Alabama Arise, partners urge COVID-19 vaccine priority for Alabamians served through Medicaid waivers

Alabamians served through home- and community-based Medicaid waivers qualify for nursing home care but receive their care at home from community providers through the state’s Medicaid waiver program. The Alabama Department of Public Health (ADPH) has acknowledged that these individuals belong in the Phase 1a priority level for the COVID-19 vaccine. But they have not yet received access to the vaccinations.

Alabama Arise and partner groups sent the following letter to Gov. Kay Ivey on Thursday in response:

Letter text

Dear Governor Ivey,

We hope you are well and breathing a little easier as spring approaches with better COVID news each day. In response to our previous letter of a month ago, you invited us to get back with you in a few weeks if we had further concerns about the vaccination roll-out. Recent trends are encouraging, but we do want to highlight an ongoing issue that has not been resolved.

After we sent our Jan. 15 letter, we learned that program directors at Alabama Medicaid, Alabama Department of Senior Services, Alabama Department of Mental Health and Alabama Department of Rehabilitation Services contacted Dr. [Scott] Harris to express their concern about the lack of vaccination planning for the Medicaid long-term care patients they serve through home- and community based service waivers. As individuals who qualify for nursing-home care but receive their care at home from community providers, waiver patients are equivalent to nursing home residents in their vulnerability to COVID-19, as well as their legal status. ADPH has acknowledged that these patients belong in the 1a vaccination priority level, but they have not been granted access to vaccinations.

We understand that the agencies offered to assist ADPH with outreach and other logistical planning to ensure timely vaccination of these vulnerable individuals. “Timely” is the critical word. The longer we wait to vaccinate the top priority populations, the more hospitalizations and deaths Alabama will experience on our way to generalized immunity. As of Wednesday afternoon, the other health agencies were still waiting to hear how they could engage with ADPH in this vital effort. We recognize the enormous task facing the department and applaud its perseverance under trying circumstances. Rather than calling that work into question, we offer this appeal in the belief that an inter-agency strategy will lighten ADPH’s load.

One example of such collaboration comes from Delaware, where paratransit resources are being deployed in a “reverse paratransit” network to deliver vaccines and vaccinators to the homes of paratransit users as vaccine supply becomes available. We have shared this model with ADPH and understand that Dr. Mary McIntyre has contacted the Delaware program to learn more. We hope to see similar ideas embraced here in Alabama. We would appreciate anything you can do to expedite an inter-agency partnership to make vaccinations available to our most vulnerable Alabamians as soon as supplies allow.

Thank you for your consideration.

Signatories

Respectfully submitted by:

Jim Carnes
Policy Director, Alabama Arise

James A. Tucker, Esq.
Director, Alabama Disabilities Advocacy Program
The Protection and Advocacy System for the State of Alabama

Eric M. Peebles, Ph.D., CRC
Chair, Consumer Advisory Committee, Alabama Select Network
President, Disabilities Leadership Coalition of Alabama
Treasurer, State of Alabama Independent Living Council
President and Chief Executive Officer, Abilities Unlimited LLC dba Accessible Alabama

Alabama Arise testimony in opposition to corporate COVID-19 immunity bill

Arise’s Robyn Hyden testified to the Senate Judiciary Committee on Wednesday in opposition to SB 30. The bill, sponsored by Sen. Arthur Orr, R-Decatur, would provide corporations with a broad range of civil immunity against lawsuits related to exposure to coronavirus or contraction of COVID-19. Here’s the full text of Hyden’s prepared remarks:

Good morning. I’m here to represent Alabama Arise, our 158 member organizations and thousands of members and partners around the state of Alabama who believe that poor and working-class people deserve equal protection and opportunity for dignity, equity and justice.

We know you are a deliberative body, and we believe that more deliberation is needed on this bill. First, we are concerned that provisions are being made in this legislative session to protect business and corporate interests without a similar focus on protecting workers and everyday people who are the true economic engine of our state. This bill provides virtual blanket immunity, harming workers and rewarding bad actors.

Second, the standard of “clear and convincing evidence” required in this bill is simply too high and will prevent legitimate claims from being addressed. We would propose the “preponderance of evidence” standard used in other civil cases.

Inconsistent standards and lowered expectations

Third, there are major inconsistencies that need to be addressed. This bill creates two competing standards of care: one in section 4, and one in section 3. Section 4 appears to be retroactive and includes a clear link to compliance with public health standards. Section 3 does not mention anything about compliance with public health standards. Those standards should be consistent. And further, disallowing lawsuits for negligence, as this bill does, gives irresponsible entities a free pass for acts committed during the COVID-19 pandemic that would normally subject them to liability.

Finally, we believe the references to “applicable public health guidance” in the introduction should include guidance issued by federal agencies, not just state agencies. The federal SAFE TO WORK immunity legislation supported by Sen. Mitch McConnell and Senate Republicans tied immunity to reasonable compliance with public health standards, as have immunity bills in most other states. There’s no logic in lowering our expectations of businesses moving forward when they already know so much about how to prevent the spread of COVID-19.

In conclusion, I urge you all to consider actions to protect and nurture workers’ well-being through worker supports that will allow people who are medically vulnerable to protect both their health and their financial well-being during this pandemic. Front-line workers deserve access to health care, hazard pay and social support programs if they are unable to work in a high-risk field. Too many workers are being driven into risky working conditions with no alternatives.

Thank you so much for your time.

Alabama should use federal COVID-19 relief funds to heal and protect communities, Arise and partners write

To members of the Alabama Legislature,

Alabama is struggling. Even after Governor Ivey issued an emergency stay-at-home order, the average number of new coronavirus cases continues to rise. And despite those climbing case numbers, Alabama is moving forward with reopening its economy. To accomplish a successful recovery, residents must have confidence that it is safe to be in public and workers must be able to work in safe environments without fear for their health or the health and safety of their families. We are asking that you support the following recommendations so that Alabama will use the $1.9 billion under the Coronavirus Relief Fund to heal and protect the communities who have and will continue to shoulder the high costs of this crisis.

The Alabama Legislature, in consultation with Governor Ivey, has divided these federal funds into large categories of spending. Governor Ivey now has provided a method by which you and your colleagues may request release of the funds for coronavirus-related expenditures.

We recognize that $1.9 billion is inadequate to address the long-term needs of Alabamians as the present economic crisis continues to unfold. Consequently, you and your colleagues will need to find additional revenue sources to ensure that Alabama’s economy does not weaken further and that its residents are sufficiently protected from future spikes in infections. We look forward to working with you on those longer discussions.

Our recommendations aim to provide support where it is most needed, reflecting the disparate impact of the crisis. Highly educated workers have largely been able to work from home. Low-wage and many essential workers have not. Unemployment rates are highest for workers who have less than a bachelor’s degree and are higher in our Latinx and Black communities. We have also seen the largest gender gap in unemployment, where women experience unemployment at a nearly 3% higher rate than men. Our response to the pandemic and our use of the Coronavirus Relief Funds need to heal this harm, not exacerbate the disparities that already exist.

However the taxpayer-funded payments are distributed, they must be openly accounted with reasonable but sufficient detail. In addition to public reporting of expenditures, the Department of Examiners of Public Accounts must be authorized to audit receipts and expenditures of all agencies within its purview and to request accounting from other CARES Act funding recipients.

Ensuring safe workplaces and families

As Florida and Georgia have shown, merely reopening the economy does not bring back customers or jobs. Both states have seen ongoing unemployment claims at rates higher than other states in the nation. Alabama must ensure that workplaces are safe, that workers’ families are cared for, and that state and local services are ready for people to come back before the more than 500,000 newly unemployed can return to work. These recommendations focus mostly on needs that can be met with the $300 million earmarked for supporting businesses, nonprofits, and faith-based organizations.

Working

Working outside the home brings with it the very real risk that you will become infected. The primary concern of many workers is that they will become infected on the job and, in turn, infect their family.

To make work safe, we must fund testing and contact tracing, provide protective and sanitary equipment, and create new workspaces that minimize the possibility of transmission.

