Issue: Health

Cover Alabama Coalition: Medicaid expansion is essential to state’s recovery

By Chris Sanders

A nonpartisan alliance of more than 60 Alabama organizations has come together to urge Gov. Kay Ivey to say yes to Medicaid expansion. The Cover Alabama Coalition, which launched Wednesday, is calling on Ivey to close the health coverage gap for workers who don’t have employer-based insurance and can’t afford to purchase insurance on their own. Alabama Arise is a founding member of the coalition.

Cover Alabama logo

Cover Alabama is a coalition of advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations from across the state. (You can read the full membership list here.) The coalition held a virtual news conference Wednesday to highlight the critical role that Medicaid expansion can play in ensuring access to health care, protecting families against bankruptcy and stabilizing rural hospitals – both during the COVID-19 pandemic and the economic recovery.

“This pandemic only heightens the need for bold, comprehensive action,” said Evey Owen, interim coalition director for Cover Alabama. “The health and economic costs of COVID-19 will be high no matter what. Alabama must maximize the value of every state dollar we spend to protect public health. And the best way to do that is to leverage the 90% federal match for Medicaid expansion.”

The need to expand Medicaid here and now

So far, 36 states – including Arkansas, Kentucky and Louisiana – have expanded Medicaid to cover adults with low incomes. Alabama is one of just 14 states that have not done so. Medicaid expansion would benefit hundreds of thousands of Alabamians who are uninsured or struggling to pay for health coverage. Many of these uninsured people are “front-line workers” at grocery stores, hospitals, pharmacies and other essential businesses during the COVID-19 pandemic.

“It’s great to applaud the brave Alabamians who are keeping food on our tables and keeping hospitals clean during the crisis, but it would be even better to make sure they can get health coverage,” Owen said. “These are the workers most likely to be uninsured, and we should do everything we can to keep them safe and healthy.”

Speakers at Cover Alabama’s news conference Wednesday pointed out that Medicaid expansion would:

  • Help uninsured Alabamians avoid risks of delayed care, like unchecked COVID-19 transmission, poor health outcomes and overwhelming medical debt.
  • Relieve rural health care providers from financial strain, preventing further hospital closures.
  • Bring billions of federal dollars into local and state economies as they struggle to recover from revenue losses of historic proportions.

To elevate and amplify the public conversation about Medicaid expansion at this critical time, Cover Alabama plans to share stories of Alabamians caught in the coverage gap, news about expansion’s impact in other states and an opportunity for more groups to join the campaign.

Arise update: April 4, 2020

By Matt Okarmus

Like all of you, we’re doing what we can to weather this crisis, and we have many concerns about the health and well-being of our families and communities. Arise executive director Robyn Hyden highlights some resources on our website that can help you navigate new SNAP and unemployment insurance benefits available for people who need immediate assistance.

Targeted releases should be part of Alabama corrections system’s response to COVID-19 pandemic

By Dev Wakeley

State and local governments are responding in a variety of ways to the emergent coronavirus pandemic in Alabama. But that response thus far has fallen short where incarcerated people are concerned.

The Alabama Department of Corrections (DOC) has more than 27,500 people in custody right now. (For context, that’s more people than live in Anniston, Homewood or Northport.) Thousands more sit in county and municipal jails. And the conditions in which most of them live are wretched.

Alabama’s correctional institutions are extremely understaffed and dangerously overcrowded. And even after the U.S. Department of Justice warned the state last year about the system’s shortcomings, some of those problems are getting worse.

Quick, targeted releases would lessen harm and save lives

Temporarily halting visitation, as the DOC is doing, is one step to slowing the spread of infections in Alabama’s corrections system. But reducing the overcrowding in jails and prisons is also vital to limiting COVID-19 deaths. Here are a few ways state and local officials could do that:

  • The DOC should expand medical furlough for prisoners. Jails also should release nonviolent offenders. Medical furlough allows prisoners with medical conditions, including diseases that result from aging, to be released to treat those diseases.
  • Officials should allow high-risk incarcerated seniors to go home to the greatest extent reasonable under the law. That would reduce the danger of infection and make a pandemic more manageable in prisons. People over age 60 and people with some ailments correlated with aging, like cardiovascular disease, are at greater risk of serious illness if infected.
  • Local jails should keep their cells as empty as possible. All incarcerated people with no history of violence and no charges pending for violent crimes should be released without requiring money bail. And people arrested for nonviolent crimes should be released on their own recognizance or with reasonable monitoring conditions. Slowing the coronavirus outbreak is more important than keeping people who aren’t accused of violent crimes locked up. Circuit Judge Ben Fuller’s order last week for jails in Autauga, Chilton and Elmore counties to release anyone with a bond of $5,000 or less was a good step in that direction.

