Issue: Medicaid Expansion

To strengthen the common good: Six principles for allocating Alabama’s ARPA funding

By Alabama Arise

To strengthen the common good: Six principles for allocating Alabama's American Rescue Plan Act funding

Introduction

Dear Governor Ivey,

One of the darkest years in recent memory has put Alabama’s families, communities, health system, businesses – and our leaders at all levels – to the test. Thank you for all your efforts to keep Alabamians safe and secure during this unprecedented emergency. Now that a post-COVID world is dawning, the leadership test doesn’t end. Rather, it enters a critical new phase: Your vision and your actions will help determine what a post-COVID Alabama looks like, and history will record the results. Will the comfort of the familiar pull us back into “the way we’ve always done things”? Or will we count this ordeal as an awakening to bold new possibilities for our state?

For the organizations listed below, all signs point to the second option: The opportunity to address chronic problems that the pandemic has only worsened; a chance to inspire Alabamians with a recovery plan that lifts all communities toward a healthier, more prosperous future; and – most pragmatically – the power of $4 billion in new federal funding to turn vision into reality. We enclose for your consideration six principles that we believe can guide state and local leaders in the most productive, equitable and lasting use of these tax dollars.

The signers of this letter are advocates who work closely with the communities hit hardest by the COVID-19 health and economic crises. For these Alabamians, recovery from the pandemic must mean more than restoring the pre-COVID status quo. With courageous and creative leadership, community engagement across the state, and wise use of historic levels of funding, we have what we need to move Alabama forward and strengthen the common good.

We stand ready to answer any questions you may have about our recommendations.

Respectfully submitted,

The Undersigned Alabama Organizations

Signatories

The following organizations support a principled approach to American Rescue Plan Act funding that will strengthen Alabama’s common good:

ADAP
AIDS Alabama
Alabama Appleseed Center for Law and Justice
Alabama Arise
Alabama Coalition for Immigrant Justice
Alabama CURE
Alabama Possible
Alabama Solutions
Alabama State Conference of the NAACP
Bay Area Women Coalition, Inc.
Birmingham Society of Friends
BirthWell Partners Community Doula Project, Birmingham
Church & Society, Anniston First United Methodist Church
Community Enabler Developer, Inc.
Disabilities Leadership Coalition of Alabama
Disability Rights & Resources
The E.WE Foundation
Faith and Works Statewide Civic Engagement Collective
Grace Presbyterian Church (PCUSA), Tuscaloosa
Greater Birmingham Ministries
Hispanic Interest Coalition of Alabama
Hometown Action
Immanuel Presbyterian Church (PCUSA), Montgomery
Jobs to Move America
League of Women Voters of Alabama
Medical Advocacy & Outreach
The Nightingale Clinic, Birmingham
Nurse Practitioner Alliance of Alabama
Open Table United Church of Christ, Mobile
People First of Alabama
Project Hope to Abolish the Death Penalty
Restorative Strategies, LLC, Birmingham
Sisters of Mercy
Sisters of St. Joseph
The Sisters, Tuscaloosa
St. Luke’s Episcopal Church, Jacksonville
Unitarian Universalist Fellowship of Mobile
University of Montevallo Social Work Program
Volunteers of America Southeast
West Alabama Women’s Center
YMCA of Birmingham
YWCA of Central Alabama

Letter text

To Strengthen the Common Good: Six Principles for Allocating Alabama’s American Rescue Plan Act Funding

The COVID-19 crisis has created enormous new challenges for Alabama, while shining a harsh light on long-neglected ones. To strengthen and expedite recovery, the American Rescue Plan Act (ARPA), passed by Congress in March 2021, is pumping $4 billion into Alabama’s economy over the next three years. New funding at this scale can be transformative for our state, but only if we take a transformative approach to how we spend it.