High-risk and essential workplaces, such as poultry plants, warehouses, grocery stores, child care centers, nursing homes and hospitals, require repeated and random testing for workers who do not appear ill, immediate testing of anyone who has symptoms of the novel coronavirus, and contact tracing for employees, their families, and the public who have come in contact with an employee who has tested positive.

Alabama should use a portion of the $300 million earmarked for the support of citizens, businesses, nonprofits, and faith-based organizations directly impacted by the pandemic or providing assistance to those affected to provide:

  • The tests necessary for business and government agencies that have reopened;
  • Contact tracing of positive test results;
  • Personal protective equipment for employees of those business and government agencies; and
  • Increased sanitary stations within essential workplaces.

Alabama also needs to develop or adopt technical assistance on workplace safety detailing how employers test for COVID-19, use PPE, and create safer workspaces.

In exchange for providing these supplies and equipment, Alabama must require businesses to adopt paid sick leave requirements for all employees to protect other employees and the public from transmission of the virus and allow employees to get tested without fear of losing their jobs.

When allocating these funds, Alabama should prioritize supporting minority-owned and woman-owned local businesses and provide small business loans or grants to these businesses to retain employees or make workplaces safer. Minority-owned businesses received fewer Small Business Administration loans under the CARES Act, and because the business owners have less access to credit, they rely on personal funds more than white-owned businesses to finance their work.[1]

In addition, Alabama should follow Congress’ example and provide a one-time tax rebate to low-income households to assist families who are unemployed and underemployed.

Families

One of the largest hurdles for families who are prepared to go to work is finding affordable and safe child care. Approximately one in four working adults has a child under age 18 and in two-thirds of two-parent families with children, both parents work. However, not every family can afford child care. Low-income families who pay for child care spend around 35% of their income on that care. To ensure parents are able to return to work, Alabama needs to provide child care for low-income families. This includes supporting low-income families by making child care affordable and supporting child care centers that are at risk of closing.

Stable families need stable homes. While Governor Ivey’s April 3 proclamation alleviated the immediate threat of eviction and foreclosure, it does not solve the long-term problem for Alabamians unable to pay rent or mortgages now that the emergency order has expired. Many families will not be able to pay the back rent that has accumulated. About a third of low-income and nearly two-thirds of extremely low-income households in Alabama pay more than half of their income on rent and utilities every month. The total cost of rent support needed in Alabama for the duration of this crisis is estimated at a little over $1 billion.[2]

These families and their landlords urgently need rent relief. To meet this significant need, Alabama must:

  • Allocate and leverage Coronavirus Relief Fund money in coordination with other sources of federal and private housing assistance funds; and
  • Provide emergency relief, through homeless and other nonprofit agencies, for families at risk of eviction, foreclosure or loss of utility service.

Other states have already taken this important step. Montana used $50 million of the Coronavirus Relief Funds it received to provide tenant and homeowner relief. The Pennsylvania Legislature reserved $150 million for emergency rental assistance from its federal funding. Likewise, Illinois allocated $396 million of its funds for housing assistance. It reserved $100 million specifically to meet the needs of people in disproportionately impacted areas based on COVID-19 cases and $79 million for counties that did not receive direct allotments from the federal Coronavirus Relief Funds. Alabama needs to take similar steps to protect its families who rent.

These solutions do not address the overwhelming need for more affordable housing in Alabama. To address this long-term goal, Alabama needs to increase its stock of affordable housing by funding the Housing Trust Fund administered by the Alabama Department of Economic and Community Affairs.

As more Alabama families lose jobs or work hours, hunger is growing in the state. In the last week of May, the Census Bureau’s Household Pulse Survey found that over 10% of Alabama households are experiencing food insecurity–a significant increase from the first week of the crisis. Therefore, we must greatly increase our support to Alabama-based food banks that provide emergency food to hungry families.

Improving Alabama’s health

COVID-19 is exposing chronic and deadly inequities in Alabama’s health care system. The virus’s disproportionately high mortality rate for African Americans reflects deep structural barriers to health care, economic opportunity, transportation, and other assets of the common good. These same barriers have impeded the state’s response to the pandemic by limiting the delivery system for mitigation, testing, and treatment in historically underserved communities. In light of these challenges borne of both active exclusion and passive neglect, Alabama’s COVID-19 response should prioritize interventions that explicitly address health disparities.

Allocation of federal COVID-19 relief funds does not occur in a vacuum. These funds will have their biggest impact when they flow through or alongside state programs designed to provide basic protections for all Alabamians. The single biggest action Alabama can take to maximize the impact of current and future federal COVID-19 relief funding on historic health disparities in our state is to expand Medicaid. Lack of health coverage for low-income adults creates an “outsider class,” distancing many of our most vulnerable neighbors from emergency resources that could buffer the pandemic’s toll. We recognize that the state cannot use COVID-19 relief funding for the state share of expansion costs.

Thus far, Alabama has set aside $5 million to support the Department of Health and an additional $250 million to support delivery of health care and related services related to the pandemic. Alabama should use these funds to:

  • Ensure that there is adequate testing for new infections, including funding for testing supplies;
  • Provide contact tracing after new infections are discovered;
  • Supply PPE to areas that have been most impacted by COVID-19; and
  • Strengthen public health surveillance systems to facilitate rapid response to local infection upsurges as economic activity increases.

Adequate testing for the virus is the most urgent tactical need. A primary tool for targeting finite (and admittedly inadequate) resources is accurate information. The state must evaluate the extent and adequacy of testing in each Public Health District in order to prioritize additional resources for underserved districts and facilitate partnerships between local health departments, private testing providers and local community and faith groups to ensure assistance for all who need it.

Another barrier to both testing and treatment is lack of transportation, especially in rural areas. To address this concern, Alabama should appropriate a portion of COVID-19 relief funds to the Public Transportation Trust Fund to mitigate coronavirus-related drops in local agencies’ farebox recovery rates.

Safely reopening state and local services

Reopening our courts

The Alabama Supreme Court has authorized the presiding circuit judge in each circuit to continue court closures until August 15 for all courts within the circuit, including municipal courts, to preserve the safety and welfare of court personnel and the public. We would encourage delaying non-essential hearings for as long as possible, so long as the delays do not affect the rights of litigants.  However, when courts reopen, they will need to take special precautions to protect people with disabilities or with family members who are vulnerable to infection. Funding to courts should require that they develop, and make accessible, a comprehensive reasonable accommodation policy for civil and criminal cases that addresses the individual needs of lawyers, litigants, defendants, and witnesses who cannot physically come to court due to disability.

These accommodations could be as simple as continuances or remote video proceedings for people who have access to technology necessary to participate in the proceedings remotely. If remote proceedings are used, funding should be used to allow for technology that permits video to enhance credibility determinations by fact finders, that allows the introduction and viewing of documentary evidence by remote participants, and that provides access, or education about the requisite technology for participants prior to their hearing.

Alabama also should increase funding to support ADA coordinators within courts that individuals with disabilities can contact in the event that an accommodation is needed.

In addition to delaying court reopenings and taking necessary steps to protect people with disabilities, a portion of the $10 million set aside for court services should fund personal protective equipment for all people required to attend court functions, including court personnel, attorneys, witnesses, victims, and litigants. Additionally, a portion of those same funds should be used to promptly notify individuals with court dates of delays, cancellations, and rescheduled hearings. Not only should these notices be sent to individuals, but as the hours and operating conditions of the courts evolve and change, the court should ensure that the public is aware of current court policies and how people seeking emergency relief may access the courts. These notices should be prominently posted at the courthouse, online, and in any other location likely to inform the public.

Improving state services

The pandemic caused a groundswell of need for services administered by Alabama, including the Supplemental Nutrition Assistance Program (SNAP), Medicaid, Temporary Assistance for Needy Families, Unemployment Insurance benefits, and subsidized housing programs (which are primarily run at a local level). As more residents need these supports to make it through the pandemic, Alabama should prioritize the $300 million it has set aside for state agencies to increase the numbers of case handlers they employ to respond to the increased demand, provide those workers with resources they need to work from home or with the same testing and PPE that we recommend for all essential workers when they engage with the public, and collectively improve access to their services using mobile technology.

