunding hits many schools that primarily serve Black students especially hard.
  • Equitably distribute funding for affordable housing and public transportation. Alabama has trust funds for both but hasn’t funded them yet. Lawmakers should fund public transportation to help everyone get to work, school and other places they need to go. Alabama should support the Housing Trust Fund to ensure people living in deep poverty have safe shelter. Our state also should commit to eliminating redlining, fighting housing discrimination and proactively reducing residential segregation.
  • Overhaul the criminal justice system and the death penalty. Areas with large Black populations often see a larger police presence. The weight of harsh sentences and criminal justice debt falls more heavily on these Alabamians as a result. Lawmakers should reform sentencing laws and ease the crushing burden of exorbitant fines and fees. They also need to end abuses of civil asset forfeiture and eliminate racial injustice in the state’s death penalty system.
  • Strengthen and expand voting rights. Voting barriers should find no home in the heart of the Civil Rights Movement. Automatic voter registration, no-excuse absentee voting and same-day registration are a few changes that would make voting more accessible. Alabama also should ease barriers to voting rights restoration.
  • Raise the minimum wage and restore home rule to localities. Alabama is one of only five states with no minimum wage law. Birmingham tried to raise its minimum wage in 2016, but state lawmakers blocked that effort. The Legislature has that power due to the 1901 state constitution, whose authors explicitly said the document aimed to “establish white supremacy in this state.” Alabama should lift constitutional barriers to home rule and allow local governments to make decisions in their own communities.

A better, more inclusive future for Alabama

Undoing the legacies of slavery and segregation in Alabama will require more than reassuring words and vague platitudes. It will require substantive policy changes to break down centuries-old barriers and ensure all Alabamians have a chance to reach their full potential.

Many of these changes – and others not mentioned above – won’t be easy. Some of them may not happen quickly. But we must keep advocating and working toward the day when they will. The road to dignity, equity and justice for all Alabamians remains a long one. But walking together and working together, we can and will reach that destination.

Cover Alabama Conversations: Alabama Arise’s Jim Carnes

Alabama Arise’s Sherrel Wheeler Stewart talks to Arise policy director Jim Carnes about how Medicaid expansion would save lives and reduce suffering for hundreds of thousands of adults with low incomes across Alabama. They also discuss how expansion would help the state combat the COVID-19 pandemic and rebuild in its aftermath.

Listen to the full interview below:

Arise is a proud member of the Cover Alabama Coalition, which is urging Medicaid expansion in our state. Click here to share your health care story with Arise and Cover Alabama today.

Full transcript


Our state, our nation and our world are at a crisis point right now. The global pandemic COVID-19 is claiming thousands of lives, flooding hospitals with patients and wrecking the economy. In Alabama, it’s exposing a serious gap in health care for poor people in our state.

Now a coalition of partners, Cover Alabama, is working together to help bring change, expanded access to Medicaid now and a better quality of life in the years ahead.

I’m Sherrel Wheeler Stewart, story collection coordinator for Alabama Arise. I’m talking by phone with Jim Carnes, the Alabama Arise policy director. He tells us why Medicaid expansion is needed in Alabama right now.


So recently, the vice president said states have been given some flexibility in using their Medicaid dollars to help the uninsured at this time. What does it mean for Alabama? If anything?


If anything, there is that basic question offered by the Affordable Care Act. You know, will you expand Medicaid to cover this population of people who are earn up to 138% of the poverty level?

Alabama is one of 14 states that have not accepted that option. What’s happened with the COVID-19 pandemic is that states have some additional flexibilities. Now, a lot of these are flexibilities that states always have, but emergencies kind of open that door. And there are things Alabama could do through several different mechanisms, through a waiver process or an amendment process. The technical mechanisms differ, but the general idea is that there are a whole host of things that Alabama could do to broaden our coverage and to streamline coverage and services. For example, we could suspend a lot of the administrative processing required for people to get certain kinds of services or to get coverage that they qualify for.


In other words, what you’re saying is, get rid of some of the red tape?


Exactly, exactly. There is an opportunity now to get rid of a lot of the red tape. Alabama has made some moves in that direction. We have passed for and gotten permission to do a few things. But there are many more options available to Alabama that we have not yet sought.

