Issue: Medicaid Expansion

Arise 2026: How we’re working to build a better Alabama

By Matt Okarmus

Alabama Arise believes in dignity, equity and justice for all. We believe in an Alabama where everyone’s voice is heard and everyone has the opportunity to reach their full potential. And we believe better public policies are the key to building a brighter future for our state. 

Below, we’ll share some details of that vision as the Alabama Legislature’s regular session begins January 13. This blog focuses on the crucial legislative priorities on our 2026 roadmap to change.

If you’re not already a member of Alabama Arise, join us! Members will receive an exclusive version of our weekly Legislative Updates throughout the session. These emails include a weekly video update from Arise staff members on what’s happening at the State House, as well as details about upcoming legislation and links to additional resources.

Executive Director Robyn Hyden welcomes us to the 2026 session

Arise’s Robyn Hyden welcomes everyone to the Alabama Legislature’s 2026 regular session. Watch to see what to expect this year and to learn more about our advocacy on school breakfast, protecting funding for public schools and other member-selected legislative priorities. 

Strong investments in schools, housing and transit improve life for all Alabamians

Strong funding for public services like education and public health broadens opportunity for everyone, especially for Alabamians with low incomes. Arise members for decades have urged robust and secure state funding for these services. Our top adequate state budget priorities include protecting funding for public schools and securing state support for affordable housing and public transportation.

READ OUR FACT SHEET

Closing the health coverage gap: Alabama must enact policies to save lives

As Alabama enters the 2026 legislative session, Medicaid expansion and maternal health will be central to the state’s health equity conversations. Recent federal policy changes have made these conversations more urgent and more complex. Our top health equity priorities are Medicaid expansion and investments in comprehensive maternal health care.

READ OUR FACT SHEET

Federal SNAP cuts underscore Alabama’s need to protect and increase food access

Alabama’s food insecurity rates are among the worst in the country. More than 1 in 6 people in our state (17%) face food insecurity, according to the Alabama Department of Public Health. And that share is even larger for children: Nearly 1 in 4 Alabama children (23%) live in households with food insecurity. Our top hunger relief priorities are increasing the availability of no-cost school meals, protecting SNAP food assistance and continuing the successful SUN Bucks summer nutrition program.

READ OUR FACT SHEET

An inclusive democracy is vital to building a better Alabama for all

Alabama was central to the struggle for democracy and voting rights in the United States during the Civil Rights Movement in the 1950s and 1960s. And the need for our state to do more to build a more inclusive democracy continues today. That is especially true after recent U.S. Supreme Court decisions affecting the rights of people nationwide to have their say in who represents them at the local, state and federal levels. Our top inclusive democracy priorities include no-excuse absentee voting, early voting and removal of barriers to voting rights restoration.

READ OUR FACT SHEET

Alabama’s justice system should focus on rehabilitation, not cruelty

Alabama’s criminal justice system too often prioritizes punishment over evidence-based interventions. This cruel orientation has fueled heavy-handed sentencing policies and a broken parole system. And it has led to a death penalty system where state officials continue to kill prisoners against the recommendation of the juries that convicted them. Our justice reform priorities include reforms to Alabama’s sentencing and parole practices and legislation to make the state’s ban on judicial override in death penalty cases retroactive. 

READ OUR FACT SHEET

Alabama’s tax system is upside down and needs real reform

Alabama’s tax structure is among the nation’s most unfair and unjust. The state is heavily reliant on regressive sales taxes on consumer goods that account for a larger share of spending for households with low incomes. Our state continues to tax groceries, though at a lower rate than other goods after grocery tax reductions in 2023 and 2025. And Alabama does not tax numerous services that people with higher incomes more often purchase. Our tax reform priorities include untaxing groceries, reining in income tax breaks for wealthy households and opposing further diversion of public school funding to private schools and homeschooling.

READ OUR FACT SHEET

Empower workers to build an economy that works for all Alabamians

Alabama has a history of anti-worker policies that prioritize the interests of wealthy corporations over those of working people. This top-down structure has led to our state falling behind in measurable standards of well-being. Our worker power priorities include increased accountability for child labor law violators, expansion of paid leave and stronger protections for temp workers.

READ OUR FACT SHEET

Closing the health coverage gap: Alabama must enact policies to save lives

By Alabama Arise

By Jennifer Harris, senior health policy advocate, and Debbie Smith, Cover Alabama campaign director

As Alabama enters the 2026 legislative session, Medicaid expansion and maternal health will be central to the state’s health equity conversations. Recent federal policy changes have made these conversations more urgent and more complex.

Alabama Arise will continue to support health investments to save lives, create jobs and protect rural residents across our state. This will include advocacy to close the state’s health coverage gap through Medicaid expansion. We also will urge lawmakers to approve legislation to protect and expand access to comprehensive maternal health care.

Federal policy changes are reshaping Medicaid financing

Alabama remains one of only 10 states yet to expand Medicaid. As a result, hundreds of thousands of Alabamians are caught in the state’s health coverage gap, earning too much to qualify for Medicaid but too little to qualify for Marketplace insurance subsidies under the Affordable Care Act (ACA).

HR 1, the so-called One Big Beautiful Bill Act, eliminated a two-year increase in the federal Medicaid match rate that was available to states that expanded Medicaid. This increased match rate was an additional incentive for states that had not yet expanded Medicaid to cover adults
with low incomes to do so.