When an individual is going through a crisis or the entire state is in a pandemic, these disparate services need to be accessible in one place with minimal barriers to applying for benefits, receiving important correspondence about deadlines or reporting obligations, and communicating with case workers about the services. Applying and maintaining these services comes at a high opportunity cost to families. Currently, to apply for and communicate about each service takes hours, often at different agencies and with different case workers. That is time that people need to take care of their children, their elderly parents or neighbors, or to look for employment. Improving capacity and access now both responds to the current crisis and inoculates these agencies for future crises.

Voting

In addition to improving access to state services, Alabama must protect our citizens’ health and fundamental  right to vote. A portion of the $300 million set aside for state services should be used to provide absentee ballot applications to every registered voter or, at a minimum, allow every registered voter to request and vote by absentee ballot during the pandemic. In addition, because many voters require or prefer in-person voting, the state must work to improve the safety and accessibility of in-person voting and permit curbside voting. To ensure voters know how to vote safely during the COVID-19 pandemic, Alabama will need to increase its spending to educate voters in coordination with local election officials.

Taking responsibility for people in our custody

Alabama has both a legal and a moral responsibility for the safety and well-being of the people it incarcerates. There are tens of thousands of individuals housed in state prisons, local jails, and ICE detention facilities — all places where it is impossible to practice social distancing. To date, less than 1% of those incarcerated in Alabama’s prisons have been tested for COVID-19.

Governor Ivey with approval from the Legislature has set aside $200 million for the Department of Corrections to help meet Alabama’s moral and legal obligations during this pandemic. We recommend that Alabama prioritize its use of the funds to:

  • Release all incarcerated people who do not pose a threat to public safety, who are pregnant, and people who are at a higher risk if infected with COVID-19;
  • Assist with reentry services to enable successful reintegration for returning persons;
  • Test people in Alabama jails and prisons prior to release and while incarcerated; and
  • Provide PPE, soap, sanitizer, and other supplies necessary to maintain a safe and hygienic environment for the remaining incarcerated people and correctional staff.

The fastest way to reduce the threat of infection in jails and prisons is to test and release as many people as possible to reduce the number of people within the facilities. However, decarceration requires more than releasing someone from jail or prison. We also must prioritize a successful reentry into communities to prevent recidivism. A portion of the funds allocated for the Department of Corrections must go to increasing reentry services to ensure successful and safe transitions into the community. Particularly important to this transition are ensuring that people are tested for the coronavirus before reentering and that they are provided with the housing, employment, and medical services necessary once they are in the community. Some states have reduced their populations by nearly 20%. Alabama must do more.

In addition to expediting reentry and funding reentry services, Alabama needs to ensure that people are not set up to fail with onerous fines and fees used to fund the criminal justice system and reentry monitoring. Unemployment is already at record highs, and we know that the effects of racial bias in the hiring process increase the already negative effects of criminal records for people of color. Studies have shown that Black applicants with a criminal record had only a 5% chance of receiving a call back, less than one-third of white applicants with a criminal record. Reentering into this economy will be tough. Having paid for reentry with federal funds, Alabama should waive the fines and fees for people who are struggling to reintegrate into our communities, giving them a clean start and a better chance for success.

Even with fewer people in facilities, we will still need to dramatically increase testing of employees who work in prisons and jails and for the people who are incarcerated therein. Only four in every 100 residents in Alabama have been tested for COVID-19. Alabama has tested fewer than 1% of people incarcerated in its prisons. This is wholly inadequate to slow, let alone stop, the spread of COVID-19 within Alabama’s facilities.

Securing our children’s futures

The pandemic radically impacted education and threatens to worsen future education outcomes in Alabama for the many students who already did not have the benefit of an equitable opportunity to learn before it began. Alabama must focus its attention on addressing the inequities exacerbated by access to technology, space to learn, and caretakers to support their learning and those for whom specialized services are not available, including for students with disabilities. If it does not, the opportunity gap will widen with significant economic impacts for students and their families far into the future.

The opportunity gap experienced by low-income children and children of color begins early in life. We must intervene and use a portion of the dedicated $300 million for expenditures related to technology and infrastructure for remote instruction and learning to provide support to organizations offering early intervention programs for at-risk children so that these services can be provided safely and, as necessary, remotely.

Alabama also should prioritize the use of the $300 million to fund public schools with the highest proportion of students who are low-income children, children of color, children with disabilities, English-language learner children, children in immigrant families, children in foster care, migrant children, children experiencing homelessness, LGBTQ children, and children in the juvenile justice system. Public schools likely will need to hire additional staff, including counselors, to provide necessary education, social and emotional, and health and safety services and increase salaries to remain competitive for educators who now take greater risks to their own health and are required to master more technological skills to teach their kids.

We recognize that the $300 million allocated by the Legislature will not be enough. Additional funding could also be taken from the $250 million fund for local government expenditures directly related to the pandemic to provide these disproportionately affected school systems and their local communities with funding for after-school, summer school, and community programs for youth.

Finally, where there are competing priorities for funding, the Legislature has set aside an additional $118 million that can be used to supplement the funds required for these recommendations. If you have any questions or concerns about any of these recommendations, please contact Robyn Hyden ( or 334-832-9060) or Katie Glenn ( or 334-531-7638).

Signatories

Sincerely,

90 Alabama organizations

ACLU of Alabama
Adelante Alabama Worker Center
AIDS Alabama
AL CURE
Alabama Appleseed
Alabama Arise
Alabama Black Women’s Roundtable
Alabama Civic Engagement Coalition
Alabama Coalition for Immigrant Justice
Alabama Coalition on Black Civic Participation
Alabama Faith Council
Alabama Institute for Social Justice
Alabama Justice Initiative
Alabama NAACP
Alabama Poor People’s Campaign
Alabama Rivers Alliance
Alabama Solutions, A Grassroots Movement
Alabama Youth and College NAACP
Amalgamated Transit Union Local 770
Auburn Unitarian Universalist Fellowship
Baptist Church of the Covenant
Bay Area Women Coalition, Inc.
Beloved Community Church
Birmingham AIDS Outreach (BAO)
Children First Foundation, Inc.
Christian Church in Alabama-Northwest Florida
Christian Methodist Episcopal Church
Church of the Reconciler, UMC (Birmingham)
Church Women United Montgomery
Citizens’ Climate Lobby – Baldwin County, Alabama Chapter
Collaborative Solutions, Inc.
Etowah Visitation Project
Fairhope Unitarian Fellowship
Faith and Works Statewide Civic Engagement Collective
Faith in Action Alabama
Fall Injury Prevention And Rehabilitation Center
First Christian Church – Disciples of Christ (Montgomery)
First Congregational Church, UCC (Birmingham)
Five Horizons Health Services
GASP
Greater Birmingham Ministries
Hispanic Interest Coalition of Alabama
Holiday Transitional Center
Holy Rosary Catholic Church
Human Rights Campaign Alabama
Humanists of North Alabama
Immanuel Presbyterian Church, PCUSA (Montgomery)
Interfaith Montgomery
Jesuit Social Research Institute
Jobs to Move America
Just Faith, Prince of Peace Catholic Church (Birmingham)
Just Faith, Our Lady of the Valley Catholic Church (Birmingham)
League of Women Voters of Alabama
Low Income Housing Coalition of Alabama
Macedonia Missionary Baptist Church (Daphne)
March of Dimes
Mary’s House Catholic Worker
Medical Advocacy & Outreach
Mission Possible Community Services, Inc.
Monte Sano United Methodist Church
Montevallo Progressive Alliance
Montgomery Pride United
National Action Network – Birmingham Chapter
National Lawyers Guild
National MS Society
Nightingale Clinic
North Alabama Conference United Methodist Women
North Alabama Peace Network
Open Table United Church of Christ
People First of Alabama
Planned Parenthood Southeast
Progressive Women of Northeast Alabama
Project Hope to Abolish the Death Penalty
Restorative Strategies, LLC
Saint Junia United Methodist Church
Shelby Roden, Attorneys at Law
Sierra Club, Alabama Chapter
Sisters of Mercy Alabama
Sisters of Mercy of the Americas
Southern AIDS Coalition
SPLC Action Fund
St. Andrew’s Episcopal Church (Birmingham)
The Empowerment Alliance
The Green Kitchen
The Right Place, Inc.
The Women’s Fund of Greater Birmingham
Unitarian Universalist Fellowship of Mobile
URGE: Unite for Reproductive & Gender Equity
Yellowhammer Fund
Youth Towers
YWCA Central Alabama

