“To improve maternal health, we have to focus on improving all women’s health and access to care – not just during labor and delivery, but before and after pregnancy, and throughout our lives.” – Dr. Leana S. Wen
Download a full PDF copy of The Alabama Maternal Health Toolkit here. You also can access the PDF by clicking the “Download” button at the top of the page.
Table of contents
Introduction
Welcome to The Alabama Maternal Health Toolkit! Alabama Arise created this resource with one primary goal: to support and empower you as you navigate the complexities of maternal health care in Alabama. Whether you’re a new mom, an expectant mother or a health care advocate, this toolkit is designed to provide you with critical information on maternal health, Medicaid coverage, health care access and community resources.
Our hope is that this guide will help you understand available health care options and provide the confidence you need to take the next steps in securing and maintaining necessary care. We are committed to improving maternal health outcomes and supporting families across our state. We’re here to help guide you through every step of the way.
We encourage you to share this toolkit with others who may benefit. Together, we can build a healthier future for all Alabama mothers and their families.
Background
Maternal health in Alabama faces serious challenges. Alabama has some of the highest rates of maternal mortality and preterm births in the United States. Limited access to comprehensive health care worsens these disparities, especially for women in underserved and rural communities. Medicaid plays a critical role in addressing these gaps by covering more than half of all births in Alabama. However, many women still lack the continuous care they need.
Key statistics
- Alabama has the third highest rate of maternal mortality in the nation.
- 1 in 2 births are covered by Medicaid in Alabama.
- Black women are three times more likely to die from pregnancy complications.
Maternity care access in Alabama
Alabama has one of the United States’ highest rates of maternity care deserts, defined as areas where access to maternity care is limited or absent. This leaves many women in rural areas without access to necessary obstetrical services. The ongoing closure of maternity wards, specifically in rural areas, further limits access to prenatal care, safe deliveries and postpartum services.
Statistics
- 16 of the 55 Alabama counties considered rural have hospitals providing obstetrical services today, compared to 45 of the 55 counties in 1980.
- On average, Alabama women travel 17.4 miles and 23.5 minutes to their nearest birthing hospital.
- Hospitals are closing or reducing services due to financial strain. This is a situation worsened by Alabama’s lack of Medicaid expansion.
- 8.9% of all Alabama births occur in maternity care deserts.
Medicaid benefits and coverage
Medicaid offers a comprehensive range of services to support maternal health during preconception, pregnancy and postpartum periods.
Preconception
Plan First Program
The Medicaid Plan First Program offers family planning services to women ages 19 through 55 in Alabama. For women, the program includes coverage for essential exams, birth control and planning assistance.
SERVICES COVERED BY MEDICAID PLAN FIRST
- Yearly family planning exam
- Access to birth control (including pills, IUDs, diaphragms, shots and implants)
- Tubal ligation (and vasectomies for men)
- Lab work for pregnancy
- Testing for sexually transmitted infections
- Assistance in planning when to have a baby
- Tobacco cessation
Pregnancy
Health coverage during pregnancy ensures access to prenatal care, which is critical for monitoring the health of both mother and baby.
SERVICES COVERED BY MEDICAID
- Regular prenatal checkups
- Prenatal vitamins
- Diagnostic tests like ultrasounds
- Health education (such as childbirth preparation classes)
- Dental services
- Nurse-Family Partnership (NFP) services (See page 13 for more)
- Alabama Coordinated Health Network (ACHN) care management services (Patients must register with an ACHN before scheduling their first prenatal appointment)
Postpartum
Postpartum care is essential for both mother and baby. Extended coverage after birth helps ensure proper recovery, mental health support and access to necessary infant care. Postpartum coverage is available for one full year after childbirth or pregnancy loss.
SERVICES COVERED BY MEDICAID
- Postpartum checkups
- Mental health counseling to address postpartum depression and other conditions
- Family planning services to assist with birth spacing
- Dental services (until 60 days after birth)
- Infant care, including vaccinations, regular checkups and developmental screenings
Maternity Medicaid enrollment
There is no open enrollment period for Maternity Medicaid. People may apply and enroll at any time.
