370,000 Alabamians removed from Medicaid after COVID restrictions lifted

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

About 370,000 Alabamians were removed from Medicaid in the 10 months after federal restrictions on disenrollment expired earlier this year.

While in line with national trends, the number in Alabama is significantly higher than an April 2023 estimate by KFF, a health policy research and news organization, which projected 170,000 total disenrollments in Alabama during the 12-month period.

“As it stands, Alabama is kind of mid-pack, I would say, in terms of when looking at unwinding outcomes, and particularly if you’re looking at disenrollment rates,” said Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured and the director of State Health Reform at KFF.

As of April, 745,771 enrollees renewed their coverage and 369,554 enrollees were disenrolled, including 47,968 who were determined ineligible and 321,586 who were disenrolled for procedural or administrative reasons, such as not turning in required paperwork on time.

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 1.38 million in May 2023.

The ban was lifted last year, leaving states responsible for determining whether people are still eligible for Medicaid coverage.

Alabama sees higher-than-expected Medicaid disenrollment after pandemic freeze lifts

About one-quarter of people who lost coverage nationwide during unwinding say they are now uninsured, and because Alabama has not expanded Medicaid, the number could be higher in the state, but that data is not yet available, Tolbert said.

“The expectation in non-expansion states like Alabama is that a much higher share of people are actually becoming uninsured because they are falling into the coverage gap,” Tolbert said.

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.

A message seeking comment was left with the Medicaid Agency. Melanie Cleveland, a spokesperson for the Alabama Medicaid Agency, said in December those who lost coverage have 90 days to reinstate it .

Alabama’s Medicaid enrollment declined by 16.7% between June 2023 and April 2024, slightly higher than the national average decline of 11.4%. As of April 2024, the state’s enrollment stood at approximately 1.1 million, down from 1.4 million the previous year.

Tolbert said Alabama has seen a rise in federal marketplace enrollments, driven in part by enhanced subsidies and the unwinding process, but detailed data on specific transitions from Medicaid to marketplace coverage in the state remain scarce.

“The timing of the increase this year is partly, we think due to unwinding, because people who would have transitioned over the past three years are now all being disenrolled at one time and therefore looking for marketplace coverage,” Tolbert said.

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