cc: Governor Kay Ivey and policy staff

[1] The SBA Inspector General found that the SBA failed to instruct lenders to prioritize underserved and rural markets [found at https://www.sba.gov/sites/default/files/2020-05/SBA_OIG_Report_20-14_508.pdf on May 27, 2020]. Disparities in lending between minority-owned and white businesses already existed as documented by the Federal Reserve Bank of Atlanta’s December 2019 Small Business Credit Survey [found at https://www.fedsmallbusiness.org/medialibrary/fedsmallbusiness/files/2019/20191211-ced-minority-owned-firms-report.pdf on May 27, 2020].

[2] Estimate from the National Low Income Housing Coalition.

Alabama Arise and partners urge Ivey to use every Medicaid tool available to save lives during COVID-19 pandemic

To: Gov. Kay Ivey and Commissioner Stephanie Azar
From: The Undersigned Alabama Organizations
Re: Alabama’s Policy Response to COVID-19
Date: March 19, 2020

Thank you both for your leadership, especially at this critical time. Alabama’s health care system, like most others around the world, is facing severe stresses with the COVID-19 pandemic. Seniors and people with underlying health conditions, including people with disabilities, appear to be at most serious and immediate risk from the virus. Alabamians with low income and those who lack health insurance are also high-risk groups, because their options for responding to the health threat and related challenges are limited. In the best of times, public services that provide health care for the most vulnerable Alabamians form the backbone of the health system that protects us all. A health emergency only heightens the need for Alabama’s state health agencies to be as strong as we can make them.

Federal law gives states wide flexibility in using their Medicaid and Children’s Health Insurance Programs (ALL Kids in Alabama) to respond to health emergencies and other disasters. They can expand eligibility and benefits and take steps to make it easier for people to enroll and stay enrolled. The options below include some that Alabama Medicaid has adopted already, many that could be implemented in short order and some that could be requested now for future use. They are in keeping with the important recognition by Governor Ivey and President Trump that COVID-19 requires a bold, timely and comprehensive response.

A few things to consider:

  • People who are eligible for Medicaid can enroll at any time – the “open enrollment” period is year-round.
  • Alabama Medicaid is a “bare-bones” program that has some of the nation’s most stringent eligibility limits.
  • More than 220,000 Alabamians with low incomes are uninsured. Another 120,000 are struggling to pay for work-based or private plans they can’t afford.
  • President Trump has signed a bill that would give states a temporary 6.2 percentage point increase in its federal share of Medicaid funding. For Alabama, that would mean a boost of $380 million for the one-year period starting retroactively on Jan. 1.
  • The pandemic poses critical challenges for certain groups, including people who depend on long-term services and supports at home and in community-based, intermediate and long-term facilities; people experiencing homelessness; and people with special health care needs related and unrelated to COVID-19.
  • Even if a state took up most or all of the emergency options, there would still be gaps in coverage for people who don’t meet Medicaid’s citizenship and immigration status rules.

Current Alabama Medicaid policies that facilitate emergency response:

  • Alabama Medicaid already uses “presumptive eligibility” (PE) to provide temporary coverage for children, pregnant women and parent/caretaker relatives who are determined by a qualified hospital, on the basis of preliminary information, as likely to be eligible for Medicaid.
  • Alabama Medicaid already uses “express lane eligibility” (ELE) to renew children’s Medicaid eligibility automatically on the basis of income data available from the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF).
  • Alabama already uses the “continuous eligibility” option to provide children with 12 full months of coverage through Medicaid and the Children’s Health Insurance Program (ALL Kids), even if the family’s income increases beyond the eligibility limit during the year.

Eligibility: Expanding coverage for the uninsured

Alabama can immediately expand eligibility by submitting state plan amendments (SPAs), applying for 1115 waivers (expedited on an emergency basis if CMS allows), and amending its section 1915 home- and community-based waivers for long-term care:

  • Governor Ivey can submit a SPA to expand coverage for adults with incomes up to 138 percent of the poverty line with enhanced match (90 percent FMAP).
  • Governor Ivey can submit a SPA to increase eligibility for pregnant women, people with disabilities and seniors at the state’s regular FMAP.
  • Alabama can seek an emergency 1115 waiver for federal authority and matching funds to implement continuous coverage for women enrolled in pregnancy-related Medicaid through 12 months postpartum.
  • Alabama can adopt the “ICHIA” option to provide Medicaid and CHIP coverage to lawfully residing children and pregnant women. States can also provide prenatal care to women regardless of immigration status by extending CHIP coverage to the unborn child.
  • Alabama can eliminate or decrease asset tests for seniors and people with disabilities.
  • Alabama can modify its section 1915 home- and community-based services (HCBS) waivers to increase the number of “slots,” or openings for participants. CMS has a template to facilitate changes in section 1915 waivers. The template can also be used to provide additional services that are needed to address COVID-19.

Enrollment: Ensuring that all eligible people can easily enroll and get coverage

  • Alabama should maximize its use of presumptive eligibility (PE) by expanding the definition of qualified entities to include the state agency, community health centers and other community sites and by adding eligibility for seniors and individuals with disabilities. Alabama should develop a plan for follow-up to ensure eligibility of individuals beyond the PE period.
  • Alabama should outstation eligibility staff to the maximum extent possible.
  • Alabama should enroll people based on their self-attestation and follow up with verification requests only when the attestation is not compatible with electronic data sources.
  • States are required to provide a reasonable opportunity period of at least 90 days to individuals who attest they are citizens or have an immigration status that would make them eligible for benefits, as well as to those who don’t have a Social Security number. This means Alabama should enroll people and assist them in providing any documents they need after exhausting attempts to verify citizenship or status through electronic verification.
  • Alabama should add the school lunch program to the express lane eligibility data-sharing process for Medicaid eligibility.

Renewal: Keeping people covered

  • Alabama should temporarily delay renewals under authority to exceed time limits in emergency situations.
  • Under existing Medicaid rules, Alabama should maintain coverage for people temporarily residing out of state because of the coronavirus.

Benefits: Getting people the care they need

  • Alabama should submit a SPA to take up the option in the Affordable Care Act (ACA) to ensure all necessary treatment and preventive services, including vaccines, are covered for all adults Medicaid beneficiaries without cost-sharing. States that take up this option receive a 1 percentage point bump in the FMAP for those services under section 4106 of the ACA.
  • Alabama should cover 90-day supplies of maintenance medications, allow advance refills and cover home delivery of prescription drugs.
  • Alabama should provide expanded benefits for affected populations through 1915(i) state option for home- and community-based services.
  • Alabama should educate providers on Medicaid coverage, especially the EPSDT benefit for children, guaranteeing that children receive regular screening exams and preventive care and all necessary follow-up diagnostic and treatment services.
  • Alabama should maximize the use of telehealth — including reimbursement for the full range of early intervention, treatment and rehabilitative services — to extend provider access and reduce direct personal contact during the pandemic.
  • Alabama should maximize coverage and awareness of emergency services available to people not eligible for Medicaid due to immigration status.

Continuity of care: Preventing disruption of services for people with special health care needs and disabilities

Thousands of Alabama Medicaid members depend on health services and daily living supports provided in home- and community-based settings and long-term care facilities. For these individuals, disruptions in care and assistance can be life-threatening.