For Alabama, the federal incentive eliminated under HR 1 would have brought an estimated $619 million in federal funding for two years. That would have been enough to cover at least the first two years of Medicaid expansion.

Without this incentive – which would have been in addition to the ongoing 90-10 federal match rate for covering residents under Medicaid expansion – expanding Medicaid will cost more. It also will require identifying new, sustainable financing sources.

Provider tax changes create additional budget constraints

Federal changes under HR 1 also restrict how states can use provider taxes to finance Medicaid. Under HR 1, Alabama would be required to reduce Medicaid provider tax collections if it expanded Medicaid in the future.

This provision could result in Alabama losing more than $100 million in health care revenue annually if the state expanded Medicaid. Arise will continue making the case that lawmakers should not pit current Medicaid enrollees against people who need coverage but cannot afford it.

Affordable coverage through Healthcare.gov remains at risk

At the same time, affordability challenges are growing for people who receive health coverage through the ACA Marketplace. Enhanced premium tax credits (ePTCs) have helped nearly 500,000 Alabamians afford coverage through Healthcare.gov. But the ePTCs expired Dec. 31, and Congress has yet to renew them.

As a result, many Alabamians’ monthly health coverage premiums will double – or increase by even more. An estimated 130,000 Alabamians are expected to lose their health coverage because of this change.

Persistent gaps in health coverage and outcomes

Nearly 200,000 adults remain stuck in Alabama’s coverage gap. And that number unfortunately is expected to grow since the ePTCs expired.

At the same time, Alabama continues to rank poorly on key health outcomes, including infant and maternal mortality. These realities make clear that coverage policy and maternal health outcomes cannot be addressed in isolation.

Building on progress to improve maternal health

Despite these systemic challenges, Alabama has made strides in improving maternal health in recent years. extending Medicaid postpartum coverage. These steps have included removing paperwork obstacles to maternity Medicaid coverage and ensuring paid family leave for state employees, K-12 teachers and two-year college workers. Lawmakers also eliminated the state sales tax on many maternity and infant items.

Here are Arise’s recommendations for next steps that legislators can take to improve maternal health care outcomes in our state:

  • Increase provider access for new moms. Alabama should act now to close maternal health deserts throughout our state. Moms in rural areas need access to birth workers, including doctors, midwives and doulas.
  • Protect access to contraceptives. Contraceptives are important to reproductive health and meeting family planning needs. These contraceptives should be readily available and affordable.
  • Ensure doctors can perform life-saving procedures and preserve fertility without fear of criminalization. Moms need safe, appropriate health care during pregnancy when complications are present. Doctors should not have to fear prosecution over providing such essential life-saving care.
  • Ensure a healthier start for newborns. Arise advocates for policies that promote a healthier start for newborns and their families. This includes support for HB 54, known as the Women’s CARE Act. This bill by Rep. Rolanda Hollis, D-Birmingham, would allow many pregnant moms sentenced to incarceration to serve supervised probation until 12 weeks after childbirth.

Bottom line

Alabama faces many difficult but important decisions about Medicaid expansion, health care affordability and maternal health. Federal policy changes have made inaction more costly, while coverage gaps and poor health outcomes continue to affect families across the state.

By addressing financing challenges, protecting access to coverage and building on recent maternal health progress, Alabama has an opportunity to move toward a more equitable health care system that better supports moms, babies and communities statewide.

Long federal road ahead for SNAP, health care

By Alabama Arise

By Carol Gundlach, senior policy analyst, and Debbie Smith, Cover Alabama campaign director

Alabama Arise believes that society should care for the most vulnerable in our nation—children, the elderly, those who are disabled and those who have fallen on temporary hard times. Since the Great Depression, Americans have been assured that, no matter how hard times get, our basic nutritional needs would be met by our government.

But 2025 has been a head-spinning and traumatic year for the 750,000 Alabama recipients of SNAP food assistance (commonly called Food Stamps), a stable pillar in America’s response to poverty and hunger. For 60 years, through multiple federal shutdowns, budget crises and wars, SNAP assistance has reliably fed hungry Americans. 2025 was different. 

Bill doesn’t help those who need it

HR1, the budget reconciliation bill (or “One Big Beautiful Bill”) passed by Congress in July, made it harder for people to receive food assistance and reduced the amount of assistance available, even as grocery costs rose. Existing time limits and burdensome paperwork requirements for some SNAP recipients were expanded to include unhoused people, veterans, children aging out of foster care and elderly recipients. 

Non-citizens and refugees legally in the U.S. were denied food assistance. And states, for the first time, will have to pay for some SNAP benefit costs. By mid-2027, Alabama will have to come up with approximately $175M to pay for our existing SNAP program.

Shutdown deepened impact

The October federal government shutdown only made the food crisis worse. The United States Department of Agriculture (USDA) refused to use its emergency funds and instead cut off food assistance to 42 million Americans, including all SNAP recipients in Alabama. 

Food banks and pantries, bolstered by small state grants, tried to fill the gap but many of our neighbors faced hunger as the holidays approached. The ending of the shutdown allowed the Department of Human Resources to get SNAP benefits out in record time, but legal immigrants face immediate termination of SNAP benefits. And many more people face new, draconian time limits that began in December. 

And many of the same people face huge increases in the cost of their health care.

