A state appropriation for Summer EBT will ensure $40 in food benefits per summer month for more than 500,000 eligible Alabama children ages 5-17.
1 in 4 Alabama children are food insecure.
Too many of our children don’t know where their next meal will come from. Because of systemic barriers to food access, a disproportionate amount of food-insecure children come from communities of color. The Summer EBT program has been shown to help alleviate this problem by both reducing hunger and supporting healthier diets among children.
500,000+ Alabama children will benefit starting in 2025.
In recent years, 94% of Alabama’s children who relied on free and reduced-price meals during the school year have not had access to these meals over the summer. The Summer EBT appropriation in the 2025 Education Trust Fund budget will help reduce hunger for hundreds of thousands of Alabama children in summer 2025.
Summer EBT could spur $100M each year in economic activity.
This federal nutrition program required a $10 million state match for administrative and setup costs. This funding will generate substantial economic benefits, both for families and for local retailers that accept EBT benefits. Also worth noting: The costs of operating this program likely will decrease in future years.
Preparing for Summer 2025
Summer EBT cards will be addressed to and in the eligible child’s name.
Children will be automatically eligible to receive Summer EBT benefits if at least one of these is true:
The child’s household receives assistance under Medicaid, the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) and/or the Food Distribution Program on Indian Reservations (FDPIR).
The child is in foster care or experiencing homelessness.
Applications will be required for all other eligible children.
Enroll Alabama navigator Rebecca Sylvester staffs a table at a community event in Huntsville. (Photo courtesy of Enroll Alabama)
Rebecca Sylvester spends her days answering phone calls from desperate Alabamians.
As an enrollment navigator for Enroll Alabama, a grant-funded organization dedicated to helping people find health coverage, she faces a daily battle with the harsh realities of Alabama’s health care system.
But despite her dedication to finding resources for everyone who calls, she is forced to deliver heartbreaking news to most of her callers: There might not be any options for them. Especially for people caught in Alabama’s health coverage gap, who earn too much to qualify for Medicaid but too little to qualify for insurance subsidies under the Affordable Care Act (ACA).
“I think that I can count one mom who was able to get back on Medicaid out of hundreds of people I spoke to,” Rebecca said.
Even then, this mother was a special exception. She was part of a brief window that allowed those who were enrolled in Medicaid during the COVID-19 pandemic to maintain coverage during the federal public health emergency (PHE). But because the PHE declaration ended in 2023, navigators are now hearing from people who are losing their Medicaid coverage during a process known as “unwinding,” or a return to pre-pandemic eligibility requirements.
Adults between ages 18 and 64 in Alabama have to meet some of the strictest income eligibility requirements in the country to have Medicaid coverage. Parents in a two-person household, for example, do not qualify for Alabama Medicaid if they make more than just $3,684 a year.
The wide range of people in Alabama’s coverage gap
The frustration in Rebecca’s voice is palpable. The coverage gap is a consequence of Alabama’s decision not to expand Medicaid to cover adults with low incomes under the ACA. That policy failure has left nearly 300,000 residents without affordable access to health care.
This means Rebecca talks to a very diverse group of people every day. They include young adults aging out of ALL Kids (Alabama’s Children’s Health Insurance Program). Many are working adults who don’t get insurance through their employer. Some are older adults who are approaching age 65 but are not yet eligible for Medicare.
Rebecca’s work is more than just finding coverage solutions. It involves discussing complicated and systemic failures with confused and often desperate callers who are learning about it for the first time.
“I don’t think I’ve had a single client where I’ve been like, ‘You’re in the Medicaid coverage gap,’ and they knew what that was,” she said.
The stories never stop coming
Enroll Alabama navigators answer questions at a community event in Montgomery. (Photo courtesy of Enroll Alabama)
Many people are shocked to learn how few resources exist for all the Alabamians living in the gap.
Rebecca discussed one conversation that was particularly hard. The caller not only had lost health coverage but also had become homeless and reached out for help.
“This person genuinely believed that there was some sort of help out there for people who really needed it,” Rebecca said.
She said the harsh truth is that, without Medicaid expansion, such public resources are virtually non-existent in our state. And while she tries to find free or sliding scale clinics to help, they can’t be the fix for everything.