  • Alabama must respect the rights of people with special health care needs and disabilities to make their own choices in all aspects of their COVID-19 contingency plan.
  • Alabama should waive all administrative requirements except federal and state background checks to allow on-the-spot hiring of personal care attendants by people receiving long-term services and supports.
  • Alabama should suspend or waive overtime-limiting regulations for personal assistance services to facilitate continuity of care when illness, quarantine and other factors reduce staff and support network capacity.
  • Alabama should guarantee personal assistance service providers paid sick time to encourage providers to stay home and decrease spreading infection.
  • Alabama should provide funding to community organizations such as Independent Living Centers and developmental disability service providers to establish or expand expedited recruitment processes for emergency backup assistance for all formal and informal, government and non-government supports and services to close COVID-19 gaps and keep people independent.

Bottom line

Use every tool available to protect Alabamians in the short, medium and long term.

These recommendations are adapted from analysis provided by the Center on Budget and Policy Priorities, the Medicaid and CHIP Coverage Learning Collaborative, the Kaiser Family Foundation, Disability Rights & Resources, and Accessible Alabama.

Signatories

The following organizations respectfully endorse these recommendations:

Accessible Alabama
AIDS Alabama
Alabama Appleseed Center for Law & Justice
Alabama Arise
Alabama Coalition for Immigrant Justice
Alabama Disabilities Advocacy Program
Alabama Faith Council
Alabama-Florida Episcopal District of the AME Zion Church
Alabama Institute for Social Justice
Alabama Justice Initiative
Alabama Poor People’s Campaign: A National Call for Moral Revival
Alabama Rivers Alliance
Alabama Select ICN Consumer Advisory Committee
Alabama State Association of Cooperatives
Alabama State Conference of the NAACP
AME Church of Alabama
Disabilities Leadership Coalition of Alabama
Disability Rights & Resources
Faith and Works
Faith in Action Alabama
Fifth Episcopal District, Christian Methodist Episcopal Church
Greater Birmingham Ministries
Hispanic Interest Coalition of Alabama
Hometown Action
The Knights & Orchids Society
Medical Advocacy & Outreach
NAMI Alabama
National MS Society, Alabama
People First of Alabama
Planned Parenthood Southeast
Save Ourselves Coalition for Justice and Democracy
Sickle Cell Disease Association of America
Southern Poverty Law Center
United Cerebral Palsy of Alabama
VOICES for Alabama’s Children
The Women’s Fund of Greater Birmingham
YWCA Central Alabama

Ending an ‘unjust burden’: Alabama Arise testimony in favor of SB 144 to untax groceries

Arise’s Robyn Hyden testified to the Senate’s education budget committee Wednesday in support of SB 144. The bill, sponsored by Sen. Andrew Jones, R-Centre, would eliminate Alabama’s state sales tax on groceries and replace the lost revenue by capping the state deduction for federal income taxes. Here’s the full text of Hyden’s prepared remarks:

Good morning! I’m Robyn Hyden, executive director of Alabama Arise. We’re a nonprofit coalition of 155 congregations, organizations and individuals promoting public policies to improve the lives of Alabamians with low incomes.

For our 31-year history, Alabama Arise members have advocated to remove barriers to opportunity for people who struggle to make ends meet – and ending the grocery tax is at the top of our list of policy goals. Last month, we brought 200 advocates to the State House to ask you all to consider several ways to remove the grocery tax. And we are very pleased to see this bill receive your attention today.

We believe that while the grocery tax is an unjust burden on people who simply need to eat, the flip side is that the federal income tax (FIT) deduction is a giant and unfair tax loophole, allowing people with higher incomes to pay a lower percentage of their overall earnings. Only two other states still allow the full FIT deduction, and only two other states fully tax groceries.

The grocery tax brings in about $480 million a year, while the entire FIT deduction for individuals costs our budget more than $719 million a year. Essentially, we are subsidizing our reliance on this giant tax loophole with a ridiculous tax on food.

How to end the state grocery tax responsibly

We shouldn’t continue to subsidize an unfair tax loophole with an unjust grocery tax. We support Sen. Jones’ proposal because it would end this unfair tax shift by capping the total FIT deduction allowed. This would allow working families who pay federal income taxes to still benefit from the deduction, but also would prevent the Education Trust Fund from losing revenue.

Our modeling of the impact of SB 144, completed by the Institute on Taxation and Education Policy, shows that this bill would generate a conservative estimate of an additional $474 million a year to the ETF. That’s almost an even swap for grocery tax revenue that would be returned to taxpayers.

Most Alabamians would get a tax cut from untaxing groceries and capping the FIT deduction. Here is the estimated net tax change as a share of income if Alabama capped its federal income tax deduction at $6,000 for a single tax filer and $12,000 for a couple filing jointly. Bottom 20%: -2.81%. Next 20%: -1.31%. Next 20%: -1%. Next 20%: -0.62%. Next 4%: 0.31%. Top 1%: 0.93%.

If you look at the chart I’ve shared with you, the blue and green bar graph shows the impact of both removing the grocery tax and capping the FIT deduction on the average household at each income level. Notice that for the bottom 95% of taxpayers, the combination of removing the grocery tax and ending the FIT deduction produces a net tax cut.

For lower- and middle-income families, it’s quite a significant cut. It’s only for households making well above $135,000 a year that any type of significant net increase is going to happen. When you consider that the median household income in our state is just $48,123, what we’re looking at here is effectively the biggest tax cut affecting the most people that you’re ever going to get a chance to vote on.

I thank you for your time today. And I urge you to consider this proposal to bring tax relief to hard-working families and bring more fairness to our tax code.

Alabama Arise comments on how proposed SNAP changes would reduce school meal access

The U.S. Department of Agriculture (USDA) is proposing a rule that would require some states to reduce gross income limits for Supplemental Nutrition Assistance Program (SNAP) applicants. It also would force 42 states, including Alabama, to impose resource limits on applicants.

More than 3 million people would become ineligible for food assistance under the rule, federal officials estimate. Alabama Arise originally submitted comments in opposition to this proposal in September 2019. But the USDA later reopened the comment period after calculating that the change would leave more children at risk of losing free school meals than original estimates showed. Arise policy analyst Carol Gundlach submitted the following additional comments in response:

Introduction

Re: Supplemental Nutrition Assistance Program Notice of Proposed Rulemaking: Revision of Categorical Eligibility in the Supplemental Nutrition Assistance Program (SNAP) [FNS–2018–0037]

Dear Program Design Branch:

Thank you for the opportunity to submit additional comments on behalf of Alabama Arise in response to the proposed changes to the categorical eligibility state option in the Supplemental Nutrition Assistance Program (SNAP).

Organizational purpose and interest

Alabama Arise is a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of Alabamians with low incomes. Arise believes acts of charity are vital, but they are not enough. We also must work to improve harmful policies. Arise provides a structure through which Alabamians can engage in public debates with the goal of improving the welfare of all Alabamians.

Arise envisions an Alabama where all people have resources and opportunities to reach their potential to live happy, productive lives, and each successive generation is ensured a secure and healthy future. We envision an Alabama where all government leaders are responsive, inclusive and justice-serving, and the people are engaged in the policy-making process. And we envision an Alabama where all people live with concern for the common good and respect for the humanity of every person.

Arise has engaged actively in advocacy to improve access to SNAP since our origin. In recent years, Arise has opposed state legislation restricting Alabama’s use of broad-based categorical eligibility (BBCE) and imposing other restrictions on Alabama’s election of state options.

Arise staff participated in formal and informal discussions and meetings with representatives of the Alabama Department of Human Resources (the state’s SNAP administrating agency), the Alabama Food Bank Association, Legal Services of Alabama and other organizations to improve state-level SNAP policy, staff training, outreach and client notices. Most recently, Arise and the Alabama Food Bank Association have spearheaded the creation of a Hunger Free Alabama advocacy coalition representing more than 20 diverse organizations and agencies.

Alabama has used BBCE to eliminate asset tests for working families

Alabama has elected to eliminate the SNAP asset test for applicants who are categorically eligible because they received a non-cash benefit under the Temporary Assistance for Needy Families program. Without BBCE, Alabama would be forced to reinstate a SNAP asset test.