Health costs will soar

As of this writing, Congress has not extended enhanced premium tax credits (ePTCs), which lower monthly premiums for nearly 500,000 Alabamians who get their coverage through the ACA Marketplace. As a result, 130,000 Alabamians are expected to lose coverage. This decision threatens to roll back the significant progress Alabama has made in reducing its uninsured rate.

The enhanced tax credits have played a central role in that progress. Lowering premiums opened Healthcare.gov plans to workers who had long been locked out of affordable coverage. Nearly half of Alabama’s Healthcare.gov enrollees fall into income ranges that would qualify them for Medicaid expansion if they lived in the 40 states that have expanded. Without the credits, many will face premiums they simply cannot pay, increasing the number of uninsured at a time when families are already navigating high costs of living.

This shift will place additional pressure on Alabama’s health care system, especially rural hospitals and clinics that already struggle with staffing shortages, rising uncompensated care, and service reductions. 

HR 1 complicates health care access

Federal changes under HR 1 create additional challenges. The law eliminates financial incentives meant to help states like Alabama adopt Medicaid expansion, including extra federal funding that would have supported expansion startup costs for the first two years. It also places new restrictions on increasing provider taxes, which Alabama uses to help fund its share of Medicaid. These limits would become more restrictive if Alabama chose to expand Medicaid in the future, and even now, they place a long-term cap on our state’s flexibility to finance Medicaid as health care costs continue to rise.

HR 1 also shifts new SNAP funding responsibilities to states. This will strain the state budget at a time when food insecurity is rising and families are struggling to meet basic needs.

Taken together, these issues ensure that health care and food access will be unavoidable priorities in the 2025 legislative session. The coming year will bring real challenges, but it also offers Alabama lawmakers an opportunity and a responsibility to strengthen the state’s health and nutrition safety nets at a moment when Alabamians need them most.

Las prioridades legislativas de Alabama Arise para 2026

By Alabama Arise

Más de 150 grupos miembros de Alabama Arise y más de 1,500 miembros individuales eligen todos los años nuestras prioridades legislativas. Este proceso garantiza que los habitantes de Alabama más afectados por la pobreza participen de las decisiones. A continuación se enumeran las prioridades que nuestros miembros eligieron para 2025.

Para obtener una versión de este documento en PDF, haga clic aquí o en el botón de “Descargar” (Download) arriba.

Equidad en salud – Alabama debe salvar vidas, crear trabajo y proteger la salud rural cerrando la brecha de cobertura de Medicaid y mejorando el acceso a atención de maternidad de alta calidad.

Alivio del hambre – Alabama debe ayudar a las familias a prosperar al asegurar que todas las escuelas públicas puedan ofrecer comidas gratuitas para todos sus estudiantes y al proteger programas de nutrición vitales.

Presupuestos estatales adecuados – Los servicios públicos robustos amplían las oportunidades para todos. Alabama debe proteger la financiación para las escuelas públicas e invertir en vivienda asequible y transporte público.

Democracia inclusiva – Todos merecen tener su opinión en nuestra democracia. Alabama debe permitir el voto en ausencia sin excusas y eliminar barreras para la restauración de los derechos de voto para personas que no están involucradas.

Reforma de justicia – El sistema de justicia de Alabama debe enfocarse en rehabilitación, no en crueldad. Nuestro estado debe dejar de ejecutar a personas sentenciadas a muerte contra la recomendación de un jurado. Alabama también debe reformar la libertad condicional y las sentencias.

Reforma impositiva – Un sistema impositivo más equitativo puede ayudar a las personas en dificultades a llegar a fin de mes. Alabama debe quitar los impuestos a artículos básicos y asegurar financiamiento justo y sostenible para servicios vitales.

Poder trabajador – Alabama debe apoyar a la gente trabajadora quitando incentivos de impuestos a las empresas que violan las leyes de empleo de menores, extendiendo la licencia por paternidad/maternidad a más trabajadores y mejorando las salvaguardias para trabajadores temporarios.

Alabama Arise 2026 legislative priorities

By Alabama Arise

More than 150 Alabama Arise member groups and nearly 2,000 individual members choose our legislative priorities each year. This process ensures that Alabamians most impacted by poverty have a seat at the table. Below are the priorities that our members selected for 2026.

For a PDF version of this document, click here or click the “Download” button above.

Health equity –Alabama should save lives, create jobs and protect rural health care by closing the Medicaid coverage gap and improving access to high-quality maternity care.

Hunger relief – Alabama should help families thrive by ensuring all public schools can offer free school meals for all of their students and by protecting vital nutrition programs.

Adequate state budgets – Strong public services broaden opportunity for all. Alabama should protect funding for public schools and invest in affordable housing and public transportation.

Inclusive democracy – Everyone deserves a say in our democracy. Alabama should allow no-excuse absentee voting and lift barriers to voting rights restoration for disenfranchised people.

Justice reform – Alabama’s justice system should focus on rehabilitation, not cruelty. Our state should stop executing people sentenced to death against a jury’s recommendation. Alabama also needs to reform parole and sentencing.

Tax reform – A more equitable tax system can help struggling people make ends meet. Alabama should untax groceries and ensure fair, sustainable funding for vital services.

Worker power – Alabama should support working people by removing tax incentives from companies that violate child labor laws, extending paid parental leave to more workers and improving safeguards for temp workers.

Alabama Arise unveils 2026 roadmap for change in Alabama

By Chris Sanders

Expanding health care access and improving maternal and infant health will remain top goals on Alabama Arise’s 2026 legislative agenda. The organization also will continue advocating for state funds to help public schools provide free school meals to every student.