Enroll Alabama helps people navigate the often confusing landscape when trying to find health coverage, but the resources they can offer are limited. Our state’s failure to expand Medicaid leaves hundreds of thousands of people scrambling to find a patchwork of temporary solutions to their health issues.
One young woman Rebecca helped was attending community college and needed ongoing mental health support. She lost coverage when she turned 19, aging out of ALL Kids, and her small campus didn’t offer student health resources that larger universities do. Her mother received disability payments, and her family couldn’t afford private insurance premiums of more than $400 a month.
“She apologized to me for needing Medicaid,” Rebecca said. “I couldn’t believe it!”
Rebecca says navigators come face to face every day with stories like these every day. These situations highlight how stigma and misunderstanding surrounding public assistance programs hurt so many people across Alabama. Rebecca’s frustration is evident when she talks about not being able to assist everyone who reaches out for help.
“It’s heartbreaking to tell someone there’s nothing I can do for them,” she said. “They fall in the gap, and there are just no options available.” She said this sense of helplessness is shared among other navigators who see firsthand the gaps in the system.
A growing network of navigators
Mark Linn, assistant project director for Enroll Alabama, also does navigator work. He said that though navigators often hit roadblocks when working with folks in the coverage gap, they still keep their phones and schedules open for anyone who needs them.
The Enroll Alabama navigator team gathered at their 2023 annual meeting at the Tutwiler Hotel in Birmingham. (Photo courtesy of Enroll Alabama)
“Everyone is different, and no situation is permanent,” Mark said. “If we can, we’re going to find something for you.”
There are enrollment navigators all across Alabama, including nine navigators within United Way. Two other navigators work within hospitals (DCH in Tuscaloosa and East Alabama Medical Center in Opelika). Another navigator based at The Right Place serves individuals and families who have low incomes or face homelessness in Anniston.
And this year, resources are becoming available in areas where they weren’t before. New navigators are serving Black Belt communities, as well as areas in northeast Alabama like Fort Payne, Rainsville and Scottsboro.
Enroll Alabama’s partnership with 211 also makes it accessible for anyone in the state to reach out and get connected with clinics, programs or resources close to home.
“Our navigators are familiar with all the resources in their area and have a list right beside them,” Mark said. “So if someone calls from Chilton County, but I’m not there, I can plug them in with our navigator from that area… on top of them just calling 211. It’s really a great resource.”
Navigating unfamiliar territory together
Mark agreed with Rebecca that a lot of folks reaching out to navigators for help are in unfamiliar territory, facing not having coverage for the first time. Through a partnership with social workers at UAB, Mark said, he often helps patients in heart failure navigate their new situation. He also meets them where they are.
“I do make house calls and go out to hospitals. A lot of times, I’m meeting in the library or at McDonald’s,” he said.
Mark said a lot of Enroll Alabama’s work focuses on helping people submit Medicaid applications, or checking to see if they are eligible for tax credits through the ACA. But in Alabama, the income eligibility restrictions can make the path forward very narrow.
“Beyond that, when they’re in the coverage gap, sometimes the best we can do is give them a phone number and pass them along to charity care, which doesn’t feel great.” Mark said.
It’s also important for people to know that even if they don’t qualify for a special enrollment period, ACA tax credits or Medicaid, other community resources like low-cost clinics may be available. Mark still encourages everyone to call 211 or set up an appointment with a navigator directly if they are uncertain about finding care or resources.
“You are never bothering us. ‘Navigator’ is right there in the name,” he said. “We are always here to help.”
It’s time for Alabama to join our neighbors
The benefits of Medicaid expansion are clear. States like Arkansas and North Carolina that have expanded Medicaid report lower uninsured rates, improved access to care, and better health outcomes. Rural hospitals, which have been closing at alarming rates in non-expansion states like Alabama, have access to life-saving funds that allow them to stay open and serve their communities.
Recently, Alabama’s Joint Health Committee held a hearing where legislators spoke with lawmakers from Arkansas and North Carolina about their experiences with Medicaid expansion. The testimonies highlighted the positive impact, emphasizing how expansion has bolstered rural hospitals and provided vital health coverage to those who needed it.