Asset tests disproportionately affect certain types of households, including working families with small savings accounts or multiple cars. Many families at risk of losing SNAP because they exceed the asset limit will be working families with school-aged children. Because of the interaction between SNAP eligibility and eligibility for free school meals (either through direct certification or through the Community Eligibility option), children in families who lose SNAP assistance are also at risk of losing free school meals.

Restrictions on BBCE would increase child hunger and educational failure

Approximately 12,000 Alabama children live in SNAP households with “excess resources,” despite very low household incomes. Children who live in SNAP households are categorically eligible for free school meals. If these children lose SNAP assistance, they also lose automatic eligibility for school, breakfast, lunch and sometimes dinner.

Children who lose categorical eligibility would have to go through the school’s application process to receive free school meals. Some almost certainly would lose eligibility due to this additional hurdle.

Childhood hunger is strongly associated with negative educational outcomes, multiple studies have found. Hungry children have lower math scores and worse grades than do children who are not at risk of hunger.[1] Hungry children are more likely to be absent from school or tardy.[2] And hungry children are more likely to have to repeat a grade than are children not at risk of hunger.[3] The proposal would create additional barriers for children who are now eligible for free school meals. In doing so, it would increase childhood hunger and fuel lower educational achievement.

Reducing availability of universal free school meals would harm children and schools

Under the Community Eligibility option, schools with more than 40% “identified students” can elect to offer no-cost breakfast, lunch and sometimes dinner to every student in the school. By far the largest category of these “identified students” are children in families who receive SNAP. As in other states, the Alabama Department of Human Resources (the SNAP administrator) routinely sends the Alabama Department of Education a list of children who are members of SNAP households. Officials use this list, along with other data, to determine whether a school can elect Community Eligibility.

A reduction in the number of children receiving SNAP assistance could tip a school below the 40% threshold necessary for the adoption of Community Eligibility. And the loss of Community Eligibility would deny no-cost meals to all children who attend the school.

Undermining Community Eligibility would increase hunger among students

Chuck Marcum, superintendent of Roanoke City Schools in east Alabama, said Community Eligibility is vital to his system’s overall success. “I can’t overstate the importance of the program and what it’s doing for our students,” Marcum told Alabama Daily News. Community Eligibility has been especially helpful at ensuring high school students can eat breakfast, he said. “I couldn’t get them in high school to turn in the forms because they didn’t want other kids to know they were free,” Marcum said. “Now, everyone is free and we’ve removed that stigma.”[4]

Even if a school does not lose the ability to elect Community Eligibility, the reduction in the number of identified students would result in a financial loss. This is because the school’s meal reimbursement rate is based on its percentage of identified students.

The proposed rule certainly would reduce the number of identified students across Alabama. And it could reduce the percentage in some school systems so much that Community Eligibility is no longer an option. A return to the free/reduced/full-cost school meal system would increase schools’ administrative costs. Most troublingly, it would increase hunger among many of the children attending those schools.

Conclusion

For the reasons outlined in our previous comments and those discussed above, Alabama Arise again urges the USDA to withdraw this proposed rule. We urge the agency to work instead to ensure that all children, including those from households with low incomes, continue to have access to the nutrition they need to learn and thrive, both at home and school.

Footnotes

[1] Alaimo, K., Olson, C. M., & Frongillo, E. A., Jr. (2001). Food Insufficiency and American School-Aged Children’s Cognitive, Academic and Psychosocial Development. Pediatrics, 108(1), 44-53.

Shanafelt, A., Hearst, M. O., Wang, Q., & Nanney, M. S. (2016). Food insecurity and rural adolescent personal health, home, and academic environments. Journal of School Health, 86(6), 472-480.

[2] Murphy, J. M., Wehler, C. A., Pagano, M. E., Little, M., Kleinman, R. F., & Jellinek, M. S. (1998). Relationship Between Hunger and Psychosocial Functioning in Low-Income American Children. Journal of the American Academy of Child & Adolescent Psychiatry, 37, 163-170.

[3] Kleinman, R. E., Murphy, J. M., Little, M., Pagano, M., Wehler, C. A., Regal, K., & Jellinek, M. S. (1998). Hunger in Children in the United States: Potential Behavioral and Emotional Correlates. Pediatrics, 101(1), E3.

[4] Sell, Mary (Oct. 31, 2019). “Change to SNAP would impact some Alabama students’ access to free lunch.” Alabama Daily News. Available at https://www.aldailynews.com/change-to-snap-would-impact-some-alabama-students-access-to-free-lunch.

Alabama Arise comments in opposition to proposed SNAP categorical eligibility changes

The U.S. Department of Agriculture (USDA) is proposing a rule that would require some states to reduce gross income limits for Supplemental Nutrition Assistance Program (SNAP) applicants. It also would force 42 states, including Alabama, to impose resource limits on applicants.

More than 3 million people would become ineligible for food assistance under the rule, federal officials estimate. Alabama Arise policy analyst Carol Gundlach submitted the following comments in opposition to this proposal:

Introduction

Re: Supplemental Nutrition Assistance Program Notice of Proposed Rulemaking: Revision of Categorical Eligibility in the Supplemental Nutrition Assistance Program (SNAP) [FNS–2018–0037]

Dear Program Design Branch:

Thank you for the opportunity to submit comments on behalf of Alabama Arise in response to the proposed changes to the categorical eligibility state option in the Supplemental Nutrition Assistance Program (SNAP).

Organizational purpose and interest

Alabama Arise is a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of Alabamians with low incomes. Arise believes acts of charity are vital, but they are not enough. We also must work to improve harmful policies. Arise provides a structure through which Alabamians can engage in public debates with the goal of improving the welfare of all Alabamians.

Arise envisions an Alabama where all people have resources and opportunities to reach their potential to live happy, productive lives, and each successive generation is ensured a secure and healthy future. We envision an Alabama where all government leaders are responsive, inclusive and justice-serving, and the people are engaged in the policy-making process. And we envision an Alabama where all people live with concern for the common good and respect for the humanity of every person.

Arise has engaged actively in advocacy to improve access to SNAP assistance since our origin. In recent years, Arise has opposed state legislation restricting Alabama’s use of broad-based categorical eligibility (BBCE) and imposing other restrictions on Alabama’s election of state options. Arise staff participated in both formal and informal discussions and meetings with representatives of the Alabama Department of Human Resources (the state’s SNAP administrating agency), the Alabama Food Bank Association, and Alabama Legal Services and other organizations to improve state-level SNAP policy, staff training, outreach and client notices. Most recently, Arise and the Alabama Food Bank Association have spearheaded the creation of a Hunger Free Alabama advocacy coalition representing more than 20 diverse organizations and agencies.

Categorical eligibility has made SNAP more efficient in Alabama

Alabama has made limited but effective use of broad-based categorical eligibility. The state has elected to eliminate the SNAP assets test for applicants found to be categorically eligible because they received a non-cash benefit under the Temporary Assistance for Needy Families (TANF) program. Alabama has not elected to increase the income eligibility limits for participants who are not seniors or people with disabilities.

By eliminating the assets test, Alabama has ensured that food-insecure seniors and people with disabilities can receive SNAP assistance without being driven into even deeper poverty. This move also has ensured that working people in poverty can receive both nutrition services and work supports. And it has helped SNAP operate economically and efficiently in a state that struggles to support basic human services adequately.

These changes would harm seniors and people with disabilities

The proposed categorical eligibility regulation revision would increase hunger among seniors and Alabamians with disabilities. Seniors in Alabama often maintain savings accounts to cover funeral expenses so these costs will not burden their children. Additionally, many seniors and individuals with disabilities wisely save money to pay for unexpected medical or long-term care expenses.

Elimination of broad-based categorical eligibility would force seniors and people with disabilities to spend down their hard-saved safety net. When faced with a medical crisis, many may have to forgo essential nutrition assistance or suffer other devastating consequences.