The starting point is recognizing and breaking our old mindset of scarce resources, limited possibilities and patchwork policy solutions. For too long, Alabama’s leaders – and the voters who empower them – have settled for poor outcomes in health, education, community development and other measures of shared prosperity, because they thought we couldn’t tackle such deep problems. The pandemic is challenging us to reclaim – and redefine – the common good. ARPA funding gives us a rare opportunity to meet the challenge, if we’re willing. The undersigned organizations offer the following six principles as a framework for seizing this unprecedented opportunity to build a better Alabama for all.

  1. Engage local communities at every step.

    The COVID pandemic has hit people where they live, work, learn and play. The best use of ARPA funds will reflect the needs and goals identified by ordinary Alabamians through a process that solicits, accommodates and heeds public input.

Crucial question

How are local leaders, advocates and community members involved in identifying and prioritizing both needs and solutions?

Recommendations
  • Identify or create effective, inclusive, results-oriented, nonpartisan, community-based councils in each county or region to develop recommendations for local ARPA funding priorities. Potential lead organizations may include United Way, community foundation or Community Action Agency advisory bodies; children’s policy councils; university extension services; or community round tables convened by local governments. Make it a priority to engage segments of the community underserved by the status quo, such as Alabamians of color, people who work for low wages or have lost jobs, and those who lack adequate basic services.
  • Provide opportunities for broad public participation in developing and finalizing local, regional and state ARPA spending plans. State leaders should agree not to appropriate ARPA funds until the public engagement process is completed.
  • Review existing community and state needs assessments to identify common local concerns, as well as gaps in information and perspective.
  • Facilitate information-sharing and coordination among local, regional and state efforts to enhance efficiency, leverage capacity and avoid duplication.
  • Designate a statewide source of technical assistance, best practices and other aids to local and regional decision-making.

  1. Aim for equity in outcomes.

    Some regions, counties, municipalities and populations have suffered deeper blows than others from the pandemic because of chronic gaps in resources, infrastructure, services and opportunities. Rural Alabamians, people of color, people with disabilities, and women have faced disproportionate impacts from both the health and economic crises. Simply restoring the prior status quo is not transformation. ARPA funding decisions should take into account the un-level playing field of COVID recovery, targeting investment toward improving the basic standards of living for areas and people long left behind. Assistance to those most deeply impacted by COVID-19 should come with as little “red tape” and administrative delay as possible. Direct cash assistance to people with low incomes should be a priority.

Crucial question

How do proposed funding allocations contribute to the removal of historic barriers to individual, family and community well-being?

Recommendations
  • Within each jurisdiction (state, region, county, city), use socioeconomic indicators such as poverty, unemployment and workforce participation rates, and racial/ethnic health disparities to target strategic, expedited community investments.
  • Provide grants to minority- or women-owned small businesses, especially those that did not receive earlier federal business loan assistance.
  • Provide up to $13 per hour in bonus or “premium” pay – on top of their regular pay – to essential public and private workers, up to $25,000 per worker per year, as allowed under the Rescue Plan, for work performed during the public health emergency, awarding the largest bonuses to the lowest-paid workers.
  • Provide cash assistance to SNAP food assistance recipients with incomes below 50% of the Federal Poverty Level.
  • Provide a grocery tax rebate to households earning less than 200% of the federal poverty level.
  • Fund and train organizations that already help people access SNAP, Medicaid, tax credits and other supports as navigators for the full range of ARPA assistance, including the expanded federal Child Tax Credit.

  1. Maximize well-being by addressing health in all policies.

    What began as the COVID-19 health emergency quickly became an economic and social crisis. In turn, the toll the virus has taken on communities of color, people with disabilities and the uninsured revealed how deeply socioeconomic conditions are connected to health risks and outcomes. Nutrition, housing, transportation, education and other factors are widely recognized as social determinants of health, but Alabama has been slow to broaden our approach to health policy and funding. ARPA offers us the chance to apply the lessons of COVID-19 and design a recovery plan that puts eliminating health disparities and improving health at the center of investments in every sector.

Crucial question

How does this funding proposal advance the goal of a healthier Alabama?