Weak, slow responses would mean worse outbreaks and more deaths

The COVID-19 pandemic layers a public health crisis on top of the state’s prison crisis. And the DOC’s response so far has unfortunately been too timid to stop the rapid spread of the virus if it reaches prisons. Many city and county jails also haven’t laid out detailed policies to address COVID-19.

The DOC has issued a perfunctory statement that it is following CDC recommendations. But the CDC recommendations aren’t focused on jails or prisons. And they don’t address inmate holding practices or recommend circumstances for release. The DOC is attempting to reduce the number of person-to-person contacts by stopping work release and suspending in-person legal visits. But these steps alone are unlikely to do enough to protect people who are in custody or who work at the facilities.

Alabama is running short on time to get this response right. An employee at an unnamed state prison already has tested positive for COVID-19, the DOC announced last week. A widespread outbreak could tear quickly through Alabama’s overcrowded prisons and jails, jeopardizing hundreds or thousands of lives. State and local leaders must take quick, meaningful action right now to reduce the risk of that nightmarish scenario.

Alabama Arise and partners urge Ivey to use every Medicaid tool available to save lives during COVID-19 pandemic

By Alabama Arise

To: Gov. Kay Ivey and Commissioner Stephanie Azar
From: The Undersigned Alabama Organizations
Re: Alabama’s Policy Response to COVID-19
Date: March 19, 2020

Thank you both for your leadership, especially at this critical time. Alabama’s health care system, like most others around the world, is facing severe stresses with the COVID-19 pandemic. Seniors and people with underlying health conditions, including people with disabilities, appear to be at most serious and immediate risk from the virus. Alabamians with low income and those who lack health insurance are also high-risk groups, because their options for responding to the health threat and related challenges are limited. In the best of times, public services that provide health care for the most vulnerable Alabamians form the backbone of the health system that protects us all. A health emergency only heightens the need for Alabama’s state health agencies to be as strong as we can make them.

Federal law gives states wide flexibility in using their Medicaid and Children’s Health Insurance Programs (ALL Kids in Alabama) to respond to health emergencies and other disasters. They can expand eligibility and benefits and take steps to make it easier for people to enroll and stay enrolled. The options below include some that Alabama Medicaid has adopted already, many that could be implemented in short order and some that could be requested now for future use. They are in keeping with the important recognition by Governor Ivey and President Trump that COVID-19 requires a bold, timely and comprehensive response.

A few things to consider:

  • People who are eligible for Medicaid can enroll at any time – the “open enrollment” period is year-round.
  • Alabama Medicaid is a “bare-bones” program that has some of the nation’s most stringent eligibility limits.
  • More than 220,000 Alabamians with low incomes are uninsured. Another 120,000 are struggling to pay for work-based or private plans they can’t afford.
  • President Trump has signed a bill that would give states a temporary 6.2 percentage point increase in its federal share of Medicaid funding. For Alabama, that would mean a boost of $380 million for the one-year period starting retroactively on Jan. 1.
  • The pandemic poses critical challenges for certain groups, including people who depend on long-term services and supports at home and in community-based, intermediate and long-term facilities; people experiencing homelessness; and people with special health care needs related and unrelated to COVID-19.
  • Even if a state took up most or all of the emergency options, there would still be gaps in coverage for people who don’t meet Medicaid’s citizenship and immigration status rules.

Current Alabama Medicaid policies that facilitate emergency response:

  • Alabama Medicaid already uses “presumptive eligibility” (PE) to provide temporary coverage for children, pregnant women and parent/caretaker relatives who are determined by a qualified hospital, on the basis of preliminary information, as likely to be eligible for Medicaid.
  • Alabama Medicaid already uses “express lane eligibility” (ELE) to renew children’s Medicaid eligibility automatically on the basis of income data available from the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF).
  • Alabama already uses the “continuous eligibility” option to provide children with 12 full months of coverage through Medicaid and the Children’s Health Insurance Program (ALL Kids), even if the family’s income increases beyond the eligibility limit during the year.