Nearly 600 members voted in the last week to affirm Arise’s legislative priorities. The seven priorities chosen were:

  • Health equity, including policies to close Alabama’s health coverage gap for adults with low incomes and to protect access to maternity care.
  • Hunger relief, including legislation to allow more public schools to provide no-cost breakfast and lunch for all of their students.
  • Adequate state budgets, including equitable public education funding for every student and state funding for affordable housing and public transportation.
  • Inclusive democracy, including no-excuse early voting and removal of barriers to voting rights restoration for disenfranchised Alabamians.
  • Justice reform, including legislation to apply Alabama’s ban on judicial override of jury sentencing decisions in death penalty cases retroactively, as well as improvements to the state’s sentencing and parole systems.
  • Tax reform to build a more just and sustainable revenue system, including eliminating the rest of Alabama’s state sales tax on groceries and replacing the revenue equitably.
  • Worker power to advance the health and safety of Alabama families, including legislation to remove tax incentives from companies that violate child labor laws, as well as efforts to extend paid parental leave protections to more workers.

“Alabama Arise believes in dignity, equity and justice for everyone,” Alabama Arise executive director Robyn Hyden said. “Our legislative priorities seek to empower Alabamians of every race, income and background to reach their full potential. And they reflect our members’ commitment to building a healthier, more just and more inclusive Alabama for all.”

Alabama Arise graphic text reads "2026 legislative priorities: Arise's roadmap to a better Alabama." Issues named are health equity, hunger relief, adequate state budgets, inclusive democracy, justice reform, tax reform and worker power.

The urgent need to close Alabama’s coverage gap and protect affordable Marketplace plans

Arise members believe Medicaid expansion is a path toward a healthier future where all Alabamians can afford the health care they need. Expanding Medicaid would reduce racial health disparities and remove financial barriers to health care for adults with low incomes. Expansion also would support thousands of new jobs across the state. And most importantly, it would save hundreds of lives every year.

Alabama is one of only 10 states yet to expand Medicaid. Medicaid expansion would ensure health coverage for nearly 200,000 Alabamians caught in a coverage gap. Most of these residents earn too much to qualify for the state’s bare-bones Medicaid program but too little to afford private plans.

The number of Alabamians in the coverage gap could soar in 2026 if Congress fails to renew enhanced Premium Tax Credits for Marketplace plans under the Affordable Care Act. If lawmakers allow the credits to expire, about 130,000 Alabamians would lose their health coverage, and premiums for many others would nearly double.

Those setbacks would add further strain to the health care infrastructure that serves all Alabamians. About two dozen rural hospitals in Alabama are at immediate risk of closure, and four labor and delivery units have shut down since 2023. These closures have reduced care options in a state that already has one of the nation’s worst maternal mortality rates.

“Everyone should be able to get the health care they need when they need it,” Hyden said. “Congress must act quickly to protect affordable Marketplace coverage for hundreds of thousands of Alabamians. And our state policymakers need to step up to close Alabama’s health coverage gap once and for all. This investment would pay off in the form of healthier families and stronger economic growth in communities across our state.”

No-cost school meals help Alabama children learn and thrive

Another key step toward a healthier Alabama is to ensure every public school can offer no-cost meals to every student. Hundreds of Alabama schools provide no-cost meals through the Community Eligibility Provision, but some schools cannot participate in the program.

Arise will advocate for additional state funding that local districts can use to match federal funds to offer no-cost meals. Legislators this year approved $17.3 million to expand school breakfast and continue Alabama’s participation in SUN Bucks, which provides $40 in food benefits per summer month for hundreds of thousands of Alabama children.

Stronger investment in school meals is more urgent amid threats to federal funding for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and cuts to the Supplemental Nutrition Assistance Program (SNAP). Alabama and other states could run out of money for WIC in a few weeks if Congress does not renew its funding. And the federal budget law enacted in July will make fewer people eligible for SNAP while shifting more costs to states.

Children and communities across Alabama would enjoy immediate and long-term benefits from no-cost meals in public schools. No-cost meals would reduce child hunger in a state where nearly 1 in 4 children face food insecurity. Extending the reach of school meal programs would help reduce behavioral problems and improve attendance and test scores. Reducing food insecurity for children also can help improve their mental health and overall health as teenagers and adults.

“It’s hard for children to focus in school when they’re hungry,” Hyden said. “Lawmakers should ensure that WIC and SNAP continue to provide food assistance for families across our state. And our legislators should invest in no-cost school meals to reduce hunger and help every Alabama child succeed both in the classroom and throughout their lives.”

What the new federal budget law means for SNAP, health care in Alabama

By Alabama Arise

By Carol Gundlach, senior policy analyst, and Debbie Smith, Cover Alabama campaign director

While many Alabamians were celebrating July 4, Congress passed a sweeping budget reconciliation law that will hurt families across the country. To extend more than $1 trillion of tax cuts for the richest Americans, Congress slashed health care, food assistance and other vital services for ordinary people.

“It’s wrong to hurt people who are struggling to help people who are already far ahead,” Alabama Arise executive director Robyn Hyden said after the bill’s passage. “But Congress just passed legislation that will do exactly that. This budget bill is not only a moral failure. It’s bad policy, and it is a really bad deal for Alabama and our entire country.”