Recommendations
  • Name it and claim it: There’s enough ARPA funding to achieve significant health improvement in Alabama if leaders set clear, ambitious goals and plan accordingly. 
  • Engage public health experts to incorporate health goals and strategies across the full span of ARPA allocation planning.
  • Increase professional staffing at county health departments.
  • Strengthen our workforce, families and communities by using the generous ARPA incentives (an estimated $720 million) to expand Medicaid and close the coverage gap for 340,000 Alabamians with low incomes.
  • Invest in mobile mental health crisis services and expand mental health crisis centers.
  • Expand school nurse programs and school-based mental health services.
  • Fund Healthy Food Financing grants for fresh food markets, including mobile markets, as well as local worker-owned food cooperatives to boost local economies, provide jobs and expand availability of fresh foods in food apartheid areas (where healthy food access is hindered by racially discriminatory economic or political factors) and food swamp neighborhoods (where food and beverage sources like fast food outlets, convenience stores and liquor stores crowd out healthier food options).

  1. Invest in existing assets and capacities to help funds work faster, go farther and avoid duplication.

    Over recent decades, budget cuts to education, public health and other essential services – and our failure to expand Medicaid – have left Alabama unprepared for a prolonged emergency like COVID-19. Similarly, charitable nonprofit organizations across the state have faced unprecedented demand for their services during the pandemic and risen to the challenge. By directing ARPA funds to restoring critical services and supporting experienced, trusted charitable nonprofits, state and local governments can strengthen community resources, meet needs efficiently, avoid reinventing the wheel, and multiply the economic benefit.

Crucial question

What programs and organizations are already working to meet the goals of this ARPA funding proposal, and how can a partnership approach improve outcomes?

Recommendations
  • Fund organizations that are well-positioned to reach people with significant barriers to accessing support, such as immigrants, people with disabilities and people of color with low incomes.
  • Expand community schools in neighborhoods where the pandemic has taken a particularly heavy toll.
  • Provide additional funding for existing in-home early childhood education services like HIPPY, Parents as Teachers and Nurse-Family Partnership programs.
  • Increase support for school-based social and health services, particularly in high-poverty neighborhoods and districts.
  • Help children catch up on unfinished learning by expanding the teacher workforce through pay increases and other supports for early childhood teachers, child care workers and special education teachers who work in at-risk communities and schools.
  • Expand existing in-home and community-based services for the elderly and people with disabilities.
  • Expand or develop local alternatives to incarceration such as specialized courts, community correction programs, re-entry programs and services for people at risk of offending.
  • Invest in workforce development by creating subsidized apprenticeships, two-year scholarship programs, and subsidized certificate programs for low-income workers.

  1. Think big and create a 21st-century infrastructure for the common good.

    Alabamians have long recognized the human cost of inferior and outdated public works and services like sanitation, health care, transportation and information technology systems. But the monetary cost has kept our leaders from modernizing them. COVID has revealed the deadly consequences of that neglect, and ARPA includes massive funding aimed at moving states forward on all of these fronts, including a large share for education (not addressed in these recommendations because of specific earmarking). The opportunity calls for bold leadership and vision. Our spending plan must seek to coordinate local, regional and statewide investments for fundamental and long-lasting impact.

Crucial question

How will today’s investments benefit future generations of Alabamians?

Recommendations
  • Modernize and align state agency computer systems to create a “no wrong door” approach to streamlined eligibility and enrollment across benefit programs.
  • Modernize and improve state unemployment insurance (UI) technological infrastructure, application and payment systems.
  • Upgrade water and sanitation systems, prioritizing communities with a history of unsafe water quality and waste-water disposal.
  • Provide critical infrastructure and equipment (such as trucks, refrigeration, trainers, lift gates, etc.,) to local food banks and food pantries to expand emergency food distribution.
  • Expand Alabama’s affordable housing capacity, stabilize families and communities and reduce homelessness by seeding the Affordable Housing Trust Fund with $25 million and providing grants for eligible new construction, renovation and maintenance.
  • Recognizing that lack of reliable transportation is a major hindrance to health care, economic activity and workforce development in many areas of the state, seed the Public Transportation Trust Fund with $20 million and provide state match for increased federal public transportation funding.
  • Promote equity in high-speed internet access by targeting earmarked broadband funding to help local service providers expand into underserved areas and by ensuring community oversight of access and quality standards.
  • Provide state technical assistance to localities in consolidating, evaluating and negotiating broadband contracts to minimize the danger of approving projects with little public benefit.