Medicaid coverage may be used alongside private insurance coverage. If a woman has a private, non-Marketplace insurance plan, she also may enroll in Maternity Medicaid if she meets the income and eligibility requirements. A child born to a woman enrolled in Medicaid at the time of the birth is eligible for what is known as “deemed newborn coverage.” This is coverage that begins at birth and lasts for one year, regardless of any changes in household income during that period.
How can Alabama moms get coverage?
Medicaid is a vital resource for pregnant women and new mothers in Alabama. Understanding how to qualify and enroll in Medicaid is essential for ensuring access to health care during pregnancy and after childbirth.
Eligibility criteria
- Age
- Pregnant Alabama women of any age can receive full Medicaid coverage if they meet all eligibility requirements. Pregnant women under age 19 also may receive full coverage if their parents’ income is counted and they meet the income guidelines for a child.
- Income
- The household income limit for pregnant women is 146% of the federal poverty level (FPL). See page 10 for more.
- Citizenship
- Pregnant women must be a U.S. citizen or have satisfactory immigration status to qualify.
- Residency
- Pregnant women must reside in Alabama to receive Alabama Medicaid benefits.
Eligibility help
2024 income guidelines
Household size includes the pregnant woman and the unborn child. It also may include the spouse, father and/or other children under age 19, depending on who is living in the home and how taxes are filed.
Financial eligibility
Medicaid financial eligibility is based on Modified Adjusted Gross Income (MAGI), which starts with a person’s Adjusted Gross Income (AGI). AGI is the total income earned in a year after certain deductions like retirement contributions or student loan interest. To determine MAGI, applicants should add untaxed foreign income, non-taxable Social Security benefits or tax-exempt interest (if any) to their AGI. For many applicants, AGI and MAGI are the same. For Medicaid, the household income is calculated by adding up the MAGI of each person in the household, whether they file taxes or not.
Documentation examples
- Income verification
- Recent pay stubs
- Tax returns
- Unemployment insurance or Social Security benefits statements
- Proof of identity and citizenship
- Driver’s license or state-issued ID card
- U.S. birth certificate or passport
- Permanent Resident Card (Green Card)
- Pregnancy confirmation
- Doctor’s note or verification from a health care provider
- Ultrasound report
- Proof of Alabama residency
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- Utility bill (electricity, water, gas)
- Lease agreement or mortgage statement
- Voter registration card
Steps to enroll
Check eligibility
Be sure your income meets the requirements for your household size (which includes you, dependents and your unborn child). Review the eligibility checklist and income limits table in this toolkit to confirm eligibility.
Gather required documentation
Before applying, gather the required documentation:
- Income verification
- Pregnancy confirmation
- Proof of identity and citizenship
- Proof of Alabama residency
Apply
Online
Apply online at insurealabama.adph.state.al.us
By mail
Download, complete and mail the Medicaid application to:
Medicaid, P.O. Box 5624
Montgomery, AL 36103-5624
Confirm and wait
After applying, you should receive a confirmation letter within a few weeks. Be sure all your information is accurate. If you don’t hear back, follow up with the Medicaid office to check on your application status.
Need help?
Call the Medicaid helpline if you need assistance with the application process or renewing your coverage.
Medicaid helpline: 888-362-1504
Monday-Friday, 8 a.m. to 4:30 p.m.
How Alabama is improving outcomes
Despite the challenges, numerous programs and initiatives across Alabama are working to improve maternal health outcomes. Here are a few of them.
ALABAMA 211 CONNECTS
Alabama 211 is a statewide helpline that connects residents to essential health care, maternal health and social services. It acts as a central resource for navigating local support options during pregnancy and the postpartum period. Individuals can simply dial 2-1-1 to access a wide range of services.
ALABAMA MARCH OF DIMES
The March of Dimes is a nonprofit organization that supports research, advocacy and programs to improve maternal and infant health. In Alabama, it focuses on preventing birth defects, premature births and maternal health disparities. This organization offers prenatal education and support to expectant mothers, especially those in vulnerable communities.
