You may have a list of topics that you consider taboo at holiday gatherings. But I hope that finding ways to help Alabamians living in poverty isn’t on that list. When you’re among friends and family who believe life should be better for struggling Alabamians, I hope you’ll make sure they know about Alabama Arise.
Arise’s membership has grown exponentially in recent years, and we hope to continue that trend. As an inclusive organization, we welcome everyone who wants to advocate for a brighter future for Alabama.
We need to bring together people who support Medicaid expansion, payday lending reform and voting rights. We need to bring together people who want to fund public transportation and untax groceries. And we need to bring together people who are determined to break down policy barriers to shared prosperity across our state.
Gift memberships are another way to introduce friends to Arise. Email us at info@alarise.org with the names and complete contact info for those you’re sponsoring.
The deadline to #GetCovered is one month away! Open enrollment for 2020 Marketplace health coverage under the Affordable Care Act ends Sunday, Dec. 15, 2019. Don’t miss your chance to make sure you’re covered in case of accident or illness.
Visit healthcare.gov or call 800-318-2596 to explore your coverage options. And be sure to spread the word about this opportunity to your friends and family, too.
Even if you already have Marketplace coverage, we still recommend that you log in and double-check your options. Another plan may better meet your needs in the coming year.
Our state’s uninsured rate for children (3.5%) remained one of the best in the South in 2018. After years of improvement, though, Alabama’s number of uninsured children ticked up from 32,000 in 2016 to 41,000 in 2018.
That’s a warning sign that our policymakers should heed. Alabama must protect the coverage gains we’ve made through ALL Kids. And we should build on those gains by expanding Medicaid to cover adults with low incomes.
When parents have health insurance, their children are more likely to have coverage as well. Medicaid expansion would boost health security for struggling families across Alabama. That would be good for children, good for communities and good for our entire state.
Veterans Day gives Alabama a chance to shine. Our cities and towns hold parades and ceremonies each Nov. 11 to honor service members and to burnish the state’s reputation as a great place for veterans to retire.
This year, as we celebrate those who have risked and sacrificed to defend our country, let’s remember a group too often overlooked: veterans who have low incomes and no health insurance. And let’s commit to expanding Medicaid to help them meet their health needs.
It’s a common misconception that people who serve in the U.S. military automatically receive lifetime eligibility for health coverage and other benefits. In reality, though, veterans’ health benefits depend on their length of service, military classification, type of discharge and other factors. Treatment for service-connected conditions has no time-of-service requirement, but other health benefits do.
Active-duty service members and their families receive health coverage through the Department of Veterans Affairs (VA). Most also receive “bridge” health insurance coverage in the 180 days before and after their active-duty service.
But many veterans — including many National Guard and Reserve members — return home without military health care for the long term. For the 13,000 Alabama veterans and adult family members who have no military health insurance and can’t afford private plans, the consequences can be dire.
A lasting commitment to Alabama’s uninsured veterans
Returning to civilian life can be challenging enough without the added burden of being uninsured. Injuries sustained from combat, environmental hazards or physical stress can cause chronic disability or loss of function. And the mental stress of combat and separation from family also puts some veterans at risk for mental health problems and substance use disorders. The rising rate of veteran suicides is stark evidence of this troubling toll.
There’s something Alabama can do to help. If we expanded Medicaid to adults earning up to 138% of the federal poverty level ($29,435 a year for a family of three), nearly 13,000 uninsured veterans and family members could get the health coverage they need. Medicaid expansion would be a meaningful and lasting commitment to make life better for veterans across Alabama.
Shortchanging higher education is shortchanging Alabama’s future. It’s a harmful choice that’s limiting opportunity for people across our state. But better policy choices can create a more prosperous future and help all Alabamians reach their full potential.
Alabama has slashed its per-student state higher education funding more than any other state over the last decade, according to the Center on Budget and Policy Priorities (CBPP). Since 2008, Alabama has cut higher ed funding by 36.2%, or $4,466 per student, CBPP found. Those cuts are the nation’s worst by dollar amount and third worst by percentage.