Arkansas lawmakers shared that expansion has decreased their uninsured rate and improved overall health outcomes. And North Carolina officials pointed to the financial stability it has brought to rural health care facilities.
Expanding Medicaid in Alabama could have similar positive health and economic outcomes, a recent study by the Public Affairs Research Council of Alabama (PARCA) found. Medicaid expansion would create more than 20,000 local jobs and bring significant federal funding into Alabama’s economy, PARCA projected. Most importantly, it would ensure health coverage for nearly 300,000 Alabamians and save hundreds of lives every year.
Remaining hopeful for change
Rebecca said she still listens to everyone who calls asking for help, even when there aren’t many resources available. However, there is an important way that folks in the coverage gap can get involved.
“We encourage anyone who is struggling to access health care to call their legislators and let them know the issues they’re having,” said Debbie Smith, Alabama Arise’s Cover Alabama campaign director.
“Legislators need to hear from real people that this is a real issue. It can be easy for legislators to overlook a statistic,” Debbie said. “It’s much more difficult to ignore when someone is suffering because they can’t access the medical care they need.”
Navigators play a vital role in the coalition of private partners, providers and nonprofits working every day to address the issues facing Alabamians in the coverage gap.
“We’re thrilled to partner with Enroll Alabama,” Debbie said. “We’re so thankful that there is an organization that can help people find the resources that are available to them even though our state has shamefully created gaps in coverage.”
If you or someone you love would like help navigating the health care marketplace, applying for Medicaid or finding a federally qualified health care clinic in your area, please visit Enroll Alabama’s website to set up an appointment with a navigator. You also can call them directly at 844-248-7698.
Whit Sides is the Cover Alabama storyteller for Alabama Arise, a statewide, member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Email: whit@alarise.org.
Arise is a founding member of the Cover Alabama coalition. Cover Alabama is a nonpartisan alliance of advocacy groups, businesses, community organizations, consumer groups, health care providers and religious congregations advocating for Alabama to provide quality, affordable health coverage to its residents and implement a sustainable health care system.
Alabama Arise staff and members participated in a listening session with the U.S. Department of Labor and the City of Birmingham on June 11, 2024. From left: Arise board member Kenneth Tyrone King, Arise’s Cover Alabama storyteller Whit Sides, former Arise board member Helen Rivas, health coverage gap storyteller Diana Isom, acting U.S. Labor Secretary Julie Su, Arise worker policy advocate Dev Wakeley, Arise communications director Chris Sanders, Arise member Marva Douglas and Birmingham Mayor Randall Woodfin. (Photo courtesy of Chris Sanders)
Alabamians need quality jobs that provide economic security and an opportunity to get ahead. That was the message Alabama Arise staff and members were excited to share with acting U.S. Secretary of Labor Julie Su during her visit to Birmingham last week.
Numerous Arise supporters participated in a worker listening session with the Department of Labor (DOL) on June 11. And worker policy advocate Dev Wakeley represented Arise at a June 12 roundtable meeting on good jobs.
Alabama Arise worker policy advocate Dev Wakeley (third from right) participated in a June 12, 2024, roundtable on job quality with acting U.S. Labor Secretary Julie Su (center) and local business and civic leaders. (Photo by Shawn T. Moore, Department of Labor)
The DOL’s initiative to enhance job quality aligns well with Arise’s advocacy to improve life for Alabamians who are marginalized by poverty, Wakeley said. He also praised Su’s willingness to visit Alabama to hear workers’ concerns personally.
“We saw the closest thing you could imagine to unity of purpose,” Wakeley told AL.com after the visit. “When the Department of Labor comes in and talks about wanting to build good jobs that really allow for human beings to thrive and advance and to provide for their families, we are grateful for their presence, and we love to hear that.”
‘Alabama’s workers should not have to settle’
Su expressed her appreciation for Arise’s work as well. She praised both Arise and Jobs to Move America (an Arise member group and partner in the Alabama Coalition for Community Benefits) during a June 12 news conference at the North Birmingham Library.
“I did want to thank the union leaders for showing up here and every single day, to Jobs to Move America and Alabama Arise, who have helped make this trip so rich and meaningful for me,” Su said. “You are all truly incredible.”