The biggest cuts nationally will be to Medicaid and to food assistance under the Supplemental Nutrition Assistance Program (SNAP). Alabama has not yet expanded Medicaid to cover adults with low incomes, but the harmful new budget law will make it harder for our state to improve and expand health care access. And the law’s SNAP cuts and barriers will increase hunger and hardship across Alabama.

SNAP cuts will make it harder to make ends meet

The SNAP cuts will threaten Alabama’s ability to fund essential state services. They also will impose red-tape barriers for SNAP participants and reduce the future buying power of SNAP.

Threats to state budgets: Beginning in 2026, the Alabama Legislature will have to appropriate an estimated $35 million a year in new funding for SNAP administration. Beginning in 2027, the Legislature also may have to appropriate an estimated $172 million annually in new funding to help cover SNAP benefits, which have been fully federally funded for decades. If Alabama lawmakers cannot or will not provide the required state share of funding, the state would have to reduce the number of SNAP participants or opt out of the program entirely. Eliminating SNAP would end food assistance for more than 750,000 Alabamians and send hunger rates soaring in a state where 1 in 4 children already struggle with food insecurity.

Changes that place time limits on more people who receive SNAP: Many older adults, families with teen children, veterans, people who are experiencing homelessness and young adults who were in foster care may face burdensome new work reporting requirements to receive food assistance. And beginning immediately, many people who are legally in the United States as refugees, asylum seekers or victims of domestic violence or sexual assault may no longer be eligible for SNAP.

Changes that likely will reduce the amount of SNAP assistance over time: The new law prohibits the federal government from making substantive changes to the USDA’s Thrifty Food Plan, on which the amount of SNAP benefits is based. This change will reduce the value of SNAP assistance over time.

Health care cuts will increase human suffering

Reconciliation cuts to Medicaid primarily targeted states that had expanded Medicaid, but the bill also will make it harder for Alabama to improve our Medicaid program. The law also failed to renew subsidies that make health coverage more affordable for hundreds of thousands of Alabamians.

The law eliminates key financial incentives that encouraged Alabama and other states to expand Medicaid. We no longer will be eligible for $619 million in additional federal funding on top of the 90% federal match, which would have helped pay for the startup costs of Medicaid expansion.

The law also includes restrictions on provider taxes — a key tool Alabama uses to help fund its share of Medicaid. This will make it more difficult for Alabama to expand coverage going forward and could put a long-term limit on how our state finances Medicaid as health care costs rise.

Congress also failed to renew enhanced tax credits that have made Marketplace plans under the Affordable Care Act (ACA) more affordable since 2021. These subsidies have helped hundreds of thousands of Alabamians lower their monthly premiums. Now, those enhanced subsidies are going away at the end of 2025.

The cuts to healthcare.gov tax credits mean that Alabamians’ monthly premiums will increase and fewer people will qualify for financial help. About 130,000 Alabamians are expected to lose coverage because of these changes.

Where we go from here

Arise is taking numerous steps in response to this law’s passage. These actions include:

  • Analyzing the law’s long-term impact on SNAP, Medicaid and ACA financing.
  • Creating resources for partners, community organizations and the public to explain the changes and what they mean. 
  • Meeting with state and local leaders to discuss options and ensure they understand the financial and human stakes of these changes. 

Even in the face of harmful federal policies, Arise’s commitment to the people of Alabama remains strong. We are working every day to protect access to food and health care and make sure families have the information and support they need.

What we know about the health care changes in the new federal budget law

By Debbie Smith

While many Alabamians were preparing for the July 4 holiday, Congress passed the One Big Beautiful Bill Act — a sweeping federal budget law with serious consequences for families across the country, including right here in Alabama.

The Center on Budget and Policy Priorities put it plainly:

“House and Senate Republicans have now passed a bill that will raise families’ food and health care costs, increase poverty and hunger, take health coverage away from millions of people, and drive up deficits — all to give costly tax cuts to the wealthy and corporations.”

This law is a cruel tradeoff — and it hits hardest in places like Alabama, where many families are already stretched thin and our health care system is fragile.

What you need to know about the Medicaid cuts

We want to be clear: We do not expect anyone in Alabama to be immediately kicked off their health coverage because of this law. However, the long-term consequences are serious and far-reaching. This law makes it more difficult for people to access coverage, and it limits Alabama’s ability to strengthen our health care system in the future.

Here’s what we know so far:

  • Work reporting requirements and six-month eligibility redeterminations target adults covered through Medicaid expansion. Since Alabama hasn’t expanded Medicaid, these provisions are unlikely to affect us directly at this time. 
  • The law eliminates key financial incentives created to encourage Alabama and other states to expand Medicaid. We no longer will be eligible for $619 million in additional funding to expand Medicaid in the future, which would have helped pay for the startup costs of Medicaid expansion. 
  • The law also includes restrictions on provider taxes — a key tool Alabama uses to help fund its share of Medicaid. We believe the most harmful restrictions would only apply if Alabama chooses to expand Medicaid in the future. This provision will make it more difficult for Alabama to consider expansion going forward, and the cap on provider taxes for Alabama will put a long-term limit on how our state finances Medicaid as health care costs rise.

What’s changing on Healthcare.gov

The law also failed to renew enhanced subsidies that have made Marketplace plans under the Affordable Care Act (ACA) more affordable since 2021. These subsidies have helped thousands of Alabamians lower their monthly premiums — and thanks in part to this support, the size of Alabama’s coverage gap shrank from about 340,000 to 200,000 people. Now, those enhanced subsidies are going away at the end of 2025.