These changes would increase transportation barriers

The proposed categorical eligibility regulation revision also would increase hunger among working families. Alabama is a deeply rural state where workers or students commonly travel 30 miles or more to employment or job training. Alabama also lacks public transportation options in much of the state, particularly in rural areas. Because of the state’s rural nature and lack of public transportation, reliable transportation is essential for working people.

Thanks to BBCE, Alabama and most other states have not treated automobiles as countable assets in determining SNAP eligibility for many years. But under the proposed rule, the state could be forced again to count the value of certain cars in excess of $4,650 as an asset. Because so few states treat automobiles as an asset, officials have not adjusted the federal exemption for cars since 1977. The amount is now so low that most moderately price cars would exceed the allowable exemption.

Counting the “excess” value of cars as an asset would force families to choose between necessary transportation and food assistance. This is a choice that would force them into deeper poverty.

These changes would harm Alabama’s children

The proposed categorical eligibility regulation revision would reduce access to school meals for hungry children. Alabama, like nearly every other state, automatically enrolls children living in SNAP households for free school meals. Should these changes be approved, Alabama estimates approximately 4.5% of households, or more than 15,000 families, will lose SNAP benefits.

Insofar as these households include children, those children also would be denied automatic eligibility for free school breakfast and lunch. It is true that officials can establish a child’s eligibility for free meals by a separate application. But if these changes occur, many families who were automatically determined eligible in the past may be unaware they would have to apply for their children’s meals and may fail to do so.

Breakfast and lunch at school are closely correlated with better educational outcomes. A loss of free school meals will both increase child hunger and reduce school performance among the most at-risk children.

These changes would harm struggling families across Alabama

The proposed regulation would force Alabama to choose between weakening its already insufficient TANF program and denying nutrition assistance to thousands of currently eligible families. The proposed rule defines TANF benefits that would confer categorical eligibility for SNAP as “ongoing and substantial benefits.” This would be restricted largely to cash benefits, child care, subsidized employment and work supports funded through the TANF block grant.

Alabama has one of the nation’s lowest benefit limits for TANF cash assistance: just $215 for a family of three. In 2018, only 8,565 families in Alabama received ongoing TANF cash assistance. Facing the declining value of the TANF block grant, Alabama has elected to use TANF funds for one-time emergency assistance. This includes housing and transportation assistance, short-term work supports and other services for struggling families who are ineligible for ongoing cash assistance but still face critical needs.

The proposed rule would deny these families the benefits of categorical eligibility. The TANF assistance they receive would not meet the proposed definition of “ongoing” assistance, even though the dollar value of the assistance they receive may be many times Alabama’s maximum monthly TANF cash assistance amount. This definition of TANF assistance is arbitrary, and it could deny SNAP to many of Alabama’s poorest residents.

These changes would add unnecessary strain to state budgets

The proposed categorical eligibility regulation revision would impose administrative burdens on Alabama and other states. Alabama estimates that 81% of its SNAP caseload, or 275,000 households, would be subject to asset testing under the proposed rule. The state also estimates that 15,000 of those households would be denied SNAP assistance because they either have assets that exceed the limit or would be unable to verify the value of their assets.

Alabama would have to verify assets for all 275,000 households, which would cost considerable time and money. It is unknown whether officials could obtain verification of cash assets easily, especially given changes in the banking industry since Alabama last had to do so. Officials also could struggle to verify the value of real property held by multiple heirs of the original owner, a common situation in the rural South.

Because verification costs are an administrative expense, Alabama would have to cover 50% of those costs. Should the proposed rule’s verification requirements force Alabama to contract with a third party, those state costs may be considerable. This additional red tape could reduce the state’s ability to provide innovative services, including employment and training services. It also could increase the risk of delays in timely approval of SNAP applications.

Other major problems with the proposed changes

The proposed categorical eligibility regulation revision would place an increased burden on emergency food providers. Alabama estimates that 4.5% of its SNAP caseload, or 15,000 households, would be ineligible for food assistance under the proposed rule.

These struggling families would remain at risk of hunger. But instead of being able to purchase food with SNAP benefits, they would have to rely on Alabama’s already stretched network of food banks and pantries. Forcing yet more people into the private, emergency food system would reduce the system’s ability to serve current clients. And that would only result in greater hunger in the state.

The proposed rule also would circumvent a policy that Congress already has rejected. During the 2018 Farm Bill reauthorization, Congress considered and rejected a policy very similar to, and having the same effect as, the one proposed in this draft rule.

Circumventing a legislative decision made less than a year ago would be an inappropriate administrative action. That is a crucial reason for the USDA to withdraw the proposed rule.

Conclusion

As described above, Alabama Arise believes the proposed rule would increase hunger, particularly among seniors, working families, and people with disabilities. The rule would increase child hunger and reduce participation in USDA school meal programs. It would place additional administrative burdens and costs on states, reducing their ability to administer SNAP effectively. It would increase the burden on private emergency food providers. And it would seek to circumvent recently enacted federal legislation.

Arise urges the USDA to withdraw the proposed rule immediately. The agency should work instead to strengthen its commitment to end hunger and protect SNAP as authorized by Congress.

Alabama Arise comments in opposition to federal plan to evict mixed-status immigrant families

The U.S. Department of Housing and Urban Development (HUD) is proposing a rule that would bar tens of thousands of “mixed-status” immigrant families from living in public housing and Section 8 programs. These families include both members who are eligible and ineligible for assistance based on immigration status.

The proposed rule would harm more than 55,000 children by forcing families either to break up or face eviction. Alabama Arise policy analyst Carol Gundlach submitted the following comments in opposition to this proposal:

Introduction

I am writing on behalf of Alabama Arise in response to the Department of Housing and Urban Development’s (HUD) proposed rule regarding “verification of eligible status,” published in the Federal Register on May 10, 2019 (RIN 2501-AD89; HUD Docket No. FR-6124-P-01).

Alabama Arise strongly opposes this proposed rule, and we urge HUD to withdraw the rule in its entirety. We believe this rule would reduce the availability of affordable housing for some of the poorest families in the country. We believe it would increase homelessness, particularly among families with children. And we believe it would impose burdens on seniors and people with disabilities who seek affordable housing in Alabama.

Organizational purpose and interest

Arise is a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of Alabamians with low incomes. Arise believes acts of charity are vital, but they are not enough. We also must work to improve harmful policies. Arise provides a structure through which Alabamians can engage in public debates with the goal of improving the welfare of all Alabamians.

Our organization envisions an Alabama where all people have resources and opportunities to reach their potential to live happy, productive lives, and each successive generation is ensured a secure and healthy future. We envision an Alabama where all government leaders are responsive, inclusive and justice-serving, and where the people are engaged in the policymaking process. And we envision an Alabama where all people live with concern for the common good and respect for the humanity of every person.

Arise has engaged actively in advocacy and outreach to increase the availability of safe and affordable housing in Alabama. We were instrumental in passage of state legislation in 2006 requiring landlords to meet minimum standards for rental housing and provide tenants with basic housing rights. We successfully advocated for creation of the Alabama Housing Trust Fund (HTF) in 2012. We continue to advocate for state HTF funding to promote affordable housing for Alabamians with low and moderate incomes. And we have researched and reported on the lack of affordable housing for Alabamians with low wages.

The proposed rule would increase homelessness, especially among families and children

By HUD’s own admission, the rule effectively would evict more than 55,000 children who are now eligible for subsidized housing. These are children who are U.S. citizens or have legal status themselves but live with parents who do not.

Under both federal law and existing HUD policy, families with mixed immigration status are eligible for prorated subsidized housing, based on the citizen child’s eligibility. Children, however, cannot enter into contracts for housing or apply for housing on their own. Both must be done by adult parents or guardians, who may not be eligible on their own. So to deny housing to a non-citizen parent is effectively to deny housing to an eligible citizen child.

The proposed rule would force these families either to face eviction or separate a non-citizen member from the rest of the family, including minor children. Maintaining the family unit would result in homelessness among many families eligible for prorated subsidized housing under current rules.

