Medicaid unwinding: 28,300 Alabamians lost coverage in July; total losses top 50,000

By: - November 1, 2023 7:01 am
Black lettering spells out "Alabama Medicaid" on a white wall. A door marked "entrance" can be seen below and to the right of the sign.

The offices of the Alabama Medicaid Agency, as seen on Jan. 24, 2023. (Brian Lyman/Alabama Reflector)

Nearly 28,300 Alabamians lost Medicaid coverage in the month of July after federal restrictions on disenrollment expired earlier this year, according to data released Tuesday by the Alabama Medicaid Agency.

The new numbers bring the total number of Alabamians known to have lost Medicaid coverage under the process to over 50,000.

“The numbers don’t necessarily scream ‘too alarming’ right now, but then we also do have a little less than half a year to go,” said Jennifer Harris, a health policy advocate at Alabama Arise, a nonprofit that works on poverty issues. “We’ll see if we’re going to surpass what those estimates are.”

Melanie Cleveland, a spokeswoman for the Alabama Medicaid Agency, said in a statement that changes were expected.

“People who are no longer eligible for Medicaid in Alabama will be removed since the COVID-19 Public Health Emergency (PHE) ended, and states are required by the Centers for Medicare and Medicaid Services to redetermine eligibility,” she said in an email statement.

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

In the first set of data after Alabama started its unwinding process, about 22,300 people lost coverage in June. If the state continues to terminate 20,000 or more people per month, at least 240,000 people could lose coverage. About 1.3 million Alabamians were eligible for Medicaid in August.


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.

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

Alabama Medicaid Agency: Up to 100,000 Alabamians may have lost coverage

With the public emergency ended, states are responsible for determining whether people are still eligible for Medicaid coverage.

The Alabama Medicaid Agency began evaluating Medicaid recipients’ eligibility for coverage in June. The agency completed five months of redeterminations, but only June and July determinations have been reported.

Cleveland previously said that they are about 3 months behind publishing unwinding data because the agency wants to validate all numbers before reporting them to the Centers for Medicare & Medicaid Services (CMS).

Since those who lost coverage have 90 days to reinstate coverage, she said Alabama wants to avoid amending numbers if they report them too early.

68% of recipients had their coverage renewed, while 32% were disenrolled in Alabama, according to KFF estimates.

Alabama Medicaid has said it has been able to renew a significant number of applications on an “ex-parte” basis, or an automated renewal based on state data. The state has renewed 52% of people through the method, just under the nation’s average of 57%.

Of the people disenrolled, KFF estimates that about 86%, up from 82% in less than a month, lost coverage for procedural reasons — because recipients did not complete the paperwork — while 14% were determined to be ineligible, down from 18%.

Harris said that for procedural terminations, there can be a number of issues or barriers for families to renew their coverage. There may be questions about whether the paperwork was sent in the recipient’s preferred language, whether the family moved or whether the family knew they had to respond to Medicaid.

She said that procedural terminations also happen when Medicaid does not have enough information to renew the coverage automatically.

“There could be a number of reasons there but generally, we know that we have not covered the bases to make a determination, in which we know for certain what the information is,” Harris said.

Cleveland stated that the agency has worked with providers and other partners to notify recipients to respond to the renewal notice. Even if they are not eligible for Medicaid, as they may qualify for other programs.

Harris said those who believe they were wrongly terminated have options. The Alabama Disability Advocacy Program is working to support those with disabilities.

Those who lost coverage may qualify for a plan in the Federal Health Coverage Marketplace, which open enrollment starts Nov. 1.


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Alander Rocha
Alander Rocha

Alander Rocha is a journalist based in Montgomery, and he reports on government, policy and healthcare. He previously worked for KFF Health News and the Red & Black, Georgia's student newspaper. He is a Tulane and Georgia alumnus with a two-year stint in the U.S. Peace Corps.