Now, the option to expand Medicaid coverage to those adults, working-age adults, is something that is obviously still available. And Alabama has not chosen to do that. That is not, however, a new flexibility that is prompted by the emergency. There is not really an emergency expansion opportunity. We can roll out services in a new way, and we can make enrolling in coverage easier. But if we want to expand coverage outright, the opportunity still stands. We could do it. The word “expand” is the key there.

There are two things to bear in mind. No. 1 is that the Affordable Care Act 10 years ago gave states the authority to expand their Medicaid programs to cover low-income adults up to 138% of the federal poverty level and to include adults without children. Here in Alabama, which has the second most restrictive Medicaid program – we have the second strictest program after Texas – we allow adults under age 65 who do have a disability, which is sort of one way to distinguish between adults who qualify and adults who don’t. People with disabilities can get Medicaid coverage under certain conditions. But looking at what some people call able-bodied adults – that is, adults who are working-age without a disability. In Alabama, No. 1, you have to have a dependent child. And No. 2, your earnings cannot exceed 18% of the federal poverty level.


In dollars, what are we talking about here?


Yeah, well, for a family of three, that would be, you can’t earn more than $329, I believe. So it’s under $350 a month, if you think of it in big round numbers. If you earn more than $100 a week in Alabama, you can’t get Medicaid.


Well, that doesn’t sound like a whole lot. It sounds like what you get when you pick up lots of cans and just take them down to be recycled.


Yeah, exactly. I mean, you’re talking about not being able to hold a job and get Medicaid in Alabama. It’s extraordinarily restrictive.

We do a better job with children, children and families. Up to 146% of the poverty level can get coverage for the children, but their parents cannot get coverage. So, we’re dealing with an extremely low income limit in Alabama, which means we have a lot of folks who are walking around Alabama working every day in jobs that we all depend on. You know, all the service industries and just a variety of jobs, manufacturing and all kinds of jobs, that cannot qualify for Medicaid.


You know, a lot of these Alabamians are people who are on the front lines. They are the ones who are keeping us going right now. Am I correct?


Oh, exactly. I mean, we’re depending on them more than ever right now. Exactly.


Why is it important at this time for Alabama to expand Medicaid?


You know, it’s been important for 10 years, but it is more urgent than ever right now. There are there are many, many reasons. And I’d like to hit some highlights. One is that Alabama is a high-poverty state. We estimate that we have more than 200,000 Alabamians who are trapped in the coverage gap. They simply cannot afford to buy private or employer-based coverage, and they earn too much to qualify for our very restrictive Medicaid. So they are without an option. And as you pointed out, they are the people who are working the jobs that we have deemed essential. They are cleaning our hospitals, cashiering at our grocery stores, docking the shelves of our drug stores and grocery stores. They are keeping produce rolling from the farms to the stores. They are the people that we are all more aware of probably right now than we have been in a long time.

Essential workers without health coverage

I think everybody is tuned in now to the crucial jobs that those employees are serving and fulfilling in our state right now. And I know that I’m finding myself thanking the checkout clerk much more consistently than used to be, really trying to tell them that we appreciate their critical service at this time. These are people who are much too often going without health coverage. Similarly, people in the food service industry, while most of that has shut down, there are still people who are working to provide meals that can be picked up or delivered. And too often, those are folks who are going without health coverage. We also know that we’re going to come out of this shutdown, and people are going to be reentering the workforce with that same hindrance.

They are still going to be going without health coverage, unless we can do something now. One thing that I especially want to point out is that the recent measures that Congress has taken to address the coronavirus have made sure – and I’m grateful that they have – but they’ve made sure that there is free testing available. We hope that that is becoming more and more widely available, but there should be free testing rolling out across all of the states.


What happens if Alabama doesn’t act now to expand Medicaid?


We’ve just learned recently that there will be payments for hospitals to serve COVID-related illnesses for patients who were uninsured. But they don’t have— those same people don’t have coverage for anything else that may be wrong with them or that may happen to them in the meantime. So for an uninsured worker, for example, the idea of having to deal with illness from COVID, it can mean personal financial disaster. It can mean medical debt that is simply unsustainable.


