Post COVID-emergency, Alabama not reporting how many people lost Medicaid coverage

Alabama is one of only six states that has yet to report how many people have lost Medicaid coverage during the “unwinding” process that followed the end of the COVID-19 public health emergency.

The Alabama Medicaid Agency began evaluating Medicaid recipients’ eligibility for coverage in June.  The agency completed two months of redeterminations, but those numbers have yet to be reported.

“The Alabama Medicaid Agency is not publishing termination statistics at this time since we just completed the first month of terminations,” Melanie Cleveland, Alabama Medicaid’s spokesperson, wrote in an email on July 6.

On Aug. 2, after the state completed its second month of terminations, Cleveland said those numbers were still being “validated,” and only validated numbers are reported to the Centers for Medicare & Medicaid Services (CMS).

“This is the most up-to-date information the agency can provide at this time,” she said.

The agency has not responded to further requests for information. 

As part of the response to the COVID-19 pandemic in 2020, the federal government banned states from terminating anyone’s Medicaid coverage. During that time, Alabama’s Medicaid enrollment went from just over 1 million Medicaid-eligible people before the COVID-19 to 1.37 million eligible in May 2023.

During the unwinding period, states are responsible for determining whether people are still eligible for Medicaid coverage after the COVID-19 public health emergency ended. 

An estimated 170,000 Alabamians could lose Medicaid coverage in the next year due to the end of the public health emergency.  

The information provided by Alabama to CMS only includes about 120,000 policy renewals initiated in April by Alabama Medicaid. The state also reported call center volume, call center wait times and call center abandonment rate for both April and March.

Delaware; Hawaii; Illinois; North Dakota and Wisconsin have not reported their unwinding data.

Who Medicaid covers

Medicaid in Alabama mainly covers children, the elderly and the disabled. Childless able-bodied adults almost never qualify. Adults with qualifying children must make no more than 18% of the poverty line ($2,673 a year for an individual; $4,475 for a family of three) to receive Medicaid.

Robin Rudowitz, vice president of KFF and director for the program on Medicaid and the uninsured, said that while Alabama started the unwinding process in June, other states that started after it have already published data.

“The large majority of states, even if they’ve just started, we do have some data, but Alabama, of course, is one of the states that CMS is not reporting data,” Rudowitz said. “We don’t have any other data available from Alabama.”

Rudowitz said that Alabama has taken advantage of several flexibility waivers provided by the federal government. These waivers are meant to help states manage the volume of the redetermination caseload, but also to avoid terminating coverage for those who may still be eligible.

Alabama has taken up five waivers to help with the process, such as coordinating renewals for recipients enrolled in the Supplemental Nutritional Assistance Program (SNAP) or Temporary Aid to Needy Families (TANF), and automatically renewing recipients with no income.

“There’s a whole list of strategies that CMS has worked with states on to help mitigate and minimize procedural terminations. So, there are these temporary waivers that states can adopt,” said Rudowitz.

Robyn Hyden, executive director of Alabama Arise, said that she believes Alabama Medicaid has a good plan in place, but there are still concerns that at the end of the process, those most vulnerable might lose coverage.

“We likely will have people, mostly kids, but also, low-income seniors, folks with disabilities, who are going to lose coverage,” Hyden said. “And they’re going to lose coverage sometimes because they didn’t do the paperwork and time or, you know, they didn’t receive notification.”

Cleveland said that Alabama Medicaid has taken “extraordinary efforts to notify recipients when it is time to renew.”

She said that the agency mailed renewal notices through regular mail, as well as contacted recipients by email, text message and phone when it is time to renew, but that’s only if the agency has that information. Cleveland also said the agency also held online meetings for providers and provided outreach resources to help reach patients.

Medicaid recipients that were terminated on July and Aug. 1 will have 90 days to reinstate their coverage if they are still eligible, Cleveland said.

Jennifer Harris, Alabama Arise’s health policy advocate, said that the feedback from recipients who have spoken to her said that they feel informed and that “they know what’s going on.”

“Many have joked about the amount of communication that they have received from Alabama Medicaid. So overall, it does feel like communication-wise, Medicaid had a good plan,” Harris said.