Here’s what this means:

  • Monthly premiums will increase in 2026 for many people who buy insurance on Healthcare.gov. 
  • Fewer people will qualify for financial help, especially those with lower or fluctuating incomes. 
  • It will be harder to sign up and stay covered, with shorter enrollment periods and stricter paperwork rules.

These changes make health insurance less affordable and harder to access — especially in a state like Alabama, where many people already struggle to afford care.

What this means for providers and rural hospitals

The law includes a new Rural Health Transformation Program, which allocates $50 billion over five years for rural hospitals nationwide. But how that funding will be distributed is unclear, and the funding is unlikely to be enough to meet the growing financial needs of rural hospitals.

Meanwhile, the broader impact is clear:

  • More uninsured patients will increase uncompensated care costs for providers. 
  • Hospitals and clinics will face more financial pressure — especially in rural areas. 
  • Patients may face reduced access, longer wait times and fewer services as a result.

How Alabama Arise and Cover Alabama are taking action

Alabama Arise and the Cover Alabama team are taking numerous steps in response to the passage of this law. These actions include:

  • Analyzing the law’s long-term impact on Medicaid financing, ACA Marketplace access and Alabama’s health care infrastructure. 
  • Creating resources for partners, community organizations and the public to explain the changes and what they mean. 
  • Meeting with state and local leaders to discuss options and ensure they understand the financial and human stakes of these changes. 
  • Offering presentations and briefings across the state to help Alabamians prepare and respond.

Even in the face of harmful federal policy, our commitment to the people of Alabama is strong. We are working every day to protect access to care and make sure families have the information and support they need.

We will keep moving forward — and we’ll do it together.

Federal cuts to SNAP, health coverage will harm people across Alabama

By Chris Sanders

The U.S. House voted Thursday for final passage of a budget bill that will make basic needs like food and health care more expensive for millions of American families through severe cuts to food assistance, Medicaid and other human services. These funding cuts will finance renewals and expansions of tax cuts for wealthy people and highly profitable corporations.

Alabama Arise executive director Robyn Hyden issued the following statement Thursday in response:

“It’s wrong to hurt people who are struggling to help people who are already far ahead. But Congress just passed legislation that will do exactly that. This budget bill is not only a moral failure. It’s bad policy, and it is a really bad deal for Alabama and our entire country. It also will undermine important bipartisan progress that state policymakers made this year on food affordability and maternal health care.

“This cruel budget plan will take away food assistance, health coverage and other vital services from tens of thousands of Alabama families who struggle to afford basic needs. And it will make those cuts in service of slashing taxes for billionaires and highly profitable corporations, with more than $1 trillion in tax cuts accruing to people in the top income brackets. Meanwhile, more than $1 trillion in funding cuts will impact essential services for people with low incomes.

A woman speaks behind a lectern while advocates stand behind her. Headline: "Alabama Arise news release: Federal cuts to SNAP, health coverage will harm people across Alabama."

SNAP cuts could send hunger soaring, undermine state grocery tax reduction

“Alabama likely will feel the worst effects from cuts to the Supplemental Nutrition Assistance Program. SNAP benefits have been fully federally funded for decades, but this plan will change that starting in October 2027. If this legislation were in effect now, Alabama would be on the hook for about $207 million a year in direct benefits and additional administrative costs for SNAP. That amount would be roughly the same as the state’s first-year cost to expand Medicaid to cover nearly 200,000 adults with low incomes, and it would not include the cost savings that Medicaid expansion would generate for other services.

“There is reason to worry that the Legislature would decide it can’t or wouldn’t provide the additional SNAP funding. In that case, Alabama would be forced to cut SNAP participation significantly – or even eliminate the program altogether for nearly 800,000 participants statewide. This federal cost shift would reduce our state’s ability to fund existing essential services and programs. And it could lead to deep SNAP cuts that would devastate grocery stores and other retailers in communities across Alabama.

“This bill will expand work reporting requirements to cover more SNAP participants, including veterans, people experiencing homelessness, and young adults aging out of foster care. Many of them likely will lose food assistance not because of a failure to work but because of a failure to complete complicated paperwork. These new red-tape barriers will increase hunger for struggling families while billionaires and corporations run off with a bigger slice of the pie.

“Federal SNAP cuts will leave more Alabamians unable to afford to keep food on the table. That is a step in the wrong direction, and it will undermine the benefits of the state grocery tax reduction that Alabama legislators enacted unanimously this year.

Health coverage cuts will increase human suffering, reduce health care access

“This budget plan will make health care inaccessible or less affordable for tens of thousands of Alabamians. It will allow enhanced Affordable Care Act subsidies to expire, increasing premium costs for marketplace plans. It also will remove the additional $619 million in federal incentives for the first two years of Medicaid expansion that Alabama left on the table. That increases the chances that our state will continue to refuse to expand Medicaid, leaving hundreds of thousands of our neighbors stuck in the health coverage gap with no options to afford life-saving care.

“In total, nearly 200,000 Alabamians could lose health coverage as a result of policy changes like these. Those coverage losses likely will increase hospitals’ uncompensated care costs and make health care even less accessible in rural areas. Fourteen rural hospitals in our state have closed since 2010, and more than 20 others are at risk of closing. When a hospital or clinic closes, it closes for everyone, regardless of their insurance status.