  1. Build public trust and engagement by following the highest standards of documentation, transparency and accessibility of information about funding awards and expenditures. 

    Spending taxpayer dollars is always a tremendous responsibility. When it comes to spending billions in a short time, the potential for slow uptake, poor decisions and misuse only increases. Alabama can ensure that the generous ARPA funds do their appointed job by establishing clear guidelines and full disclosure for the entire funding process, from eligibility of applicants to allocation decisions to project expenditures and results.

Crucial question

How will Alabamians be able to track the allocation, use and impact of their federal ARPA tax dollars in the state?

Recommendations
  • Create and maintain a public database of state and local ARPA funding allocations and expenditures, easily searchable and sortable by project or partner name, policy topic, service area, grant amount, award date, expenditure date and other key factors.
  • Adopt simple, accessible application and reporting requirements that allow grantees and recipients to establish their credibility and tell their story without jumping unnecessary bureaucratic hurdles.
  • Use local ARPA planning groups as conduits for ongoing reporting and feedback about plan implementation, obstacles, impact and sustainability. Build a robust outreach operation to help people access available federal, state and local aid.

Federal relief funds could transform Alabama’s future

By Carol Gundlach

How often have we gotten to say that it’s raining money in Alabama? That’s the image that comes to mind as the American Rescue Plan Act (ARPA), passed in March, begins to direct more than $4 billion in new federal funds into the state over the next three years.

The funding could help Alabama make historic progress in public health, education, family well-being and community viability if spent wisely and equitably. It also offers generous incentives that would more than offset the state’s initial cost to expand Medicaid. This new COVID-19 relief comes on top of $1.9 billion Alabama got under the CARES Act last year.

The state government will receive more than $2 billion under ARPA. Counties will get nearly $1 billion. Alabama’s 21 largest cities will receive more than $400 million, and other municipalities will get nearly $400 million as well. Both the state and localities may use funds to offset the pandemic’s strains on families, small businesses, public health and infrastructure like water and sewer systems and high-speed broadband networks.

Portions of ARPA money are earmarked for direct payments to local school districts. Other funds are dedicated to provide rental assistance and make child care more affordable and accessible.

The act also temporarily boosts the Child Tax Credit and Earned Income Tax Credit and temporarily increases food aid under the Supplemental Nutrition Assistance Program and WIC. In addition to these supports, ARPA also provides one-time cash payments ($1,400 each for most Americans). And it provides direct assistance for health care, funeral expenses and other essential needs.

Arise will continue to follow these funding streams with the goal of ensuring equitable distribution and transparency. And we will advocate to make the temporary improvements permanent in the next round of federal relief.

Arise advances justice in a pandemic session

By Chris Sanders

Advocacy barriers for Alabama Arise members were extraordinarily high during the Legislature’s 2021 regular session. The COVID-19 pandemic limited physical access to the State House and made a difficult policy landscape even rockier.

But Arise members were undeterred. They spoke out forcefully and repeatedly for justice and opportunity. And the result was real, meaningful progress on multiple issue priorities.

This year brought advances on criminal justice reform and internet access. It delivered stronger investment in early education and preserved funding for Medicaid and mental health care. And it saw efforts to chill free speech and erode the Department of Public Health’s effectiveness defeated.