“We are dissuading folks from pursuing their dreams,” I told WBHM reporter Janae Pierre last week. “We’re reducing campus diversity, and we’re reducing opportunity for people to get ahead and build a better life for themselves and their families.”
With state funding down, tuition has soared. Between 2008 and 2018, the average tuition at public four-year institutions in Alabama jumped by 72.9%. These massive increases have erected barriers to opportunity for people across Alabama. And these barriers disproportionately block the paths of black and Latino students.
As I told WBHM: “We are asking an entire generation of folks to take on massive debt to begin their careers, to pursue their professional dreams. … Either people aren’t able to pursue the degree in the first place or they have to begin their career with five- or six-figure debt hanging over their head.”
Check out Alabama Arise’s news release for more information on the CBPP report. And check out my full interview with WBHM for more on how Alabama can help make college accessible and affordable for everyone, regardless of income.
We alerted you this summer to a proposed rule that could deny 36,000 Alabamians access to food assistance under the Supplemental Nutritional Assistance Program (SNAP). By changing SNAP’s categorical eligibility requirements, this proposal would deny or reduce nutrition assistance to almost 3 million struggling Americans.
The proposal’s impact would reach beyond SNAP. Children in families who lose SNAP also may lose their free or reduced-price school meals. Appallingly, it turns out this proposed rule would put nearly twice as many kids at risk as originally estimated.
The USDA now says this portion of the rule could harm 982,000 children nationwide, including an estimated 14,000 in Alabama. That’s almost twice as many as the previous estimate of 500,000.
The comment period on this proposal previously had closed last month. But due to the USDA’s miscalculation, officials have reopened the comment period related only to the impact for school meals. The new comment deadline is Friday, Nov. 1.
Please tell the USDA that Alabama children can’t learn while they’re hungry. Use FRAC’s comment portal here to submit a comment by Nov. 1. And remember to limit your comment to the rule’s effects on children and school meals. Otherwise, it won’t be counted.
The USDA must read and consider every comment. So please share your thoughts today, and ask your friends and neighbors to do the same!
Quality, affordable child care is essential for families seeking to escape poverty and participate in employment, education and job training. And while a federal funding increase has allowed Alabama to boost child care subsidies and expanded eligibility in recent years, there’s still much work left to do.
The AL.com article highlights Alabama Arise’s recent report on child care funding. It discusses the progress that Alabama has made in the past few years. And it illustrates many needs yet to be met, especially in rural areas and among Hispanic families.
State investment would make a real difference. As I said in the article: “Alabama is a state that puts absolutely no state dollars other than those mandated by the federal government into child care. That’s not true in most states.”
Alabama has two intertwined structural problems that, together, keep us from meeting our people’s most basic needs. One problem is that our state’s tax system is upside down. Rich people get huge tax breaks, forcing people with low and moderate incomes to make up the difference. The other problem is that this upside-down system doesn’t raise enough money to support schools and other vital services adequately.
Two major drivers of Alabama’s regressive tax system are a sales tax on groceries that hurts working families and a skewed income tax break that overwhelmingly benefits wealthy people. Alabama Arise has a longstanding plan to address both problems: Eliminate the state grocery tax and end the state deduction for federal income taxes (FIT).
Untaxing groceries without replacing the revenue would take $480 million annually away from education, hurting our children and our future. But by ending the FIT deduction, Alabama could bring in more than $800 million a year in new revenue.
That’s more than enough to replace lost revenue from the grocery tax. It also would allow our state to invest hundreds of millions of dollars in K-12 and higher education.
Ending the grocery tax and the FIT deduction would make our state’s tax system stronger and fairer. About four in five Alabama households would get a tax cut overall. And the net tax increase for those who would pay more generally would be modest. Even for the top 1%, the average increase would be less than 1 percentage point of income.
Arise’s tax reform plan would boost education funding and help millions of Alabamians make ends meet. This would increase opportunity and shared prosperity across our state.
Alabama Medicaid reforms first envisioned six years ago are finally going into effect today. And Alabama Arise will work hard to ensure Medicaid’s new structure keeps patient needs and consumer voices at the forefront.