“The human toll of cutting health coverage is all too real. It might mean a later cancer diagnosis for your neighbor. Your pregnant friend might die when her preeclampsia isn’t caught or treated in time because she has to drive an hour longer to get to a doctor. Your son or daughter might experience a mental health crisis and have no way to access or pay for care. Funding for health coverage is not just a line on a spreadsheet. It is often literally a matter of life or death for people facing medical challenges.

Where we go from here

“It will be a few years before many of the federal budget bill’s worst provisions will take effect in full. Alabama Arise’s members and supporters will continue urging our state’s congressional delegation to reverse this bill’s harmful provisions. We also will continue working at the state level to advance public policies to improve the lives of Alabamians marginalized by poverty. That includes advocacy to close our state’s health coverage gap, to right the wrongs of our state’s upside-down tax system and to ensure that all Alabamians have the resources they need to survive and thrive.

“Alabama Arise believes in building an economy that works for everyone and a society where everyone has the opportunity to reach their potential. We will continue working in the years and decades ahead to make that vision a reality for our state.”

More resources

June 27: A news release on the Hands Off SNAP and Medicaid news conference at the State House in Montgomery.

June 10: A letter from Alabama Arise and 49 partner organizations urging Gov. Kay Ivey and legislators to oppose harmful SNAP cuts and cost shifts.

June 5: A letter from 52 Cover Alabama coalition partners, including Alabama Arise, urging Ivey and legislators to oppose harmful cuts to Medicaid and health coverage under the Affordable Care Act.

May 23: A statement from Alabama Arise on numerous ways that the U.S. House budget bill would harm struggling Alabama families,

Feb. 25: A letter from Alabama Arise and 111 partner organizations urging Alabama’s congressional delegation to oppose cuts to Medicaid and SNAP.

Jan. 29: A letter from Alabama Arise and 55 partner organizations urging Alabama’s congressional delegation to oppose further tax cuts for wealthy people.

Alabama Arise, partner groups urge Congress to reject devastating cuts to SNAP, health coverage

By Chris Sanders

Alabama’s congressional delegation should oppose a harmful budget bill that would reduce or remove food assistance, health coverage and other vital services for hundreds of thousands of Alabamians who struggle to afford basic needs, Alabama Arise and other advocates said Thursday during a Hands Off SNAP and Medicaid news conference at the State House in Montgomery.

The U.S. Senate could vote on the bill, HR 1, as soon as this weekend. The U.S. House passed its version of the legislation by a narrow 215-214 vote in May. Both versions include deep cuts to the Supplemental Nutrition Assistance Program (SNAP) and to health coverage under Medicaid and the Affordable Care Act. And both versions also include large tax cuts for wealthy households and highly profitable corporations.

Image of Alabama Arise executive director Robyn Hyden speaking behind a lectern with advocates standing behind her. Text: "Alabama Arise news release: Alabama Arise, partner groups urge Congress to reject devastating cuts to SNAP, health coverage."

“It’s wrong to hurt people who are struggling just to help people who are already far ahead. That’s exactly what the Senate is debating right now,” Alabama Arise executive director Robyn Hyden said during the news conference. “The budget moving through Congress is not only a moral failure. It’s bad policy, and it is a really bad deal for our state.”

Photos from the news conference are available here. A video of the news conference is available here. (Remarks start at the 2:00 mark.)

SNAP cuts would send hunger soaring, imperil local retailers

For every meal that food banks provide in Alabama, SNAP provides nine. But if state lawmakers could not or would not provide new SNAP funding required under the bill, Alabama could be forced to cut SNAP benefits significantly – or even eliminate the program altogether for nearly 800,000 participants statewide.

Deep SNAP cuts could leave food banks with a “perhaps insurmountable” challenge, said Michael Ledger, president and CEO of Feeding the Gulf Coast, a food bank serving southwestern Alabama, southern Mississippi and western Florida.

“We’re worried that SNAP reductions are going to have a dramatic impact on our ability to help our neighbors,” Ledger said. “We’ve seen so many people who would have never dreamed they’d be in that position, in that position. I think as a community, it’s our responsibility to make sure we help these people through those struggles. If we don’t, where do they go?”

A man speaks behind a lectern with advocates standing behind him.
Michael Ledger, president and CEO of Feeding the Gulf Coast, speaks at a news conference at the State House in Montgomery on June 26, 2025. (Photo by Matt Okarmus)

Rhonda Mann, executive director of VOICES for Alabama’s Children, said nearly 5,000 retailers statewide redeemed more than $2 billion in SNAP benefits in 2023. She said the wreckage of harmful SNAP cuts would reach far beyond program participants.

“SNAP is incredibly important to the economy of our state. So when you don’t think this affects you because you don’t receive SNAP benefits, think again,” Mann said. “What you’re going to see are the closings of food retailers, and that will hurt everybody. Access to food in some areas of our state is already a problem, and it could become a problem in every area of our state.”

SNAP cost shift would strain state budgets

The federal budget bill could add severe strain to Alabama’s General Fund budget. Under the House-passed bill, states would have to pay for a portion of SNAP benefits, which have been 100% federally funded for decades, according to a sliding scale. The bill also would require states to pay for 75% of SNAP administrative costs, up from the current 50%.