Su came to Alabama on the second stop of the DOL’s Good Jobs Summer Tour. The tour aims to promote and build support for the department’s Good Jobs Principles, a shared framework for job quality for workers, businesses, unions, advocates and other interested parties. The principles include equitable pay and benefits, safe and healthy workplaces, and an organizational culture that values every worker’s contributions. Birmingham Mayor Randall Woodfin announced Birmingham’s commitment to the principles during the news conference.
Watch the video above to hear acting U.S. Labor Secretary Julie Su’s full remarks about good jobs during her June 12, 2024, news conference in Birmingham.
“We are being intentional about connecting all of Alabama’s residents and all of Birmingham’s workers to good jobs,” Su said. “Because Alabama’s workers should not have to settle. Because no one should have to work full time year-round and still live in poverty. No one should have to work two or three jobs and still barely be able to put together a life. That is not the American promise. That is not the American dream.”
Workers’ rights, public transportation uplifted during listening session
Su’s remarks reflected many of the concerns that Birmingham-area workers shared during a listening session with Su and Woodfin. More than 70 people attended the June 11 session, and many discussed their personal experiences with workplace challenges or lack of essential work supports.
Alabama Arise organizer Adam Keller (right) attended a June 11, 2024, listening session with the U.S. Department of Labor and the City of Birmingham. Attending alongside him were (from left) Matt Holmes, Seth Cain and Wesley Verzwyvelt. All four men are members of the International Alliance of Theatrical Stage Employees (IATSE). (Photo by Whit Sides)
Several workers underscored the necessity of protecting employees’ right to form and join unions if they choose. Others highlighted the need for higher pay and more robust benefits like child care and health insurance. The final attendee to speak was longtime Arise member Marva Douglas, who emphasized the importance of securing state funding for public transportation so every Alabamian can get to work, school or anywhere else they need to go.
Midfield resident Marva Douglas (left), a longtime Alabama Arise member, speaks with acting U.S. Labor Secretary Julie Su after a June 11, 2024, listening session in Birmingham. (Photo by Whit Sides)
An opportunity infrastructure
Su said the DOL stands with workers in advancing racial justice and breaking down other systemic barriers to job quality. Good jobs, she said, are about more than just making ends meet today. They are about the promise of a better tomorrow.
“A good job … means a job with security,” Su said. “A job where you know that you can not just get by, but get ahead. Where you have leave and benefits, so if you or your children need to go to a doctor, you can. Where you have a retirement plan so that you know that at the end of a career, you can retire with dignity.”
Making this vision of job quality a reality will require the creation of “opportunity infrastructure” in communities across the country, Su said. That means bringing workers, businesses, policymakers, advocates and educational institutions together to build an inclusive economy for everyone, she said.
“We have more bridges to build,” Su said. “The bridge from poverty to prosperity. The bridge from racial exclusion to real equity. So let’s roll up our sleeves, and let’s build together.”
The halls of the Alabama State House had a new face this legislative session.
LaTrell Clifford Wood started as Alabama Arise’s hunger policy advocate in November. Since then, the Stillman College graduate has worked tirelessly to ensure Alabama’s most marginalized residents have access to food. In her role, she advocates directly with lawmakers for legislation that supports getting food to the Alabamians who need it most. She also convenes the Hunger Free Alabama coalition of 88 organizations.
As the youngest member of the Arise staff, LaTrell offered up insights after her first legislative session.
“I think this session has really taught me to hold space for the world to grow, change and evolve, and find new room for hope,” she said. “You can have a resume that is really heavy with blue collar and service experience, and those experiences are meaningful. Those are ‘real jobs.’”
The intergenerational relationships with other Arise staff members proved to be helpful as she navigated an especially challenging session.
“I picked up gems of wisdom from people who have been doing this work a lot longer than me, and actualized the value that young people can bring to a space when they are treated as meaningful contributors,” LaTrell said.
Making use of opportunities
LaTrell grew up in Irondale, a city of about 13,000 near Birmingham, and is a proud HBCU grad. Her time at Stillman brought her into hunger advocacy work and a systemic framework for change.
“There are systems in place by which we lose wisdom with the people we love. So I said to myself, ‘Whatever I do, I have to take care of myself, and it has to be sustainable,’” LaTrell said. “Since I was a pandemic grad, I decided to take a break and explore more options, and that led me to Congressional Black Caucus Foundation [CBCF].”