Eligibility: Expanding coverage for the uninsured

Alabama can immediately expand eligibility by submitting state plan amendments (SPAs), applying for 1115 waivers (expedited on an emergency basis if CMS allows), and amending its section 1915 home- and community-based waivers for long-term care:

  • Governor Ivey can submit a SPA to expand coverage for adults with incomes up to 138 percent of the poverty line with enhanced match (90 percent FMAP).
  • Governor Ivey can submit a SPA to increase eligibility for pregnant women, people with disabilities and seniors at the state’s regular FMAP.
  • Alabama can seek an emergency 1115 waiver for federal authority and matching funds to implement continuous coverage for women enrolled in pregnancy-related Medicaid through 12 months postpartum.
  • Alabama can adopt the “ICHIA” option to provide Medicaid and CHIP coverage to lawfully residing children and pregnant women. States can also provide prenatal care to women regardless of immigration status by extending CHIP coverage to the unborn child.
  • Alabama can eliminate or decrease asset tests for seniors and people with disabilities.
  • Alabama can modify its section 1915 home- and community-based services (HCBS) waivers to increase the number of “slots,” or openings for participants. CMS has a template to facilitate changes in section 1915 waivers. The template can also be used to provide additional services that are needed to address COVID-19.

Enrollment: Ensuring that all eligible people can easily enroll and get coverage

  • Alabama should maximize its use of presumptive eligibility (PE) by expanding the definition of qualified entities to include the state agency, community health centers and other community sites and by adding eligibility for seniors and individuals with disabilities. Alabama should develop a plan for follow-up to ensure eligibility of individuals beyond the PE period.
  • Alabama should outstation eligibility staff to the maximum extent possible.
  • Alabama should enroll people based on their self-attestation and follow up with verification requests only when the attestation is not compatible with electronic data sources.
  • States are required to provide a reasonable opportunity period of at least 90 days to individuals who attest they are citizens or have an immigration status that would make them eligible for benefits, as well as to those who don’t have a Social Security number. This means Alabama should enroll people and assist them in providing any documents they need after exhausting attempts to verify citizenship or status through electronic verification.
  • Alabama should add the school lunch program to the express lane eligibility data-sharing process for Medicaid eligibility.

Renewal: Keeping people covered

  • Alabama should temporarily delay renewals under authority to exceed time limits in emergency situations.
  • Under existing Medicaid rules, Alabama should maintain coverage for people temporarily residing out of state because of the coronavirus.

Benefits: Getting people the care they need

  • Alabama should submit a SPA to take up the option in the Affordable Care Act (ACA) to ensure all necessary treatment and preventive services, including vaccines, are covered for all adults Medicaid beneficiaries without cost-sharing. States that take up this option receive a 1 percentage point bump in the FMAP for those services under section 4106 of the ACA.
  • Alabama should cover 90-day supplies of maintenance medications, allow advance refills and cover home delivery of prescription drugs.
  • Alabama should provide expanded benefits for affected populations through 1915(i) state option for home- and community-based services.
  • Alabama should educate providers on Medicaid coverage, especially the EPSDT benefit for children, guaranteeing that children receive regular screening exams and preventive care and all necessary follow-up diagnostic and treatment services.
  • Alabama should maximize the use of telehealth — including reimbursement for the full range of early intervention, treatment and rehabilitative services — to extend provider access and reduce direct personal contact during the pandemic.
  • Alabama should maximize coverage and awareness of emergency services available to people not eligible for Medicaid due to immigration status.

Continuity of care: Preventing disruption of services for people with special health care needs and disabilities

Thousands of Alabama Medicaid members depend on health services and daily living supports provided in home- and community-based settings and long-term care facilities. For these individuals, disruptions in care and assistance can be life-threatening.

  • Alabama must respect the rights of people with special health care needs and disabilities to make their own choices in all aspects of their COVID-19 contingency plan.
  • Alabama should waive all administrative requirements except federal and state background checks to allow on-the-spot hiring of personal care attendants by people receiving long-term services and supports.
  • Alabama should suspend or waive overtime-limiting regulations for personal assistance services to facilitate continuity of care when illness, quarantine and other factors reduce staff and support network capacity.
  • Alabama should guarantee personal assistance service providers paid sick time to encourage providers to stay home and decrease spreading infection.
  • Alabama should provide funding to community organizations such as Independent Living Centers and developmental disability service providers to establish or expand expedited recruitment processes for emergency backup assistance for all formal and informal, government and non-government supports and services to close COVID-19 gaps and keep people independent.

Bottom line

Use every tool available to protect Alabamians in the short, medium and long term.

These recommendations are adapted from analysis provided by the Center on Budget and Policy Priorities, the Medicaid and CHIP Coverage Learning Collaborative, the Kaiser Family Foundation, Disability Rights & Resources, and Accessible Alabama.