When I hear you say these things, I think about my own perception of Medicaid and health care. You know, I always just thought that health care was one of those elements we needed to maintain a certain standard of living.


You hit the nail on the head. You know, one thing I’m hopeful about amid all this despair that we’re experiencing and the alarm is this bright light that we are seeing now on our health system and on our community networks and all of those infrastructural kinds of things that kind of go hidden or unnoticed. One result that I’m hoping to see is that our conversation will lead us to consider what really is the role of our public financing for the common good. What do we as communities really owe each other and ourselves in regard to a baseline safety net of public services that we all ultimately depend on?

I think never in my lifetime have we seen such a stark picture of how public services work, how they should work and how they sometimes fail. And I’m hoping that those failures and that sharp, bright light can help us reevaluate and have a really serious, productive conversation about our investment in the common good.


Talk to me a little bit about our health care system and the impact of the hospital system in Alabama.


Alabama is a state that has allowed its hospital system to become frayed. As you know, we’ve lost eight rural hospitals over the last 10 years and six hospitals in urban and suburban areas. So we are already— before the COVID-19 even emerged, we were suffering from a beleaguered hospital system.

The emergency is only going to tax those hospitals further to the limit in terms of their capacity to deliver care and their capacity to sustain the financial impact of the epidemic. Our hospitals are in more need than ever of the federal support that would come through Medicaid expansion.


But Jim, beyond the conversations, it seems like someone needs to be making things happen. And who is it? Is it the governor? Is it the Legislature?


Yes. Well, there is in Alabama— each state is different with regard to how its Medicaid works. It’s a federal-state partnership that gives states a lot of leeway. There’s the federal government sets kind of a baseline of services. But the states have a lot of flexibility. And when it comes to how they make Medicaid funding decisions, the states are really individual deciders on that.

In Alabama, the governor could initiate Medicaid expansion by approving a rule change. It’s a simple rule change that would raise our income limit for Medicaid benefits. Once she did that, there is a review process that would take that rule change to a legislative committee, and they wouldn’t even have to actively approve it. They could they could not object. In other words, they could allow the rule change to pass. They wouldn’t have to do anything. They would just have to turn the other way and let the governor do it.

The governor has that authority, but it still requires some consent, even passive consent, from a legislative committee. Once that happens, it would go to Washington for approval. And I cannot imagine that in this environment they wouldn’t expedite an approval.

I know that the Trump administration has not favored Medicaid expansion, but it’s almost impossible to believe they would deny it in this environment. Then it would go into effect. The Legislature would have to provide the extra funding for covering more people. But we think that’s an investment that would have immense return.


Now, in dollars, what’s that amount? What are we talking about here?


The estimates that we had before COVID-19 were that that year one would be that the highest costs for the state. The federal government pays 90% of the expansion cost. So in other words, the costs for enrolling and serving the new enrollees through the expansion. It’s a 9-to-1 federal program for expansion. Alabama’s cost, we estimate, would be $168 million. And then the feds would pick up the rest.

In subsequent years, we would begin to see the return on that investment. We would see new tax revenues from the increased economic activity. We would see new state savings in programs that we’re currently paying for entirely out of state dollars, particularly some mental health programs, and those would get the 90% match. So it would make new state money available. So in subsequent years, the estimate is that the state would pay about $25 million a year going forward for expansion. In return, we estimate about 340,000 Alabamians— you would get those people who are currently uninsured in the coverage gap, plus some eligible people who would then choose to take the Medicaid coverage in lieu of straining their family budget to pay for their private or employer-based coverage. So, we think about 340,000 people would get it.


Will COVID-19 change these projections? And if so, how?


We have to adjust those expectations a little bit, because COVID is going to make more people eligible, because more people are losing their jobs and losing their income. So more people would become eligible. However, the return that we would get on having those federal— that federal support for the health care for those Alabamians would be immense. I mean, that would just be an enormous gain for the state.