Wins on expanding broadband, reforming civil asset forfeiture

Arise members made their presence known throughout the session. They gathered monthly for online Membership Monday events to stay engaged and connect with advocates across Alabama. On May 18, nearly 100 people attended a virtual recap event to debrief the session and prepare for next steps. And throughout the year, our supporters flooded email inboxes and rang phones off the hook, contacting legislators and Gov. Kay Ivey more than 14,000 times.

Arise action alerts by the numbers This year, Arise’s dedicated members and supporters consistently reached out to lawmakers when we asked. It’s impossible to overstate just how critical it is for our legislators to know what their constituents want. We’re so grateful to everyone who sent messages from our action alerts during this session. Here are a few examples of just how many messages you sent to legislators and the governor in response to Arise and Cover Alabama action alerts during the 2021 regular session: Medicaid expansion: 12,442 Voting rights and protecting free speech: 597 Protecting public health: 406 Civil asset forfeiture reform: 266 Other criminal justice reforms: 389

 

That advocacy worked. Lawmakers passed SB 215 by Sen. Del Marsh, R-Anniston, to promote broadband expansion to rural communities and other underserved areas. And legislators finally began to rein in civil asset forfeiture, a practice that allows law enforcement to seize property without a criminal conviction.

SB 210 by Sen. Arthur Orr, R-Decatur, doesn’t end civil asset forfeiture, but it makes some important initial improvements. Those changes include exempting some property from forfeiture and strengthening protections for innocent owners.

Successful defense against public health threats, anti-protest bill

Arise advocacy helped stop harmful proposals as well. Our members played a key role in blocking a plan to limit the governor and public health officials’ ability to respond to emergencies like the COVID-19 pandemic. After our members sounded the alarm, SB 97 by Sen. Tom Whatley, R-Auburn, lost a House procedural vote in the session’s final hours.

Arise members also helped halt a threat to free speech. HB 445 by Rep. Allen Treadaway, R-Morris, would have expanded law enforcement’s powers to arrest protesters for “rioting” and imposed harsh mandatory minimum sentences on people convicted under the law. The bill passed in the House but died in the Senate.

The Legislature likely isn’t done this year. Lawmakers expect one or more special sessions to address unfinished business like redistricting, prison overcrowding and allocating federal relief funds. Whenever the next session may be, Arise members will be ready, advocating as always for a better, more inclusive Alabama.

Arise legislative recap: May 27, 2021

By Alabama Arise

Arise’s Robyn Hyden recaps the Alabama Legislature’s 2021 regular session. She discusses several policy wins that Arise members should celebrate, including the defeat of legislation that would limit the right to protest and passage of a bill to promote equitable access to broadband.

New report profiles essential workers most likely to lack health coverage in Alabama

By Chris Sanders

Medicaid expansion would increase access to life-saving health care while also advancing racial and gender equity in Alabama, according to a new report by the Georgetown University Center for Children and Families (CCF). Expansion also would ensure coverage for tens of thousands of essential workers in industries like health care, retail and construction.

“Everyone in Alabama has relied on these essential workers in some way during the COVID-19 pandemic,” Alabama Arise policy director Jim Carnes said. “Now it’s our turn to help them get reliable, affordable health insurance so they can continue to do their jobs and care for their families. It’s time for Alabama to accept generous federal funding to expand Medicaid to our state’s uninsured workers.”

Alabama is one of 12 states that have not yet expanded Medicaid to cover adults with low incomes. This inaction has denied hundreds of thousands of Alabamians access to quality, affordable health care.

Approximately 204,100 uninsured adults – 49% of Alabama’s uninsured adult population – would gain coverage if Alabama expands Medicaid, Georgetown CCF estimates. That estimate is in line with prior projections that Medicaid expansion would benefit more than 340,000 Alabamians who are uninsured or struggling to afford coverage.

These residents earn too much to qualify for Medicaid under the state’s stringent income limit but too little to qualify for subsidized marketplace plans under the Affordable Care Act. As a result, they are stranded in a health coverage gap.