Signatories

The following organizations respectfully endorse these recommendations:

Accessible Alabama
AIDS Alabama
Alabama Appleseed Center for Law & Justice
Alabama Arise
Alabama Coalition for Immigrant Justice
Alabama Disabilities Advocacy Program
Alabama Faith Council
Alabama-Florida Episcopal District of the AME Zion Church
Alabama Institute for Social Justice
Alabama Justice Initiative
Alabama Poor People’s Campaign: A National Call for Moral Revival
Alabama Rivers Alliance
Alabama Select ICN Consumer Advisory Committee
Alabama State Association of Cooperatives
Alabama State Conference of the NAACP
AME Church of Alabama
Disabilities Leadership Coalition of Alabama
Disability Rights & Resources
Faith and Works
Faith in Action Alabama
Fifth Episcopal District, Christian Methodist Episcopal Church
Greater Birmingham Ministries
Hispanic Interest Coalition of Alabama
Hometown Action
The Knights & Orchids Society
Medical Advocacy & Outreach
NAMI Alabama
National MS Society, Alabama
People First of Alabama
Planned Parenthood Southeast
Save Ourselves Coalition for Justice and Democracy
Sickle Cell Disease Association of America
Southern Poverty Law Center
United Cerebral Palsy of Alabama
VOICES for Alabama’s Children
The Women’s Fund of Greater Birmingham
YWCA Central Alabama

COVID-19: 7 policy changes that would help protect Alabamians

By Robyn Hyden

The World Health Organization has labeled COVID-19 a global pandemic. And state officials announced the first confirmed case of the disease in Alabama on Friday. As the virus strains our health systems, schools and economy, we must ensure the most vulnerable Alabamians have the medical care, social supports and other protections they need to weather the crisis.

The Alabama Legislature will be on spring break for the next two weeks. We hope our state lawmakers and members of Congress will take time to examine the situation developing in their communities. And we hope they will act quickly and courageously to address these critical public health needs.

Here are seven actions that policymakers should take now to protect the well-being and security of all Alabamians:

1. Gov. Kay Ivey should expand Medicaid.

Medicaid expansion would extend health coverage to more than 223,000 uninsured Alabamians with low incomes. It also would ensure coverage for another 120,000 who struggle to afford the insurance they have.

Expansion would take several months to implement, but it would prepare us for the big challenges ahead. In the short term, Medicaid could take numerous other steps to protect families. Examples include streamlining enrollment, covering new mothers for one year after delivery and increasing our “bare-bones” income limit for parents.

Email Gov. Ivey to ask her to expand Medicaid and help address the coronavirus threat. Or if you’d prefer to reach out by phone, click here to call Gov. Ivey’s office.

2. Lawmakers should increase funding for public health to ensure adequate testing, preparation and prevention.

In addition, state and local agencies should take the lead on proactive policies and procedures to protect those who are most vulnerable to this virus. Read State Health Officer Scott Harris’ report to the Senate Health Committee.

3. Congress should authorize emergency food assistance increases.

Boosting the Supplemental Nutrition Assistance Program (SNAP) would help children get the food they need while they’re out of school. It also would promote food security for seniors, people who lose their jobs and other people at risk of hunger. Read additional recommendations to address critical food security issues from our partners at the Food Research and Action Center.

4. Policymakers should remove barriers to social support services.

Medicaid, SNAP, WIC and Temporary Assistance for Needy Families (TANF) save and improve lives. Red-tape barriers to these services make it harder for struggling families to get the help they need during a crisis. Read Arise’s fact sheet to learn why state lawmakers should abandon efforts to reduce access to safety net programs.

5. State lawmakers should remove the state sales tax on groceries while protecting education funding.

As many people prepare for social distancing by purchasing enough food to last for several weeks, the grocery tax imposes the highest tax burden on the people who can least afford it. It’s yet another illustration of why this cruel tax must end. Click here to urge state legislators to untax groceries and replace the revenue by supporting SB 144.

6. Policymakers should look at options to extend paid medical and family leave to every worker.

States including Washington and Massachusetts have created affordable buy-in plans so that even smaller employers can provide extended medical or family leave. Read how paid family and medical leave was made affordable and available to every worker in the state of Washington. Then read more about federal discussions to provide short-term relief for paid leave.

7. Alabama should expand unemployment protections to mitigate the effects of job losses for individuals and communities.

Closures and layoffs in the coming months will leave many workers without essential income. Public officials must act now to reduce the financial toll on people who struggle to make ends meet. Read recommendations from the National Employment Law Project (NELP) about potential improvements to unemployment insurance coverage.