Through the CBCF, LaTrell interned in U.S. Rep. Terri Sewell’s office in Washington, D.C. That is where she first learned of Alabama Arise.
“My team in Rep. Sewell’s office really advocated for me, and Akiesha [Anderson, Arise’s former policy and advocacy director] really opened the doors for me to Alabama politics, and made a safe space for me to come back home and grow and learn at Arise, and I am so grateful for her and the rest of Arise’s staff for welcoming me,” LaTrell said.
Telling her story
LaTrell’s advocacy this year helped secure $10 million in Summer EBT administrative funding for 2025. (See page 2.) She finds that telling her personal stories to lawmakers has helped her in this work.
“It was really healing and energizing to talk to Sen. [Rodger] Smitherman, whose district I grew up in, about my experiences with hunger and its impact, and see him really stand 10 toes down for children across the state,” she said. “Countless children will have some measure of relief from hunger over the summer months, for generations to come. It’s hard to wrap my head around in more ways than one.”
After an impactful first legislative session, LaTrell has even bigger goals for Arise’s hunger advocacy work. Universal school breakfast is her next advocacy priority.
“I think the first step in that is leaning into securing a state appropriation to subsidize universal school breakfast in the next year,” she said.
LaTrell also said she hopes to help bring even more young people like her into the Alabama Arise fold.
“I look forward to building more avenues to meet young Alabamians where they are,” she said.
An optimistic look at Alabama
As a young Alabamian who returned to the state after working elsewhere, LaTrell said she wants the rest of the world to see what Alabama is really like.
“When I go out of state, a lot of people say, ‘You’re from Alabama?’ And there’s always a tone,” she said. “So my favorite experience is being able to school people on all the misconceptions they have, and all the contributions Alabamians and Alabama have made to the U.S. and the world.”
LaTrell is incredibly proud of her Alabama roots and how they’ve shaped her family.
“My family has been domestic refugees of the state, run out by racial violence during the first wave of the Great Migration. But somehow, we find our way back, and every generation, we have been able to make a meaningful difference. And that is worth being proud of,” she said.
How to get involved
For those looking to get involved with the critical work of feeding Alabamians, LaTrell has some suggestions.
Arise supporters who live in or have connections in Limestone and Morgan counties, as well as Opelika, can support hunger advocacy by talking with parents, educators and superintendents in their communities about the Community Eligibility Provision (CEP). More than 50% of the schools in these areas could serve universal school meals through CEP but are not. The deadline for schools to opt in for the upcoming school year is June 30.
The Summer EBT victory showed the power of Arise’s policy analysis, organizing and advocacy. After the House passed an education budget without Summer EBT funding, Arise ramped up pressure on the Senate. Our policy team and lobbyists educated lawmakers about the program’s benefits. Our communications team generated dozens of media stories to build public support. And our organizers rallied Alabamians to speak out.
Ultimately, folks like you got Summer EBT funding across the finish line. Arise advocates flooded lawmakers with more than 2,700 emails, calls and personal visits urging support. And it worked: Senators added Summer EBT to the budget, and Gov. Kay Ivey signed it into law.
Lawmakers dealt setbacks to several Arise legislative priorities this year but made important progress on others. Through it all, our members kept speaking out for policies to improve the lives of Alabamians marginalized by poverty.
Setbacks on school funding, voting rights, racial equity
Another bad bill rushed into law was SB 1 by Sen. Garlan Gudger, R-Cullman, which criminalizes several forms of assistance with absentee ballot applications. Arise and other advocates fear this law could have a chilling effect on good-faith efforts to assist people who need help exercising their voting rights.
A third shortsighted new law is SB 129 by Sen. Will Barfoot, R-Pike Road. The act forbids state agencies and public schools and universities from sponsoring numerous diversity, equity and inclusion (DEI) programs. It also authorizes firings of employees found to violate the act knowingly. In late May, Jacksonville State University became the first university to close its DEI office in response to this law.
Later, legislators passed two new laws that undermine worker protections. SB 53 by Sen. Arthur Orr, R-Decatur, removes the requirement for an eligibility to work form for 14- and 15-year-olds. And Orr’s SB 231 makes companies ineligible for state or local tax incentives if they voluntarily recognize a union.