Expanding Medicaid would save lives, advance racial and gender equity

Women and Black people account for a disproportionate share of low-wage uninsured working Alabamians, the Georgetown CCF report finds. Black people represent about 27% of Alabama’s overall population but 39% of the state’s low-wage uninsured workers. Women also are overrepresented in this category, making up 55% of low-wage uninsured Alabamians.

These uninsured residents work in vital but low-paid jobs. More than one-third of Alabamians working without health insurance (35.2%) are in the hospitality or retail industries, the report finds. Another one in five work in construction or in health care and social assistance.

Alabama’s uninsured rate for working people (12.1%) exceeds the national average. In 11 counties, more than 15% of working people are uninsured, Georgetown CCF finds. The highest rates are in DeKalb County (19.2%) and Dale County (18.2%).

The map below shows the range of uninsured rates for working adults across Alabama. Hover over the map to see the rate in your county.

Nearly seven in 10 Alabamians support expanding Medicaid to reduce these disparities, a statewide poll found in February. And the American Rescue Plan Act offers federal incentives that would more than offset Alabama’s initial cost to expand Medicaid.

If Gov. Kay Ivey agrees to expansion, the law would give the state a 5-percentage-point increase in federal funding for its traditional Medicaid coverage for two years. That would bring Alabama an additional $732 million over two years, based on an average of federal, state and independent estimates.

‘It’s time for someone to stick up for us’: Walker County’s need for Medicaid expansion

By Whit Sides
Rev. Robin Hinkle stands in front of the sign for St. Mary's Episcopal Church
Rev. Robin Hinkle is the rector at St. Mary’s Episcopal Church in Jasper. Her ministry has greatly scaled up food assistance to the community to help ease financial suffering during the COVID-19 recession. (Photo courtesy of St. Mary’s Episcopal Church)

Walker County has gained notoriety in recent years as one of the epicenters for Alabama’s opioid epidemic. Overprescribing, lack of health care access and extreme poverty seemed to form a cursed trifecta leaving residents of the rural county to rebuild and recover.

Outside the headlines, community organizations and rural health advocates have been earning praise for their efforts to bring as many resources as possible to the northwest Alabama county of 67,000 people.

“If there’s a problem, you don’t have to look far for someone to help,” said Rev. Robin Hinkle of St. Mary’s Episcopal Church in Jasper.

Hinkle’s ministry has scaled up its food assistance to the community exponentially in the last year. The church went from distributing about 250 bags of food a week to more than 1,000 bags a day. Hinkle said the COVID-19 pandemic and its associated recession left more people than ever in need.

“The system is absolutely not working as it is, especially with the state and local governments,” she said.

Hinkle said many people she works with do receive Supplemental Nutrition Assistance Program (SNAP) benefits or other public assistance. But the income restrictions attached often force people to make painful decisions.

“I see it all the time,” Hinkle said. “When you lose your insurance and paycheck, what used to be $5 at the pharmacy is now $40. And the first thing you give up is medicine.”

‘A big, giant problem’

Hinkle said she has been offering more financial assistance than expected to families on the margins of the middle class. Many of these households have been hit hard by the pandemic, too. And resources can be scarce for families who make too much to qualify for public assistance, but still not enough to reliably pay the bills.

These are the families who are in Alabama’s health coverage gap. They make too much money to qualify for Medicaid under the state’s stringent eligibility limits but not enough to get a subsidy to help pay for a private insurance plan on the health care marketplace.

Alabama is one of 12 states that have not expanded Medicaid to cover adults with low incomes. Even before the pandemic, more than 220,000 Alabamians were caught in the coverage gap. And another 120,000 were stretching to pay for coverage they can’t afford.

“This is a big, giant problem,” Hinkle said. “Once you lose a job or are forced to work minimum wage, it’s very hard to be poor because of all the gaps in our system.”

Medicaid expansion would relieve the burden on families and those deciding whether to pay for medicine or buy groceries, Hinkle said.

“If we had better access and treatment options, it’s better all around,” she said. “Every dollar counts. If we could just get the resources, we can work to solve the problem just like we’ve done before.”

