Issue: Health

Medicaid block grants are a dangerous path toward coverage cuts

By Jim Carnes

The federal Medicaid changes announced Thursday won’t affect anyone now enrolled in Alabama Medicaid. But they could put coverage at risk in the years ahead for hundreds of thousands of Alabamians. This is a worrisome step down a road to increased human suffering and greater financial strain for struggling families.

Guidance from the Centers for Medicare and Medicaid Services (CMS) would allow states to ask for federal permission (known as a waiver) to receive a block grant – a capped amount of federal Medicaid money – to cover working-age adults without disabilities under Medicaid expansion. In exchange, states would receive new powers that can be used to loosen Medicaid’s guaranteed patient protections.

The results could be devastating for newly covered adults who already struggle to make ends meet. For example, states could ask for a waiver to deny Medicaid coverage for certain prescription drugs. They also could seek to take coverage away from people who cannot afford to pay premiums or meet a stringent work requirement.

The waiver plan also could jeopardize state budgets. Under Medicaid’s current structure, the federal government shares all costs with states. But a block grant would leave states solely responsible for covering any costs above the capped amount. This would make it harder for Alabama to respond to health emergencies, natural disasters, economic downturns and other events that increase the need for health care.

A block grant is not a viable alternative to Medicaid expansion

In the 36 states that have adopted Medicaid expansion, it has brought significant gains in public health, family economic security and rural hospital stability. (Alabama is one of just 14 states that have failed to expand Medicaid to cover adults with low incomes.)

The CMS plan threatens these advances in important ways. First, it would weaken eligibility and coverage protections for patients, making their coverage more expensive and less comprehensive. And second, it would limit the federal funding that states can get to support health services. That would reduce the positive impact that expansion has on state economies.

All Alabamians deserve an opportunity at better health for our families, our workforce and our communities. Our state should reject capped funding and harmful barriers to care that would put our bare-bones Medicaid at further risk. Instead, our elected officials should move Alabama forward by adopting Medicaid expansion.

Arise 2020: Expand Medicaid to save lives and make Alabama healthier

By Jim Carnes

Happy anniversary – not! 2020 marks the 10th year of Medicaid expansion under the Affordable Care Act, but not in Alabama. We’re one of just 14 states that have rejected federal funding to extend affordable health coverage to adults with low incomes. And soon, Kansas may cut that number to 13.

The stakes have only gotten higher as time has passed. Over the last 10 years, Alabama has:

  • Seen 13 hospital closures, including seven rural ones.
  • Given up more than $1 billion a year in federal Medicaid funding.
  • Forfeited a similar amount in related economic activity.
  • Allowed thousands of preventable deaths.
  • Stranded more than 220,000 Alabamians in the coverage gap, unable to qualify for Medicaid or afford private coverage.
  • Left tens of thousands more struggling to pay for health insurance they can barely afford.

After a decade of missed opportunity, Alabama needs to invest in our people and our future. Uninsured working parents, caregivers, veterans, people awaiting disability determinations, adult students and other Alabamians with low wages are putting off needed health care. Nearly 90% of our rural hospitals are operating in the red. People and communities across our state are suffering unnecessarily, and it’s time to do something about it.

What will it take to move Alabama forward? 

This can and should be the year for Medicaid expansion in Alabama. It’s an overdue move that would bring our federal tax dollars home to stabilize our rural hospitals and clinics. It would provide critical investment in local economies. And it would increase economic security for struggling Alabamians.

Success would not require passing a bill. Gov. Kay Ivey could simply request a Medicaid rule change raising the eligibility limit for adults, including those without children. A legislative panel that reviews rule changes could allow Medicaid to seek permission from Washington. If that gets the OK, Medicaid would simply factor expansion costs into its next annual budget.

Arise members have identified Medicaid expansion as a top priority. It’s the single biggest step Alabama could take to make life better for people with low incomes. And we’re working hard to make it happen.

We need you with us as we work to make Medicaid expansion a reality in our state. Please join Alabama Arise or renew your membership today to add your voice to our chorus for change. Together, we can build a better Alabama!

Arise 2020: Fight harmful proposals to cut Medicaid, SNAP and TANF

By Carol Gundlach

Safety net programs are designed to protect us when times get tough. But a recent wave of legislative and administrative attacks to those programs has threatened vital food and health assistance for millions of families across Alabama and the nation.

The stakes are high for people who struggle to make ends meet. Medicaid is a health care lifeline for one in four Alabamians. The Supplemental Nutrition Assistance Program (SNAP) helps one in six Alabamians keep food on the table. The Temporary Assistance for Needy Families (TANF) program provides meager but essential cash assistance for thousands of parents living in deep poverty.

All of these services improve lives. But numerous legislative plans could erect harmful barriers that keep struggling Alabamians from getting the help they need to survive.