The new plan brings regional control and care coordination of primary care services through seven Alabama Coordinated Health Networks (ACHNs) serving more than 700,000 Alabama Medicaid enrollees, mostly children. The ACHNs also will serve pregnant women and family planning patients. The networks, which officially launched today, will begin providing care coordination services Nov. 1.
A map of the seven Alabama Coordinated Health Networks that will serve more than 700,000 Alabamians enrolled in Medicaid.
The goals: Healthier patients and a strong consumer voice
For the first time, Alabama Medicaid governance will include consumer voices at the policy table. Each ACHN will have a Consumer Advisory Committee as well. Arise and our advocacy partners are pleased with this accountability provision and are working to strengthen consumer oversight.
Arise has partnered with the Alabama Disabilities Advocacy Program and the Disabilities Leadership Coalition of Alabama to recruit consumer representatives for the new roles. Together, we held a training for the group on Sept. 20. A major goal of Arise’s Medicaid consumer advocacy is to help the regional representatives work together as a statewide team.
Alabama Arise organizing director Presdelane Harris speaks at a training session for Medicaid regional consumer representatives Sept. 20 in Montgomery.Alabama Arise policy director Jim Carnes presents at a training session for Medicaid regional consumer representatives Sept. 20 in Montgomery.
In addition to the new consumer voices, we’re hopeful about the plan’s emphasis on improving health outcomes. Each ACHN will receive funding to develop and implement Quality Improvement Projects (QIPs) targeting three initial quality measures: (1) childhood obesity, (2) infant mortality and birth outcomes and (3) substance use disorders. Doctors will be eligible for bonus payments for meeting or exceeding goals on numerous care coordination and quality measures.
Arise will seek to ensure the QIPs reflect and respond to community needs. We’re working particularly closely with local partners in Mobile to bring community input into the QIP design process there. Stay tuned for more information about our food security work in the Trinity Gardens neighborhood!
Compare and contrast with past reforms
The Legislature voted overwhelmingly in 2013 to create Medicaid regional care organizations (RCOs) to cut costs and promote preventive care. But Gov. Kay Ivey, citing delays and budget problems, used an escape clause in the law to abandon RCOs in 2017.
The new ACHNs resemble the former RCOs, with a few key differences. Under the RCO plan, Medicaid would have given private, nonprofit managed care organizations a set monthly payment for each Medicaid enrollee (or member) in their region. The organizations, in turn, would have assumed full financial risk if overall costs exceeded those payments.
ACHNs also involve private nonprofit contractors, but payments will be based on medical services and care coordination services provided. The organizations also will assume only partial financial risk.
How the new ACHNs will work
The ACHNs will coordinate primary care for people with Medicaid coverage. Your ACHN will have a phone line to call when a Medicaid member has a health problem.
Their doctor will become their “medical home” – the first place to contact for ordinary health needs. And new services will be offered to improve patient health.
Medicaid members who already have a primary doctor can continue under their care. Coordinating patient care through a primary doctor helps avoid expensive emergency room visits for routine health care needs.
Other Medicaid reform efforts underway
ACHNs are the next step down the reform path for Alabama Medicaid. In October 2018, the agency launched a new statewide Integrated Care Network (ICN) to serve Medicaid long-term care patients. About 16,000 of the ICN members live in nursing care facilities. Another 9,000 receive long-term care services at home or in their communities through Medicaid waivers.
The state’s 13 regional Area Agencies on Aging provide the care coordination services for the statewide ICN. And as with ACHNs, Arise is working to ensure a strong consumer voice in the ICN. Arise has a seat on the ICN Consumer Advisory Committee, as well as an appointee on the ICN board.
Alabama’s Medicaid reforms are an encouraging move toward more patient-centered care. The inclusion of consumer voices and the emphasis on care coordination for quality improvement have the potential to move the needle on some of Alabama’s most persistent health challenges.
That would be a win for hundreds of thousands of Alabama Medicaid members – and for the whole state.