If we are saddled with even more uninsured people who are now facing even more health challenges in a hospital system that has not gotten that extra support it needs, then that just spells disaster for the state. So the hospital system itself is another beneficiary. Obviously, we would get to infuse those federal dollars into our struggling hospitals. That in turn would help revitalize our community economies, because, as you know, our state and local economies are going to be reeling from this blow.

So the best leverage we can use right now, just thinking beyond the health care system and beyond COVID— the best leverage we can use for bringing federal dollars into the state to respond and recover from the emergency is to expand Medicaid. We will get nine times the funding we put up as a state. So it’s a 9-to-1 gain. For a dime on a dollar, we could bring in billions of federal dollars to help our state recover and bounce back.


Let’s just say this moves through the process, through the governor’s office, through the Legislature. And then how long will it actually take for us to get Medicaid expansion in place in Alabama?


Our best guess is that it would take about six months for the coverage to get up and rolling. However, there’s a wonderful provision that allows Medicaid coverage to be retroactive in the quarter in which it starts. So the sooner we start – we’re now in the second quarter of the year, it’s the third quarter of the fiscal year – the sooner we start, we can retroactively cover from April 1.

So although it would take about six months to get the actual machinery up and running, so to speak, on getting coverage, we could we could actually build some of that retroactively. So we would have good financial coverage there. However, in the meantime, Alabama needs to use every tool in the Medicaid toolbox. That means going ahead and initiating all of the flexibilities that you mentioned earlier that we can to make enrollment easier, to make getting services easier, to make it easier for medical providers to get their payments. There are just all kinds of streamlining that we can do to expedite or fast-track our startup on Medicaid expansion.

Now is the time. Every day we waste is a day that puts more Alabamians at risk, that puts more hospitals at risk and more communities at risk of financial disaster.


This has been Cover Alabama Conversations. Thanks for listening.

Arise update: April 24, 2020

Personal stories have power. And we want to hear yours. Arise’s Sherrel Wheeler Stewart talks about the importance of personal stories as we work to convince Alabama lawmakers to expand Medicaid. She also explains how folks who are uninsured or struggling to afford health coverage can share their stories with Arise and the Cover Alabama Coalition.

Click here to get started.

Arise update: April 16, 2020

State and federal leaders have taken action to help struggling Alabamians stay healthy and make ends meet amid the COVID-19 pandemic, but they must do more. Arise’s Robyn Hyden gives a video update on the coronavirus’ implications for Medicaid expansion, public health funding, food assistance, unemployment insurance, paid family and medical leave, prisons and jails, and other concerns.

Cover Alabama Coalition: Medicaid expansion is essential to state’s recovery

A nonpartisan alliance of more than 60 Alabama organizations has come together to urge Gov. Kay Ivey to say yes to Medicaid expansion. The Cover Alabama Coalition, which launched Wednesday, is calling on Ivey to close the health coverage gap for workers who don’t have employer-based insurance and can’t afford to purchase insurance on their own. Alabama Arise is a founding member of the coalition.

Cover Alabama logo

Cover Alabama is a coalition of advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations from across the state. (You can read the full membership list here.) The coalition held a virtual news conference Wednesday to highlight the critical role that Medicaid expansion can play in ensuring access to health care, protecting families against bankruptcy and stabilizing rural hospitals – both during the COVID-19 pandemic and the economic recovery.

“This pandemic only heightens the need for bold, comprehensive action,” said Evey Owen, interim coalition director for Cover Alabama. “The health and economic costs of COVID-19 will be high no matter what. Alabama must maximize the value of every state dollar we spend to protect public health. And the best way to do that is to leverage the 90% federal match for Medicaid expansion.”

The need to expand Medicaid here and now

So far, 36 states – including Arkansas, Kentucky and Louisiana – have expanded Medicaid to cover adults with low incomes. Alabama is one of just 14 states that have not done so. Medicaid expansion would benefit hundreds of thousands of Alabamians who are uninsured or struggling to pay for health coverage. Many of these uninsured people are “front-line workers” at grocery stores, hospitals, pharmacies and other essential businesses during the COVID-19 pandemic.

“It’s great to applaud the brave Alabamians who are keeping food on our tables and keeping hospitals clean during the crisis, but it would be even better to make sure they can get health coverage,” Owen said. “These are the workers most likely to be uninsured, and we should do everything we can to keep them safe and healthy.”