Removing barriers and strengthening rural clinics

Over the past decade, community organizations have come together to form networks bringing more money and treatment options into the county. Spearheaded by the Walker County Community Foundation, the Healing Network of Walker County includes 25 organizations providing prevention, intervention, treatment and recovery resources for mental health and substance use disorders.

One of those partners is Capstone, a group of rural health clinics located across Walker and neighboring Winston counties.

“Over half of our patients are uninsured, and the majority of the others receive Medicare or Medicaid,” said Dr. F. David Jones, executive director of Capstone Rural Health in Parrish.

Jones is one of more than 300 medical professionals who signed a joint letter last week urging Gov. Kay Ivey to expand Medicaid.

Photo of Dr. F. David Jones
Dr. F. David Jones is executive director of Capstone Rural Health in Parrish. He said Medicaid expansion would allow clinics like his to grow and serve more people across Walker County. (Photo courtesy of Capstone Rural Health)

Capstone’s clinics often house primary care, dentistry, pharmacy, social work and mental health care under one roof. While this one-stop shop can be invaluable for rural communities, Jones said access barriers are always involved when someone is struggling to make ends meet.

“We do still need to see valid ID, a bill showing your current address, and proof of income, which can be hard to get if you’re unemployed or don’t have a license,” he said.

Jones said the clinic tries to treat everyone who comes in. But even with local help, they can’t do it all.

“Communities can keep casting off the poor by just ignoring all their problems or burdening the church, but they need us more than they realize,” he said.

Medicaid expansion’s life-saving potential in Walker County

An injection of money from Medicaid expansion could be a lifesaver, Jones said. The funding could ease the burden placed on community health centers and UAB to treat areas of Walker County with low access.

“Medicaid expansion is a no-brainer,” he said. “With that kind of money coming in, we would grow. We could bring professionals in, and it could prop up a lot of the other community health centers that do good work.”

Jones said he hopes Alabama can put aside partisan politics and finally take advantage of the taxes we already use to pay for Medicaid expansion in other states.

“I hope the governor will sign on,” he said. “It’s time for someone to stick up for us. We should’ve been at that table a long time ago.”

About Alabama Arise and Cover Alabama

Whit Sides is the story collection coordinator for Alabama Arise. Arise is a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of Alabamians with low incomes.

Arise is a founding member of the Cover Alabama Coalition. Cover Alabama is a nonpartisan alliance of more than 100 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.

American Rescue Plan Act offers path to recovery

By Chris Sanders

As vaccinations continue across Alabama, COVID-19’s viselike grip on our lives is loosening. The pandemic has caused immense physical, emotional and economic suffering, and those aftereffects will not fade quickly. But the American Rescue Plan Act – the federal relief package that President Joe Biden signed March 11 – includes many important policies to begin the healing.

Some of the most crucial investments come in health care. The law increases subsidies for marketplace health coverage under the Affordable Care Act. It also creates new incentives that would more than offset the cost of Medicaid expansion. The incentives would remove Alabama’s last financial barrier to extending coverage to more than 340,000 adults with low incomes.

If Gov. Kay Ivey agrees to expand Medicaid, Alabama would receive between $740 million and $940 million over two years. That would result from a 5-percentage-point federal funding increase for traditional Medicaid coverage.

Alabama State Capitol in Montgomery

“Medicaid expansion is the single biggest step Alabama can take to recover from the pandemic,” Alabama Arise campaign director Jane Adams said.

“Congress did their job. Now it’s time for the governor and state lawmakers to do theirs.”

The act also slashes poverty by boosting unemployment insurance and nutrition assistance benefits and expanding the Child Tax Credit and Earned Income Tax Credit. It funds rental and mortgage assistance to help prevent evictions and foreclosures. And it provides Alabama’s state and local governments with $4 billion of federal assistance to help avoid cuts to education and other vital services.