Alabama Arise’s new fact sheet explains some of the harmful safety net proposals we may see this year. Arise members have helped defeat many of these proposals in the past. In 2020, we’ll need your help to do it again.

We need you with us as we work to defend programs that struggling people use in our state. Please join Alabama Arise or renew your membership today to add your voice to our chorus for change. Together, we can build a better Alabama!

A strong safety net means a stronger Alabama for all

By Carol Gundlach

We all know that people get down on their luck sometimes. They lose a job, have a sick child or need time to recover from an injury. And most Alabamians – understanding that “there, but for the grace of God, go I” – want to do what they can to help people going through a rough time.

The way that we, collectively, help our fellow Americans is through the safety net, a set of publicly funded services designed to help people meet basic needs when things get tough. Safety net programs include:

  • Food assistance through the Supplemental Nutritional Assistance Program (SNAP).
  • Health insurance through Medicaid or the Children’s Health Insurance Program (known as ALL Kids in Alabama).
  • Unemployment compensation.
  • Disability benefits.
  • Cash assistance through Temporary Assistance for Needy Families (TANF).

Attacks on the safety net in Alabama and other states

Some conservatives have been trying to cut the safety net at state and federal levels. During the 2018 Farm Bill reauthorization debate, the Foundation for Government Accountability (FGA) and other groups encouraged Congress to restrict hungry people’s ability to put food on the table. But these efforts failed, and SNAP emerged even stronger than before.

After this failure, opponents of the safety net turned their attention to the friendlier administrative rule process. They sought to force rules through the federal Departments of Agriculture, Housing and Homeland Security to cut food and housing assistance to marginalized people, including immigrant families.

Alabama Arise members and our state and national partners have submitted thousands of comments against these proposed changes. This advocacy has stopped or slowed some harmful plans, including the state’s proposed Medicaid work requirement. But the threats persist.

Another insidious attack on the safety net is happening in state legislatures across the country, including Alabama. While Medicaid and SNAP operate largely by federal rules, states have some discretion in how they design their programs. This discretion is called “state options” in SNAP.

Groups like the FGA have combed through the choices states have made in these state options. They have written “model” state legislation that would force states to select the most restrictive options allowed under federal law. Some of these bills are crafted to sound “reasonable” to legislators and to the general public. But together, they are designed to cut millions of struggling people off from the help they need.

Barriers to food and health care for struggling Alabamians

Since 2016, Arise has fought successfully against harmful barriers that would keep struggling Alabamians from getting the help they need. And we’re geared up to continue that fight for years to come. Here are a few of the damaging legislative proposals we expect to see again:

  • Stigmatize SNAP and TANF participants by requiring some of them to be tested for illegal drugs. States that implemented this approach have found it expensive and ineffective, with few participants testing positive. The plans would deny assistance to people who refuse a drug test or fail a drug test more than once. But they would not guarantee those participants get treatment for substance use disorders.
  • Prohibit Alabama from requesting a waiver of time limits for a small class of SNAP participants called able-bodied adults without dependents (ABAWDs). New federal rules already severely restrict these waivers, and the governor should have the authority to respond to an economic or environmental crisis by ensuring affected Alabamians can get the food they need during bad times.
  • Impose work requirements on SNAP participants who are not already working and who are not seniors or people with disabilities. This proposal would end Alabama’s very promising volunteer job training and employment assistance program for SNAP participants. Instead of getting the real job training they need, SNAP participants would be forced either to engage in less effective job search programs or to lose food assistance their families desperately need.
  • Require participants in “public benefits” to engage in community service at schools, nonprofits or other places. This could cut off assistance to hundreds of thousands of Alabamians who cannot jump through complex administrative hoops. It also would be time-consuming and expensive for participating agencies.

Other costly, harmful proposed administrative barriers

  • Require a photo ID to buy groceries using an Electronic Benefit Transfer (EBT) card for SNAP. This would be a tremendous barrier for seniors, people with disabilities and other Alabamians with transportation challenges. It would require store clerks to learn complex federal rules about who is allowed to use SNAP benefits. And it would slow down grocery store checkout lines for everyone.
  • Impose an asset test on applicants for SNAP food assistance. Alabama ended asset tests for SNAP because they were complex, time-consuming and expensive to administer, especially for seniors. They also rarely identified anyone too wealthy to be eligible for assistance.
  • Impose complex, duplicative and costly verification of income and assets for Medicaid, SNAP or TANF. This would slow down the processing of applications and deny or delay essential health and nutrition services for eligible people.
  • Require SNAP applicants to “comply” with child support orders or seek child support from the other parent before receiving food assistance. Cutting food assistance for families behind in child support does nothing but make children hungrier. And cutting assistance to a parent who has not demanded child support may force victims of domestic violence or child abuse to choose between their safety and their next meal.