Those cost shifts could leave Alabama on the hook for more than $120 million a year in direct benefits and additional administrative costs. For a sense of scale, that amount would be almost identical to the state’s Education Trust Fund (ETF) budget appropriations next year for both Jacksonville State University and the University of North Alabama combined. In a worst-case scenario, the state could be forced to find nearly $300 million a year for SNAP. That would be more than the 2026 ETF appropriation for either the University of Alabama or Auburn University.

A woman stands behind a lectern with advocates standing behind her.
Alabama Arise executive director Robyn Hyden speaks at a news conference at the State House in Montgomery on June 26, 2025. (Photo by Matt Okarmus)

While increasing Alabama’s cost to administer SNAP, the bill also would expand work reporting requirements to cover many more participants. Hyden said these changes would harm many veterans, people experiencing homelessness, and young adults aging out of foster care. She also warned that many families could lose food assistance not because of a failure to work but because of a failure to complete complicated paperwork.

“These cuts will see hunger skyrocket while our state government, churches and charities and everyday working families are struggling to get by, and we’re all going to pay for that,” Hyden said. “It’s going to reduce our ability to fund existing essential services and programs. And we are going to be left on the hook to pick up the slack while billionaires and corporations run off with a bigger slice of the pie.”

Medicaid, ACA cuts would increase health care costs across Alabama

The Senate bill also would make health coverage more expensive or less accessible for tens of thousands of Alabamians. The legislation would allow the expiration of extra financial help for health coverage through HealthCare.gov and would block Alabama from receiving an additional $619 million in federal incentives to expand Medicaid to cover adults with low incomes. In total, nearly 200,000 Alabamians could lose health coverage as a result of the bill’s changes.

A woman speaks behind a lectern with advocates standing behind her.
Rhonda Mann, executive director of VOICES for Alabama’s Children, speaks at a news conference at the State House in Montgomery on June 26, 2025. (Photo by Matt Okarmus)

These coverage losses could make health care even less accessible in rural areas of Alabama, Mann said. Fourteen rural hospitals in the state have closed since 2010, and more than 20 others are at risk of closing.

“Medicaid dollars are for services and resources we all use, and cuts to Medicaid are going to result in increased health care costs for all of us,” Mann said.

Hyden underscored the human toll that losing health coverage could take on families and communities across Alabama.

“Cutting Medicaid and cutting the enhanced HealthCare.gov tax credits is going to mean one less early cancer diagnosis for your neighbor,” she said. “Your pregnant friend might die when her preeclampsia isn’t caught or treated in time because she has to drive over an hour to get to her doctor. Your daughter might experience a mental health crisis and have no way to access and pay for care.”

A woman speaks behind a lecture with advocates standing behind her.
Rev. Valtoria Jackson, the Montgomery lead organizer for the Alabama Poor People’s Campaign, speaks at a news conference at the State House in Montgomery on June 26, 2025. (Photo by Matt Okarmus)

Rev. Valtoria Jackson, the Montgomery lead organizer for the Alabama Poor People’s Campaign, called the bill’s proposed cuts to food assistance and health care “a war on the poor.”

“This is not just bad policy. It is a moral sin,” Jackson said. “We know that when people lose access to health care, they die. When food stamps are cut, hunger rises.”

‘Do something better for our state’

State Sen. Kirk Hatcher, D-Montgomery, said he sees up close the struggles that people living in poverty face, both as a legislator and in his role as Head Start director in Montgomery County. Passing legislation to make life even harder for struggling families would be “an absolute moral abomination,” he said.

“I do know what this particular bill and many of the things in it will do to damage the lives of so many,” Hatcher said. “Every life – and I do mean every life – has value. … We can do better.”

A man speaks behind a lectern with advocates standing behind him.
State Sen. Kirk Hatcher, D-Montgomery, speaks at a news conference at the State House in Montgomery on June 26, 2025. (Photo by Matt Okarmus)

Jackson said the federal budget bill would cause significant harm to “the least of these” and urged Congress to reject it.

“Budgets are moral documents, not just numbers. And this budget is morally bankrupt,” Jackson said. “The budget will not reduce poverty at all; it will increase it. It will not help seniors live with dignity; it will push them deeper into despair. It will not uphold Alabama’s moral values; it will betray them.”

Hyden closed by urging U.S. Sens. Katie Britt and Tommy Tuberville to oppose cuts to food assistance and health care and to focus instead on policies that would improve the well-being of every Alabamian.

“We have time to ask Congress to do something better for our state,” Hyden said. “We ask you to protect essential services like SNAP and Medicaid to help us build strong, healthy communities. For the future of our state, for our children and families, for all of us who struggle and anyone who might struggle, please vote no on HR 1.”

More resources

Thursday: A photo gallery and a video livestream from the Hands Off SNAP and Medicaid news conference at the State House in Montgomery.

June 10: A letter from Alabama Arise and 49 partner organizations urging Gov. Kay Ivey and legislators to oppose harmful SNAP cuts and cost shifts.

June 5: A letter from 52 Cover Alabama coalition partners, including Alabama Arise, urging Ivey and legislators to oppose harmful cuts to Medicaid and health coverage under the Affordable Care Act.

May 23: A statement from Alabama Arise on numerous ways that the U.S. House budget bill would harm struggling Alabama families.

Feb. 25: A letter from Alabama Arise and 111 partner organizations urging Alabama’s congressional delegation to oppose cuts to Medicaid and SNAP.

Jan. 29: A letter from Alabama Arise and 55 partner organizations urging Alabama’s congressional delegation to oppose further tax cuts for wealthy people.