Good new laws on child care, housing, criminal justice reform
One positive workers’ rights law this year was SB 119 by Sen. Robert Stewart, D-Selma, which increases penalties for child labor violations. The Legislature also created tax credits designed to increase access to child care (HB 358 by Rep. Anthony Daniels, D-Huntsville) and workforce housing (HB 346 by Rep. Cynthia Almond, R-Tuscaloosa). And Orr’s SB 270 improved access to public records.
Lawmakers also enacted two good criminal justice and due process reforms. Almond’s HB 275 will increase pay for many lawyers representing indigent defendants. And HB 188 by Rep. Terri Collins, R-Decatur, requires a uniform hearing process and hearing rights for students suspended or expelled from public K-12 schools.
The work continues
Several other Arise-backed bills made major progress but came up just short of passage. HB 29 by Rep. Chris England, D-Tuscaloosa (allowing resentencing hearings for some defendants convicted under the Habitual Felony Offender Act) won House committee approval. Orr’s SB 62 (removing state sales tax from many infant and maternity products) passed the Senate but never reached the House floor. And HB 309 by Rep. Ginny Shaver, R-Leesburg (providing paid parental leave for state employees) passed the House but died on the Senate calendar.
With your support, Arise will keep advocating for important policy changes like these in 2025 and beyond. We will keep working to expand Medicaid and eliminate the state grocery tax. And we will keep strengthening our movement for a better, more inclusive Alabama.
Alabama Arise members helped secure a policy change this year to reduce hunger for more than 500,000 children across the state. Beginning in summer 2025, eligible children ages 5-17 will receive $120 in Summer EBT benefits to continue to have school meals through the summer. The state must cover half of the administrative costs, but the benefits are 100% federally funded.
Children will be automatically eligible to receive Summer EBT benefits if their household receives assistance under Medicaid, the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) and/or the Food Distribution Program on Indian Reservations (FDPIR). Foster children and children experiencing homelessness also will qualify automatically. Applications will be required for all other eligible children.
Arise advocacy builds momentum
Rep. Laura Hall, D-Huntsville, was the first legislator to inquire about Summer EBT this session during February’s budget hearings. Hall offered an amendment to the Education Trust Fund (ETF) budget to add Summer EBT administrative funding. But the House approved the budget without it.
Arise then kicked advocacy efforts into high gear. Hundreds of our supporters demanded that their senators support Summer EBT funding, and Arise generated dozens of media stories to increase public awareness and pressure. Reports from Senate secretaries and members foreshadowed Summer EBT’s success. Several said they were overwhelmed by the number of emails and calls they were receiving.
Legislative supporters kept up the push, too. Hall joined Rep. Barbara Drummond, D-Mobile, in efforts to build momentum for Summer EBT in the Senate. Sens. Vivian Figures, D-Mobile; Garlan Gudger, R-Cullman; and Rodger Smitherman, D-Birmingham, submitted requests to add an ETF line item for Summer EBT.
A victory to reduce hunger in Alabama
Arise and other Hunger Free Alabama coalition members made their case directly to the Senate’s ETF budget committee April 25, testifying in support of Summer EBT. Our advocacy worked. The following week, the committee added $10 million for the Department of Human Resources to administer Summer EBT in partnership with the state Department of Education.
The full Senate approved the budget 30-0 in early May. And after a brief jump-scare moment when lawmakers delayed the bill in a conference committee, the House and Senate both voted unanimously for the final budget – including the Summer EBT funding – on May 9, the session’s final day. Gov. Kay Ivey signed the budget into law on May 15.
Arise is relieved by the great news that Alabama children and families will be able to participate in this essential program in summer 2025. And we are inundated with gratitude for our members and partners who responded to our action alerts. Your advocacy made the difference!
Alabama Arise and the Cover Alabama coalition have built powerful momentum to expand Medicaid and close the state’s health coverage gap in recent months.
Arise held a news conference with our partners at the March of Dimes and Alabama Rural Health Association during our annual Legislative Day in April. The event highlighted how Medicaid expansion could improve infant and mortality rates in our state and keep rural hospitals open. More than 230 individuals from across the state attended and spoke up in support of the nearly 300,000 Alabamians who need health coverage.