The bottom line

All of these harmful ideas would make life harder for struggling Alabamians. Several proposals also would force agencies to pay millions of dollars to private firms that operate verification and client tracking functions now performed by state employees. Most importantly – and most troublingly – these proposals would increase the number of sick and hungry people in Alabama.

Alabamians deserve shared prosperity and inclusion, not increased human suffering and isolation. That is why we oppose cuts to Medicaid, SNAP, TANF and other programs that help people reach their full opportunity. Arise’s members rose to this challenge during the Farm Bill debate and in response to harmful federal rule changes. And we know you will continue to help protect the safety net that protects all Alabamians when times get tough.

Striking down the ACA would undermine health security for all Alabamians

By Chris Sanders

The U.S. Court of Appeals for the 5th Circuit struck down the Affordable Care Act’s individual mandate on Wednesday. The court then returned the case to a district judge to consider whether other parts of the law can remain intact after the ruling. Alabama Arise policy director Jim Carnes issued the following statement Thursday in response:

“This appalling decision puts health coverage at risk for tens of millions of people. And it imperils important consumer protections for every single American. The ruling won’t affect the 2020 marketplace coverage that Alabamians have signed up for under the Affordable Care Act. But it poses a long-term threat to the health and well-being of our people and our communities.

“Let’s be clear about what’s at stake if the ACA disappears. Tens of millions of Americans who gained coverage through Medicaid expansion would lose their insurance. Young adults would lose the right to stay on their parents’ plans until age 26. Coverage guarantees for people with preexisting health conditions like cancer and diabetes would vanish. And insurers no longer would have to cover vital services like maternity care, mental health care or treatment for substance use disorders.

“We can’t afford to go back to those bad old days. This rehashed assault on health coverage flies in the face of settled law, public opinion and common sense. And this ruling should be a call to action for Alabama. Our families and our workforce deserve the same opportunity as all other Americans to stay healthy and productive. We urge our lawmakers to expand Medicaid and move toward a future where everyone can get the health care they need to survive and thrive.”

Alabama Medicaid long-term care reforms already exceeding goals

By Jim Carnes

Alabamians who need long-term care services should be able to get them at home or in their communities whenever possible. And Alabama Medicaid’s new reform initiative, the Integrated Care Network (ICN), is making progress toward that goal.

The ICN has completed a successful first year of operation with strong help from consumer voices at the policy table. The network seeks to increase the share of Medicaid long-term care patients who receive services in home and community settings rather than in nursing facilities.

In Year 1, the ICN reached its five-year benchmark for this quality measure four years early, thanks to a new approach to care coordination, data analysis and consumer education. Medicaid implemented an accelerated enrollment process Oct. 1, as consumer advisers recommended. That process should further increase the share of home- and community-based participants in Year 2.

More than 15,000 of Alabama’s Medicaid long-term care patients reside in nursing facilities. Another 8,000 receive care in other settings. Because federal Medicaid rules originally targeted long-term care services to nursing home patients only, states must request “waivers” suspending those rules to deliver home- and community-based services. The ICN includes two of Alabama’s waiver programs, both managed through the state’s 13 Area Agencies on Aging.

Alabama Arise has a seat on the ICN’s governing board, along with our partners at AARP Alabama, the Alabama Disabilities Advocacy Program and Disability Rights and Resources. We’re also represented on the network’s Consumer Advisory Committee (CAC).

The CAC has a productive relationship with Alabama Select Network, the Blue Cross Blue Shield subsidiary that administers the ICN. The committee is promoting consumer choice in care settings and working to lift practical barriers to home- and community-based care.

How Alabama Arise is lifting up community voices in Alabama Medicaid

By Presdelane Harris

Alabama Medicaid is at a moment of transformation, opening up opportunities for a new focus on improving health outcomes. And Alabama Arise is working hard to ensure community needs and voices stay at the forefront.

Medicaid primary care is moving from a statewide fee-for-service model to a system of seven Alabama Coordinated Health Networks (ACHNs). The regional, nonprofit ACHNs began offering services Nov. 1, focusing on prevention, care coordination and health improvements. The inclusion of consumer representatives on regional governing boards and advisory committees also allows an unprecedented opportunity for Medicaid consumers to provide input directly to program officials.

Alabama Arise held a community asset mapping meeting on June 11, 2019, in Mobile. We met at the Bay Area Women Coalition and Trinity Gardens Community Civic Club offices. The meeting was the first held as part of a local project to help shape a Medicaid quality improvement project with the Alabama Coordinated Health Network for southwest Alabama.

In a pilot program designed to take advantage of these reforms, Arise has partnered with the Bay Area Women Coalition to enhance the local health system’s ability to promote greater food security in the Trinity Gardens neighborhood of Mobile. We’ve reached more than 100 people over six community meetings this year.

