Alabama Medicaid unwinding: Children big part of losses, but may have gotten coverage elsewhere

By: - November 2, 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 January 24, 2023. (Brian Lyman/Alabama Reflector)

Children ranging from one to 12 made up over 31% of Alabamians who lost Medicaid coverage after federal restrictions on disenrollment expired earlier this year, according to data released Tuesday by the Alabama Medicaid Agency.

When children 18 years old or younger are included, that figure rises to over 43%.

But both Alabama Medicaid officials and independent health care advocates say there may be other factors at play.

“There are more considerations that  you need to factor in such as the number of people who moved out of the state, the number who have obtained employment with healthcare benefits, the number who have passed away, the number who may have moved into a different type of coverage, or the number who just didn’t respond at renewal time,” said Melanie Cleveland, a spokeswoman for the agency.


Jennifer Harris, health advocate for Alabama Arise, said that the main question is whether those children who are no longer eligible for Medicaid are now eligible for ALL Kids.

ALL Kids provides low-cost healthcare coverage, from $52 up to $104 a year, for Alabama’s children and teens whose family incomes are above Medicaid eligibility, but below 300% of the Federal Poverty Level.

Data from ALL Kids enrollment by age provide a limited glimpse at whether children are moving from Medicaid to ALL Kids. While Medicaid eligibility increased since the COVID-era rules, so has ALL Kids enrollment.

From August 2020 to August 2023 — the first year of the pandemic to the latest report — ALL Kids enrollment increased 11.1%, from 173,725 to 193,017.

Comparing Medicaid eligibility loss between counties, Monroe County had the highest loss in Medicaid eligibility in the two months, decreasing by 4.64%. Elmore and Choctaw counties followed Monroe.

Coffee County had the lowest eligibility loss rate, at 2.44% decrease, followed by Lowndes and Covington counties.

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

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.

The Alabama Medicaid Agency began evaluating Medicaid recipients’ eligibility for coverage in June. The agency completed four 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, the agency 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%. Procedural terminations also happen when the state agency does not have enough information to renew the coverage automatically.


Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our web site. Please see our republishing guidelines for use of photos and graphics.

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.