In another encouraging development, the House and Senate Health Committees held a joint meeting in late April to hear from other states about their efforts to close the health coverage gap. This hearing was a platform for legislators and experts to explore potential solutions, drawing insights from successful initiatives in Arkansas and North Carolina.
Alabama Arise’s Cover Alabama campaign director Debbie Smith speaks during Arise Legislative Day on April 2, 2024, at the State House in Montgomery.
‘Their loved one is now getting help’
Key figures from North Carolina, such as state Sen. Jim Burgin, shared their state’s journey in closing the coverage gap. Burgin, a vocal opponent of Medicaid expansion in the past, highlighted the overwhelming gratitude from individuals receiving assistance.
“I live in a very rural and very conservative area,” Burgin said during the hearing. “I have not had one person that has come up to me and told me, ‘Jim, you shouldn’t have done that, and we’re against you for doing that.’ But I’ve had hundreds of people come up to me and thank me because their loved one is now getting help.”
Meanwhile, we also celebrated the progress that Mississippi made in its efforts to close the coverage gap. In February, the Mississippi House voted 99-20 to expand Medicaid. While that bill ultimately did not pass in the Senate, Mississippi made incredible progress by bringing conservative lawmakers on board and making Medicaid expansion a hot topic in the state. Alabama legislators took notice, and Mississippi’s progress will put pressure on our legislators to move forward as well.
Looking forward
In the coming months, Cover Alabama will continue to beat the drum in support of Medicaid expansion. We are so grateful for your continued support. Together, we are making significant strides toward Medicaid expansion in Alabama.
Let’s continue to raise our voices, engage with lawmakers and advocate for equitable health care access for every Alabamian.
When Arise members convened at last year’s Annual Meeting to choose our 2024 legislative priorities, you voted to add maternal and infant health to our agenda. Most people didn’t know I was nearly eight weeks pregnant with my first child at the time!
As our team studied how we could improve maternal and infant health outcomes through our advocacy and organizing, we learned a lot from you, our partners and our new maternal health fellow.
Arise Executive Director Robyn Hyden holds her son, Hank.
Little did I know that what I was learning about maternal and infant health would soon affect me personally. At a routine 28-week checkup, I was diagnosed with severe preeclampsia, one of the leading causes of maternal death. Soon after, my son Hank was born three months early, causing him to spend more than 80 days in UAB’s Neonatal Intensive Care Unit (NICU).
While Hank and I are home now, happy and healthy, we were extremely lucky. Too many moms lack access to routine prenatal and postpartum care, transportation and paid family leave. I saw firsthand how many were struggling in our state’s only Level 4 NICU. I learned that around 10% of babies born in the United States will spend some time in the NICU. In a state that claims to care about babies, mothers and families still do not have the support they need. This causes us to have the third-worst rate of maternal mortality in the country.
My family was lucky to have the support we needed. I wish the same for all those who wish to become parents. Together, Arise members envision a state where everyone has the support they need to have the family they choose. Thank you for pushing our leaders to make this a reality.
As we reflect on the recent observance of Black Maternal Health Week, it is crucial to confront the staggering realities that Black women in Alabama face concerning maternal health care. A closer examination of data and statistics reveals the urgent need for targeted interventions and systemic reforms to address the unacceptable disparities in maternal health outcomes.
Disparities in maternal mortality
Multiple official definitions of maternal mortality exist. The World Health Organization defines maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” Similarly, the Centers for Disease Control and Prevention (CDC) defines pregnancy-related death as “a death while pregnant or within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy.”
In the United States, the overall maternal mortality rate was 32.9 deaths per 100,000 live births in 2021. Black women are three times more likely to die from pregnancy-related complications than white women. The maternal mortality rate for Black women is a staggering 69.9 deaths per 100,000 live births. In comparison, the maternal mortality rate for white women is 26.6 deaths per 100,000 live births. Even more tragic, data shows that more than 80% of pregnancy-related deaths are preventable.
Alabama’s maternal mortality rates
In Alabama, the maternal mortality rate is 36.4 per 100,000 live births, the third worst rate in the country. Other reports rank Alabama’s maternal mortality rate even higher. For Black women in Alabama, the maternal mortality rate is significantly higher than the national average.