Alabama needs a criminal justice system that values the lives and well-being of everyone involved. Our state should treat people fairly, apply punishment humanely and focus on restoring offenders to productive roles in society.
Alabama Arise is closely monitoring the Study Group on Criminal Justice Policy that Gov. Kay Ivey appointed in July. Former Alabama Supreme Court Justice Champ Lyons chairs the panel, which also includes six legislators, the attorney general, the finance director and the commissioner of the Department of Corrections (DOC). The group has held two meetings so far and will report its findings in January 2020.
Arise hopes the study group can identify and endorse reforms needed to modernize Alabama’s criminal justice system. Improvements are possible in every aspect of the state’s incarceration and supervision systems. Sentencing reform and recidivism reduction through improved services and re-entry programs will be two vital steps. And it will be crucial to ensure that people who were incarcerated have voices in identifying needs and developing policy.
Expanding Medicaid, mental health services would reduce prison populations
Medicaid expansion is an essential part of Alabama’s prison reform solution. Expansion would reduce financial strain on prisons and strengthen safeguards against recidivism. On the first count, Medicaid would allow prisoners who are hospitalized to receive Medicaid coverage. This would drastically reduce state costs if an inmate develops a serious illness or becomes a victim of the shockingly high levels of violence in state prisons.
Further, Alabama could use Medicaid expansion to provide mental health and substance use disorder treatment in communities with a chronic lack of such resources. Many convictions result from underlying mental health or substance use problems that go untreated. Stronger investments in mental health and addiction treatment could prevent many people from entering the criminal justice system in the first place. And Medicaid expansion would allow Alabama to expand mental health services tenfold with little or no increase in state cost.
Sentencing reform would ease burdens on Alabama’s criminal justice system
Many Alabama courts have a sad legacy of imposing large fines and overly punitive sentences for relatively minor crimes. These measures, coupled with unreasonably high economic consequences for convictions, often ruin people’s ability to start over after a conviction.
The Legislature recently adopted some beneficial changes to modernize the state’s sentencing practices. But the state still needs many other significant improvements to ensure proportionality and justice.
For instance, Alabama’s habitual offender law can lead to manifestly unjust results. The law allows people with previous convictions to be sentenced to life in prison for theft of a credit card. And people too often receive a prison sentence even when the sentencing guidelines say community correction programs are more appropriate. Fixing these shortcomings would save money and help mitigate the overcrowding crisis in state prisons. It also would reduce the odds that a minor offense would destroy someone’s life.
Alternative courts have better outcomes
The study group also should consider the benefits that problem-solving courts provide to both offenders and the state. Both drug courts and mental health courts are proven ways to reduce recidivism significantly – and therefore reduce state costs.
These programs address underlying conditions that lead many Alabamians to end up in the criminal justice system. And they can keep life-altering convictions from limiting a person’s prospects by dismissing charges upon completion of the assigned program. But these programs are expensive, and no uniform statewide eligibility criteria exist for either drug or mental health courts.
The study group should recommend expanding and standardizing the use of these proven, efficient programs. As noted above, Medicaid expansion would strengthen the capacity of community-based services to fulfill the mandate of alternative sentencing.
Alabama can create a criminal justice system that works for everyone
One of Arise’s core beliefs is that policymakers always should seek input from people who would be affected by changes. The same principle holds true when it comes to reform of the state’s prisons and criminal justice system.
Thousands of people throughout Alabama could have better lives if our state updates and improves its criminal justice system. People who have been involved in the system have valuable insight into ways it can improve. In particular, people who were formerly incarcerated can help identify needed improvements and recommend ways to avoid some pitfalls of current operations.
The study group has a chance to make desperately needed strides toward criminal justice reform before the next legislative session. The solution to Alabama’s prison problem must be broader than just building new prisons while keeping outdated sentencing procedures and resource allocation.
Doing the bare minimum to avoid federal oversight would be a disservice to our state. The study group’s recommendations should offer a vision of a fully functional criminal justice system in Alabama. With full consideration of the available options and a willingness to recommend bold, far-reaching reforms, the study group can put Alabama on the right path toward dignity, equity and justice for all.