Speakers at Cover Alabama’s news conference Wednesday pointed out that Medicaid expansion would:

  • Help uninsured Alabamians avoid risks of delayed care, like unchecked COVID-19 transmission, poor health outcomes and overwhelming medical debt.
  • Relieve rural health care providers from financial strain, preventing further hospital closures.
  • Bring billions of federal dollars into local and state economies as they struggle to recover from revenue losses of historic proportions.

To elevate and amplify the public conversation about Medicaid expansion at this critical time, Cover Alabama plans to share stories of Alabamians caught in the coverage gap, news about expansion’s impact in other states and an opportunity for more groups to join the campaign.

COVID-19: 7 policy changes that would help protect Alabamians

The World Health Organization has labeled COVID-19 a global pandemic. And state officials announced the first confirmed case of the disease in Alabama on Friday. As the virus strains our health systems, schools and economy, we must ensure the most vulnerable Alabamians have the medical care, social supports and other protections they need to weather the crisis.

The Alabama Legislature will be on spring break for the next two weeks. We hope our state lawmakers and members of Congress will take time to examine the situation developing in their communities. And we hope they will act quickly and courageously to address these critical public health needs.

Here are seven actions that policymakers should take now to protect the well-being and security of all Alabamians:

1. Gov. Kay Ivey should expand Medicaid.

Medicaid expansion would extend health coverage to more than 223,000 uninsured Alabamians with low incomes. It also would ensure coverage for another 120,000 who struggle to afford the insurance they have.

Expansion would take several months to implement, but it would prepare us for the big challenges ahead. In the short term, Medicaid could take numerous other steps to protect families. Examples include streamlining enrollment, covering new mothers for one year after delivery and increasing our “bare-bones” income limit for parents.

Email Gov. Ivey to ask her to expand Medicaid and help address the coronavirus threat. Or if you’d prefer to reach out by phone, click here to call Gov. Ivey’s office.

2. Lawmakers should increase funding for public health to ensure adequate testing, preparation and prevention.

In addition, state and local agencies should take the lead on proactive policies and procedures to protect those who are most vulnerable to this virus. Read State Health Officer Scott Harris’ report to the Senate Health Committee.

3. Congress should authorize emergency food assistance increases.

Boosting the Supplemental Nutrition Assistance Program (SNAP) would help children get the food they need while they’re out of school. It also would promote food security for seniors, people who lose their jobs and other people at risk of hunger. Read additional recommendations to address critical food security issues from our partners at the Food Research and Action Center.

4. Policymakers should remove barriers to social support services.

Medicaid, SNAP, WIC and Temporary Assistance for Needy Families (TANF) save and improve lives. Red-tape barriers to these services make it harder for struggling families to get the help they need during a crisis. Read Arise’s fact sheet to learn why state lawmakers should abandon efforts to reduce access to safety net programs.

5. State lawmakers should remove the state sales tax on groceries while protecting education funding.

As many people prepare for social distancing by purchasing enough food to last for several weeks, the grocery tax imposes the highest tax burden on the people who can least afford it. It’s yet another illustration of why this cruel tax must end. Click here to urge state legislators to untax groceries and replace the revenue by supporting SB 144.

6. Policymakers should look at options to extend paid medical and family leave to every worker.

States including Washington and Massachusetts have created affordable buy-in plans so that even smaller employers can provide extended medical or family leave. Read how paid family and medical leave was made affordable and available to every worker in the state of Washington. Then read more about federal discussions to provide short-term relief for paid leave.

7. Alabama should expand unemployment protections to mitigate the effects of job losses for individuals and communities.

Closures and layoffs in the coming months will leave many workers without essential income. Public officials must act now to reduce the financial toll on people who struggle to make ends meet. Read recommendations from the National Employment Law Project (NELP) about potential improvements to unemployment insurance coverage.

Looking ahead

The conversation about the best policy and social responses will continue to evolve over the coming days and weeks. And additional needs and solutions are likely to emerge. Throughout this crisis and beyond, Arise will continue to speak out for dignity, equity and justice for all Alabamians.