ALABAMA MATERNAL HEALTH TASK FORCE
The Alabama Maternal Health Task Force (ALMHTF) works to address the state’s maternal health challenges by coordinating efforts across various stakeholders. Its goal is to improve health outcomes by reducing maternal mortality and morbidity through policy development, collaboration and health care quality improvement initiatives.
ALABAMA MATERNAL MORTALITY REVIEW COMMITTEE
The Alabama Maternal Mortality Review Committee (MMRC) investigates maternal deaths across the state to identify the causes and determine preventable factors. By reviewing these cases, the committee provides recommendations to health care providers and policymakers to improve maternal health care and reduce maternal mortality rates.
ALABAMA PERINATAL QUALITY COLLABORATIVE
The Alabama Perinatal Quality Collaborative (ALPQC) is a statewide initiative that brings together health care providers, hospitals and public health experts to improve the quality of perinatal care. Its focus is on reducing infant mortality and maternal health complications by implementing best practices in care delivery.
BIRMINGHAM HEALTHY START PLUS
Birmingham Healthy Start Plus provides community-based services to reduce infant mortality and improve maternal health in Birmingham’s most underserved neighborhoods. The program offers prenatal and postpartum support, education and resources to ensure healthy pregnancies and safe deliveries for vulnerable families.
BIRTHWELL PARTNERS
Birthwell Partners is a nonprofit organization that trains and provides doulas to support women, particularly in underserved and rural areas of Alabama. Their services help improve birth outcomes by offering emotional, physical and informational support throughout pregnancy, labor and postpartum recovery.
COVER ALABAMA
The Cover Alabama coalition advocates for the expansion of Medicaid coverage to ensure more Alabamians, especially pregnant women and families, have access to affordable health care. By pushing to close Alabama’s health coverage gap, the coalition aims to reduce maternal mortality rates and improve overall maternal and infant health.
GIFT OF LIFE FOUNDATION
The Gift of Life Foundation supports maternal and child health by offering prenatal education, health care access and early intervention services. Their programs are designed to reduce infant mortality and ensure that mothers receive comprehensive care during and after pregnancy.
NURSE-FAMILY PARTNERSHIP
The Nurse-Family Partnership (NFP) is a national program implemented in Alabama to improve maternal and child health by connecting first-time, low-income mothers with specially trained nurses. These nurses provide home visits during pregnancy and the first two years of the child’s life, focusing on health, parenting skills and economic self-sufficiency.
PREGNANCY RISK ASSESSMENT MONITORING PROGRAM
Pregnancy Risk Assessment Monitoring Program (PRAMS) is a CDC initiative in collaboration with the Alabama Department of Public Health, aimed at collecting data on maternal attitudes and experiences before, during and after pregnancy. This information helps shape policies and programs designed to improve maternal and infant health outcomes across the state.
Medicaid expansion
Alabama is one of only 10 states yet to expand Medicaid, leaving tens of thousands of women in the health coverage gap. Expanding Medicaid would help ensure that more women receive health care before, during and after pregnancy, leading to lower maternal and infant mortality rates.
Statistics
- 10 states have not expanded Medicaid
- Nearly 200,000 Alabamians are caught in the health coverage gap
- States that have expanded Medicaid have seen fewer maternal and infant deaths compared to non-expansion states.
- Medicaid expansion could help prevent further hospital closures and increase access to maternal care in rural areas.
States
- Alabama
- Florida
- Georgia
- Kansas
- Mississippi
- South Carolina
- Tennessee
- Texas
- Wisconsin
- Wyoming
Conclusion
Ensuring better maternal health in Alabama is a collective effort that requires continuous support, access to care and well-informed decision-making. The Alabama Maternal Health Toolkit is a resource designed to help inform and guide women, families and health care providers in accessing the resources available through Medicaid and other maternal health programs. By ensuring every mother has access to essential prenatal, delivery and postpartum care, we can work toward reducing maternal mortality, addressing disparities and improving the health of both mothers and babies across our state. Together, we can strive to birth better outcomes for families across Alabama.
Alabama Arise is a statewide, member-led nonprofit organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Learn more about Arise at alarise.org. Follow @AlabamaArise on Facebook, Instagram and Twitter/X.