Looking ahead

The conversation about the best policy and social responses will continue to evolve over the coming days and weeks. And additional needs and solutions are likely to emerge. Throughout this crisis and beyond, Arise will continue to speak out for dignity, equity and justice for all Alabamians.

Arise legislative recap: March 13, 2020

By Matt Okarmus

We’re excited to introduce you this week to Sherrel Wheeler Stewart, Arise’s new story collection coordinator. In this video, Sherrel talks about her new position and explains how you can help her tell the stories of uninsured and underinsured Alabamians who live in the Medicaid coverage gap.

If you’d like to share your story with Sherrel, email her at sherrel@alarise.org or use this brief online form.

Education, health care, nutrition and more: Why the Census matters to Alabama

By Mike Nicholson

The 2020 Census is nearly here. In mid-March, the Census Bureau will begin mailing out informational postcards to all U.S. residents. The postcards will provide instructions on how to complete the Census for your household.

Filling out the Census is important for a number of reasons. Alabama’s count impacts our state legislative districts and our representation in Congress. But it also influences the quality of life in our communities in a whole host of ways.

In 2016, Alabama received more than $13 billion for 55 federal programs based on data from the 2010 Census. Our Census count affected $4.6 billion that year in federal funding for health coverage through Medicaid and ALL Kids. It also shaped another $2.7 billion for education, including special education, student loans, and Title I grants to schools with high shares of students from households with low incomes.

The effects of Alabama’s Census numbers don’t stop there. The Census count guides more than $1.6 billion annually for the Supplemental Nutrition Assistance Program (SNAP), school meals and other nutrition services. And it affects funding for a range of other services, including affordable housing, child care, transportation and water treatment. The Census has important implications for virtually every aspect of our daily lives.

The Census brings money back home to your community! In 2016, Alabama received more than $13 billion for 55 federal programs based on our Census numbers. Here's where some of those dollars went. Health: $4.6 billion. Education: $2.7 billion. Nutrition: $1.6 billion. Housing: $965 million. Family supports: $272 million. Community development: $201 million. Worker supports: $80 million. Source: The George Washington University Institute of Public Policy, January 2019.

What you need to know to participate in the Census

Here are a few important things to know regarding the Census:

  • Postcards from the U.S. Census Bureau are scheduled to arrive between March 14 and April 1.
  • Officials encourage people to fill out the Census online if possible. But you also can complete the survey over the phone or request a paper copy in the mail.
  • The Census survey is just 10 questions, and it should only take you about 10 minutes to complete.
  • You will not need to provide a Social Security number to take the survey. Just your address will do.
  • Your responses are completely confidential. The Census Bureau uses them only for statistical purposes.
  • If you have any questions, visit census.gov or call 800-923-8282.

Alabama Arise is putting together informational toolkits for groups to share with folks all across the state. If you want information to share with your community, please email me at mike@alarise.org. Let’s make sure we each take 10 minutes to secure the funding we need for the next 10 years!

Arise legislative recap: March 6, 2020

By Matt Okarmus

Arise’s Jim Carnes discusses how the coronavirus outbreak and the closure of Pickens County Medical Center showcase Alabama’s need for Medicaid expansion. Also, in the wake of the recent execution of Nathaniel Woods, Jim talks about HB 359, which would forbid the death penalty in capital cases where the jury does not agree unanimously to impose it.

Alabama needs to expand Medicaid NOW!

By Alabama Arise

Medicaid is a health lifeline for one in four Alabamians and an economic engine for communities across our state. Extending Medicaid coverage to adults with low incomes would make life better for Alabamians of all races, genders and incomes.

Medicaid expansion would ensure coverage for 340,000 Alabamians, including:

  • People who work low-wage jobs and can’t afford private coverage
  • Workers who are between jobs
  • Adults who are caring for children or older family members at home
  • People who have disabilities and are awaiting SSI determinations
  • Adult college students
  • Uninsured veterans

Medicaid expansion would help more Alabamians have:

  • Regular primary care and preventive checkups
  • Earlier detection and treatment of serious health problems
  • Regular OB/GYN visits without referral
  • Less dependence on costly emergency care
  • Better health and greater financial peace of mind

Medicaid expansion would bring our federal tax dollars home to support:

  • Healthier families, workers and communities
  • Stronger rural hospitals and clinics
  • Stronger community mental health and substance use disorder services
  • A needed boost in jobs and revenue for state and local economies

Bottom line

Medicaid expansion is the single biggest step we can take to move Alabama forward. It’s time to invest in a healthier future for our state and our people. It’s time to #CoverAlabama.