The maternal mortality rate for Black women in Alabama is about 100 deaths per 100,000 live births, according to a recent Milken Institute report. The maternal health crisis does not have a singular cause. Instead, multiple factors contribute to its complexity.
Barriers to prenatal care access
Access to prenatal care is a critical factor in positive maternal health outcomes. However, many Black women in Alabama face barriers to accessing timely and comprehensive prenatal care.
One major barrier is lack of health care providers and limited access to medical facilities. According to the Alabama Department of Public Health, 55 of Alabama’s 67 counties are considered rural, with 62% of the total population living in Primary Care Health Professional Shortage Areas (HPSAs). Additionally, many Alabama counties also are considered maternity care deserts, meaning pregnant individuals there lack access to essential obstetric services close to home.
Impact of implicit bias
Implicit bias and racism within the health care system contribute to disparities in maternal health outcomes. Implicit bias can be defined as “unconscious attitudes or stereotypes that affect our understanding, actions and decisions.”
Black women are more likely to experience mistreatment (such as shouting and scolding), dismissive attitudes, and medical neglect during pregnancy and childbirth, research has shown. The American College of Obstetricians and Gynecologists (ACOG) emphasizes the importance of addressing implicit bias in the health care system to improve maternal health outcomes.
Socioeconomic factors
Socioeconomic factors, namely poverty, also play a significant role in shaping maternal health disparities in Alabama. Alabama has several rural counties in the Black Belt that are “majority-minority,” where a majority of the population is Black. In 2019, four of Alabama’s counties with the highest poverty rates were majority-minority. Poverty and its residual effects (such as housing insecurity, food insecurity, lack of transportation and more) lead to poorer health outcomes.
Another serious consequence of poverty is lack of health coverage. In 2021, one in seven women in Alabama were uninsured. Uninsured women are more likely to have poor outcomes during pregnancy and delivery than women with insurance, research shows.
Conclusion
This data and many other studies highlight the urgent need for targeted interventions and systemic reforms to address maternal health disparities among Black women in Alabama. By addressing barriers to prenatal care access, combating bias in health care and addressing socioeconomic factors, we can work toward achieving equitable maternal health outcomes for all women in Alabama.
Many Alabama veterans face preventable barriers to obtaining health care. Closing our state’s health coverage gap through Medicaid expansion is an essential part of the solution.
In 2022, half of Alabama veterans who were uninsured had an income below 138% of the federal poverty level (FPL), which is the income eligibility limit for coverage through Medicaid expansion.
In addition to uninsurance and other barriers to accessing health care that veterans face, VA health coverage is limited as well. This is due to eligibility based on service-connected disability, income status and other service-related factors. Distance to a VA facility also poses a significant barrier that can prevent enrollment in VA health care.
Lack of health coverage most greatly affects the veterans who need it most. Veterans with previously existing disabilities have a higher uninsured rate than veterans in general.
Expanding Medicaid would empower more of our brave service members and veterans with low incomes to access health care.
In states that expanded Medicaid at the time, 50% of the veterans who were uninsured in 2013 received health coverage by 2015. In Alabama, only a little more than 1 in 3 uninsured veterans obtained coverage in the same time period.
One veteran explained the stakes of Medicaid coverage in a KFF report: “If I didn’t have Medicaid, it would be all downhill because there are not a lot of places that can afford to supply the medications that I need. Hypertension killed both my parents, so I need to take care of myself and see the doctor regularly.”
Medicaid expansion would promote employment among veterans.
The employment rate for veterans will be higher in states that expand Medicaid than in states that do not, as indicated by Urban Institute projections for 2024.
About 1 in 7 veterans (14.2%) are employed in the service industry, while 13.7% work in construction and maintenance. These are among the professions where the most workers would benefit from Medicaid expansion. Closing Alabama’s coverage gap would allow more veterans to obtain and retain employment by improving their health and productivity.
Medicaid expansion would allow veterans to have more options to receive health care.
Expanding Medicaid would ensure veterans have more freedom to seek health care outside of the VA system. This would allow them to receive care more promptly while reducing wait times in VA facilities for other veterans.
The number of VA health system outpatient visits would decrease by 12% if all states expanded Medicaid.