This proposal would increase child homelessness, which is already a serious problem in the United States. The U.S. Department of Education identified 1.3 million homeless children in 2016-17, a 70% increase since the 2007-08 school year. More than 14,000 of these children live in Alabama. This plan would harm the health, education and economic stability of tens of thousands of vulnerable children.

The proposed rule would increase the burden on seniors and people with disabilities who cannot provide proof of citizenship

The proposed rule would require applicants for subsidized housing to provide documentation of their citizenship. This would impose a significant burden on many seniors and people with disabilities, even if they are U.S. citizens.

Many Alabama seniors lack state-issued identification and do not have copies of their birth certificates. State-issued driver’s licenses or non-driver identification cards in Alabama are $36.25. And that does not include the cost of transportation to an Alabama Law Enforcement Agency office. Public transportation in rural parts of Alabama is often sparse or nonexistent, making it harder to get state-issued ID. Many seniors or people with disabilities who cannot drive must pay a neighbor to take them to town.

Copies of birth certificates in Alabama are $15, a notable expense for people barely making ends meet. Many rural areas lack high-speed internet, complicating access to the Alabama Department of Public Health’s website. And people born in other states face the added challenge of navigating another state’s rules and regulations from afar.

In some rural parts of Alabama, subsidized housing may be the only affordable housing in the area. But this proposal’s identification requirements would erect harmful, unnecessary barriers to that housing for many seniors and people with disabilities.

The proposed rule would reduce the availability of affordable housing for all families in poverty

This rule’s damaging effects would reach well beyond mixed-status households. As families who are only eligible for prorated rental assistance lost housing, families eligible for full-family subsidies would replace them. If HUD replaced the 25,000 mixed-status families with those eligible for full subsidies, the increased federal cost to house these families would be $65 million annually. Absent increased appropriations, this change would lead to reductions in either the amount or quality of subsidized housing available for low-income renters, including U.S. citizens.

Conclusion

Alabama Arise believes the proposed rule would reduce the availability of affordable housing for all families with low incomes. We also believe it would increase family homelessness and negatively impact seniors and people with disabilities. Arise urges HUD to withdraw its current proposal immediately. And we urge the agency to work instead to strengthen its commitment to affordable housing for all families in the United States.

Alabama Arise comments in opposition to federal plan to redefine poverty line

The Office of Management and Budget (OMB) is proposing to reduce annual cost-of-living adjustments to the federal poverty line. Over time, this plan would reduce or end Medicaid, SNAP food assistance and other work supports for millions of Americans. Here is the full text of the comments Alabama Arise submitted in opposition to this proposal:

Organizational purpose and interest

Alabama Arise is a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of low-income Alabamians. Arise believes acts of charity are vital, but they are not enough. We also must work to improve harmful policies. Arise provides a structure through which Alabamians can engage in public debates with the goal of improving the welfare of all Alabamians.

Arise envisions an Alabama where all people have resources and opportunities to reach their potential to live happy, productive lives, and each successive generation is ensured a secure and healthy future. We envision an Alabama where all government leaders are responsive, inclusive and justice-serving, and where the people are engaged in the policymaking process. And we envision an Alabama where all people live with concern for the common good and respect for the humanity of every person.

Arise has engaged actively in advocacy and outreach on a wide variety of means-tested programs. These include Medicaid, Affordable Care Act subsidies, the Children’s Health Insurance Program (CHIP), the Supplemental Nutrition Assistance Program (SNAP), subsidized child care and school meals.

The Office of Management and Budget’s (OMB) proposed change in consumer inflation measurement would deeply affect all of these programs. More importantly, it would deeply affect the people who use them as work supports.

We understand OMB is not seeking comments on the impact of changing the Department of Health and Human Services’ (HHS) poverty guidelines. But we encourage OMB to undertake rigorous analysis and seek public comment before changing the inflation measurement underlying those guidelines.

Analysis of the proposed change

We understand OMB proposes to change the methodology for calculating poverty by using the Chained CPI (C-CPI-U) instead of the CPI for All Urban Consumers (CPI-U). We believe this change would not adequately reflect inflation’s impact on people living in or near poverty. And we believe this change ultimately would leave millions of struggling Americans ineligible for needed work supports.

The C-CPI-U assumes that, as inflation increases, consumers will purchase less expensive versions of items, thereby reducing their total cost. The flaw in this assumption is that most low-income families already purchase the least expensive items possible. That means they cannot turn to less expensive substitutes when prices increase.

In reality, low-income families typically face more inflation in the price of goods they purchase than do wealthier families. And people with low incomes cannot afford to make the adjustments in household expenditures available to more affluent people.

For the above reasons, the C-CPI-U is not an appropriate way to calculate the poverty line. Instead, it would simply define low-income families out of poverty even when they still cannot afford basic necessities.

Denying families who are still poor in every real sense access to health care, nutrition, child care or other assistance would only increase misery and threaten the health and welfare of American families. This is no way to promote economic prosperity. And it is not what Congress envisioned when creating a safety net for Americans facing hard times.

Conclusion

We agree that there are serious problems with the official poverty measure and that its calculation needs revision and updating. But we do not agree that the OMB’s proposed change is the right way to make those updates.

Changes in the cost of child care and housing have increased the burden of those expenditures for low-income families in a way not anticipated in the 1960s, when the poverty level was first established. The U.S. Census Bureau, recognizing the problems with the official poverty calculation, has developed the Supplemental Poverty Measure (SPM).

The SPM takes into account more realistic costs for housing, child care and health care. As a result, this measure actually shows a higher poverty level than does the official measure. If OMB truly wishes to calculate poverty more accurately, we would encourage rigorous analysis of actual spending patterns, similar to that reflected in the SPM.

OMB’s proposed change would not make the calculation of inflation and poverty more accurate. It would only make problems with the current calculation worse, while denying families assistance they need to make ends meet. This proposal would disproportionately harm people of color. And it would hurt the most vulnerable Americans – children, seniors, and people with disabilities – the most.

Struggling families will continue to need the assistance of critical work support programs. Denying access to those programs would be contrary to congressional intent and would only hurt our country and its people.

Proposed Alabama Medicaid changes are ‘a catch-22 that forces people into the coverage gap,’ Alabama Arise tells officials

Alabama’s proposed new Medicaid work requirement waiver would be costly, counterproductive, ineffective and harmful to thousands of families who live in deep poverty, Alabama Arise wrote in official comments submitted to state Medicaid officials on Thursday, Oct. 11, 2018.

“Threatening loss of health care in an attempt to force work efforts, without providing the supports that would make those work attempts successful, is flagrantly cruel and will result in no outcome other than poorer, more desperate and less healthy Alabama families,” Arise’s comments concluded.

Medicaid covers about 1 million Alabamians. Of that total, the waiver would target 7.5 percent of them – about 75,000 adults with extremely low incomes who qualify for Medicaid as parents or other caretaker relatives of children. Alabamians in this group are ineligible for Medicaid if their incomes exceed 18 percent of the federal poverty level (about $312 a month for a family of three).

Because Alabama has not expanded Medicaid to cover adults with incomes below the poverty level, the state’s work requirement plan would create a “work penalty, a catch-22 that forces people into the coverage gap,” Arise wrote. About 300,000 Alabamians already are caught in the coverage gap, earning too much for Medicaid but too little to qualify for federal subsidies for Marketplace plans.

Parents who work just 10 hours a week at minimum wage earn too much to qualify for Medicaid. But the state’s proposal would require them to engage in work-related activities between 20 to 35 hours a week. That would leave thousands of Alabama parents in a no-win situation: They would lose their Medicaid coverage if they don’t work – and also if they do. Of the parents who would not qualify for an exemption – about 1.7 percent of Alabama’s total Medicaid population, by the state’s estimates – virtually all of them would end up uninsured, without access to employer-provided coverage or an affordable private plan.

Alabama’s proposal does not project the state’s cost to track Medicaid enrollees’ work activities and exemptions. It also does not identify whether or how the state would invest in child care, job training, transportation and other supports that low-income parents need to get and keep work.