Pandemic, new rule increase Medicaid enrollment

Pandemic, new rule increase Medicaid enrollment

By Mary Sell, Alabama Daily News

Enrollment in Medicaid in Alabama has increased during the coronavirus pandemic, up more than 46,000 recipients since last year and surpassing a previous enrollment high set in 2015.

Alabama Medicaid has retained an average of about 10,000 additional recipients per month since April 2020, the agency told Alabama Daily News.  Enrollment in July was 1,092,935 statewide.

“This is mainly due to the (Centers for Medicare and Medicaid Services) requirement allowing continued coverage for recipients throughout the COVID-19 national emergency,” agency spokeswoman Melanie Cleveland said.

This March, in response to federal CARES Act requirements, Alabama Medicaid, the health care provider for the state’s poor and disabled, announced it will not terminate individuals from Medicaid coverage during the COVID-19 emergency if they were already enrolled in the program or became enrolled during the emergency period. People can be removed if they move out of the state or voluntarily terminate their eligibility.

Medicaid enrollment is also up nationwide following the COVID-19 pandemic. 

State lawmakers will be watching Medicaid enrollment increases as they begin to prepare budgets ahead of the next legislative session, which is scheduled to begin Feb. 3. Medicaid is the state General Fund’s largest expense each year, followed by the prison system.

“Hearing that does not surprise me; that’s been a concern I’ve had,” Sen. Greg Albritton, R-Range, said about the enrollment numbers. Albritton is chairman of the Senate General Fund committee.

“Of all agencies, of all matters, any gains that we think we’ve made can be eaten up in one swoop by Medicaid,” he said. 

Lawmakers and Gov. Kay Ivey allocated $820 million in the General Fund for the agency in fiscal year 2021, which begins next month, and hundreds of millions of dollars from other state sources are directed to support the program each year. Most of its funding, though, is federal, amounting to nearly $5 billion for Alabama in 2019.

In the House, General Fund budget chairman Rep. Steve Clouse, R-Ozark, mentioned Medicaid as a concern on the horizon in the 2022 budget, which lawmakers will begin drafting early next year. 

He said pre-pandemic unemployment rates under 3% were keeping Medicaid enrollment stable. In April, unemployment hit nearly 14%. In August, it had dropped to 5.6%, the Alabama Department of Labor reported on Friday.

“And I’m just afraid those (enrollment) numbers are going to start picking up here,” Clouse said.

In June, Alabama Daily News reported that though unemployment in Alabama steadily decreased throughout fiscal 2019, the number of people receiving health care through Medicaid grew by 2%. In September 2019 there were 1,046,192 people receiving Medicaid.

Medicaid’s previous high-water mark for enrollment was in 2015 at 1,052,800.

Medicaid officials told ADN last year’s slight increase was due to a rise in eligible children and improvements to the system’s enrollment and eligibility apparatus.

In January, Medicaid Commissioner Stephanie Azar told lawmakers in a budget hearing that 52% of Medicaid enrollees are children in families below 146% of the federal poverty rate.

Children in a family of four qualify for Medicaid if the family’s income is $38,256 or less. At $7.25 an hour, a full-time, minimum-wage job pays $15,080 a year.

Alabama did not expand Medicaid coverage under the Affordable Care Act. Cover Alabama, a coalition of advocacy groups, said this week that 9.7% of Alabamians were without health insurance in 2019, a slight decrease from 10% in 2018. The rate of uninsured people in states that failed to expand Medicaid was twice as high as the rate in states that expanded Medicaid, the organization said.