The community engagement effort is producing results. We’ve identified potential leaders and worked with residents to prioritize their ideas. We’re also discussing ways to strengthen community input as Medicaid implements and evaluates quality improvement projects.

Arise is grateful for our partnership with our Trinity Gardens neighbors. And we hope to build similar connections in communities across Alabama.

Why Medicaid expansion is a must for prison reform in Alabama

By Jim Carnes

Against a backdrop of human tragedy, Gov. Kay Ivey’s Study Group on Criminal Justice Policy is working toward a January deadline for its recommendations to the Legislature. The U.S. Department of Justice in April issued a sobering overview of the Alabama corrections system’s numerous shortcomings. And the Montgomery Advertiser shed further light on the situation in November, publishing horrific accounts of life inside state prisons.

It’s no secret that Alabama’s prisons are overcrowded, violent and inhumane. Any meaningful solution to this crisis must address two major challenges. First, it must alleviate the abysmal conditions inside Alabama’s prisons. Second, it must help people who are at risk of incarceration or re-incarceration become productive members of their communities. (See the key policy recommendations from Alabamians for Fair Justice below.)

Dena Dickerson, executive director of the Offender Alumni Association, speaks during an Oct. 3 news conference at the State House in Montgomery. Dickerson was one of dozens of supporters of Alabamians for Fair Justice (AFJ) who assembled to show support for reforms to make Alabama’s corrections system more humane and restorative. Alabama Arise is a member of the AFJ coalition.

The missing voices who need to be heard

Alabama Arise has been following the study group’s learning curve on a broad array of criminal justice issues. In four public meetings since July, members have received a flood of statistics from prison administrators, sentencing specialists, law enforcement officers, prosecutors, judges, mental health officials and other experts. They also have toured multiple correctional facilities, becoming eyewitnesses to the shameful conditions they’re charged with improving.

Largely missing from this crash course: the voices of the people Alabama’s criminal justice system affects most. The panel should fill that gap by inviting testimony from inmates’ family members and formerly incarcerated individuals. Many of them have attended the public study group meetings, and the formal recommendations should reflect their lived experiences.

Policy solutions should ease reentry, reduce recidivism

Of the roughly 21,000 people in Alabama’s prisons in a given year, 95% eventually reenter society, according to the Alabama Department of Corrections (DOC). Of those, about 29% wind up back in prison within three years.

Breaking the cycle of recidivism is a challenge that reaches beyond DOC, or even criminal justice policy. It also requires community partnerships to serve people with untreated mental health and addiction problems. These challenges can undermine successful reentry and often contribute to incarceration in the first place.

By targeting recidivism, the study group is highlighting our state’s overburdened community mental health and substance use services network. Medicaid expansion, at a 90% federal match, would allow Alabama to expand these services tenfold for the same state investment. The study group should urge our state to take this essential step forward.

The study group’s measured, highly visible approach to its complicated challenge is not one it can easily shrug off. The panel has set a high bar for meaningful recommendations, and Arise expects them to meet it. Arise and our partners in the Alabamians for Fair Justice alliance will keep up the pressure for comprehensive, lasting reform.

The path to a better corrections system

Alabama’s corrections system must become more humane and restorative. Alabama Arise and our allies in the Alabamians for Fair Justice coalition have proposed numerous changes to put our state on a path toward dignity, equity and justice for all. Here are a few of these recommendations:

  • Expand state investments in mental health care and treatment for substance use disorders.
  • Increase state support for mental health courts, pretrial diversion and reentry programs.
  • Reduce court costs and give people a reasonable amount of time to begin paying fines and restitution after returning from prison.
  • End automatic suspensions of driver’s licenses in cases unrelated to traffic safety.
  • Apply the state’s presumptive sentencing guidelines retroactively.

Visit alabamafairjustice.org/resources to read the coalition’s full list of policy solutions on prison reform in Alabama.

Get covered: Open enrollment ends Dec. 15, 2019

By Jim Carnes

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.

Our friends at the Center on Budget and Policy Priorities put together five good reasons to visit healthcare.gov during open enrollment. This resource discusses how to compare plans, seek financial help and ensure your insurance meets your needs.

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.

Expand Medicaid to shore up children’s health coverage in Alabama

By Jim Carnes

Children’s health coverage has long been a point of pride for Alabama, and we can’t afford to backslide. But Alabama’s rate of uninsured children has moved in the wrong direction since 2016, according to a recent report from Georgetown University’s Center for Children and Families (CCF).

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.

Check out our news release for more on the Georgetown CCF report. Then urge Gov. Kay Ivey to expand Medicaid so all Alabamians can get the care they need to survive and thrive.