Persistent disparities – and how to end them

The relief package provides opportunities to begin dismantling longtime structural barriers in Alabama. Arise offers many such policy recommendations in our recent report, The State of Working Alabama 2021, which details how COVID-19 cost hundreds of thousands of Alabamians their jobs and fueled a rapid surge of hunger and hardship across our state.

COVID-19’s toll has been especially heavy for women and people of color, the report finds. The pandemic exacerbated Alabama’s preexisting racial, gender and regional disparities in health care, housing, nutrition and economic opportunity. These inequities – the legacy of bad policy decisions – prevent Alabama from reaching its full potential.

“Alabama’s economic, racial and gender inequities are preventable and reversible,” Arise policy director Jim Carnes said. “By making better policy choices now and in the future, we can chart a path toward a more equitable economy.”

A healthier Alabama is just over the horizon

By Jim Carnes

340,000+ Alabamians need our help. The time is now! Together, we can expand Medicaid.I am thrilled to report that Alabama is closer to expanding Medicaid today than we’ve ever been before! Thanks to your strong advocacy, our leaders are beginning to see the connections between the COVID-19 pandemic and unequal access to health care. They’re facing the fact that rural communities, primary care providers and everyday Alabamians are buckling under the weight of a broken health care system.

Hundreds of thousands of friends and neighbors with low incomes have had to navigate the pandemic without health insurance. Alabama can do better. We can close the coverage gap now.

Alabama Arise has a goal of raising $50,000 before June 30 to accelerate our efforts to expand Medicaid in 2021. Will you consider making a contribution of any amount you feel comfortable giving?

How your support has helped protect and improve health coverage

For nearly 11 years now, Alabama’s leaders have stemmed the national tide of Medicaid expansion. They’ve let the three-year grace period of full federal funding for Medicaid expansion expire. They’ve watched most rural hospitals teeter on the brink and eight of them close.

Our lawmakers have allowed hundreds of thousands of Alabamians with low incomes to face a pandemic without health insurance. And they’ve ignored a report from their own legislatively authorized review committee recommending Medicaid expansion as the single biggest step to address Alabama’s maternal mortality crisis. Meanwhile, 38 states and the District of Columbia have opened Medicaid coverage to adults with low incomes. No state has reversed this life-saving decision.

It might feel like an 11-year stalemate, but we have slowly moved the ball forward. And your persistence has changed the game. Arise members and our partners have engaged policymakers on their own terms to protect and improve Medicaid.

  • When they said we couldn’t expand a “broken” system, you helped shape reforms that brought community voices to the Medicaid policy table.
  • When they said we needed to scrap the Affordable Care Act and risk losing Medicaid altogether, you pushed back and stopped the effort cold.
  • And when they said Medicaid consumers needed more “skin in the game,” you helped collect more than 1,800 public comments opposing a Medicaid work requirement and blocked the proposal.

Photos of Alabama Arise members speaking out for Medicaid expansion at our annual meeting and Legislative Day.

Medicaid expansion is now within reach in Alabama

Now, as news reports confirm that Alabama policymakers are no longer “dug in” against Medicaid expansion, 11 years of hard work and steady vision have brought the prize within reach. As you know, the federal government pays 90% of the cost for Medicaid expansion. In Alabama, more than 340,000 adults with low incomes would receive affordable health coverage in the bargain. The state would chip in just a dime on the dollar for their care.

That bargain would pay wider dividends as the new funding creates jobs and generates new tax revenues throughout the economy. As one Alabama hospital executive put it, if our state recruited a new factory with the same economic impact as Medicaid expansion, we would have a parade from Huntsville to Mobile!

For 11 years, our leaders have left this offer on the table, claiming a dime was too much to pay for a dollar’s worth of health care. Now, the pandemic has put Alabama’s health care – and our health itself – in a harsh new light. Our state leaders are finally getting the message.

It’s been a long 11 years, some of them dark and dreary. But you’ve kept pushing, and the light is breaking through.

We have bipartisan Medicaid support. We have a new administration in Washington that has dedicated funding to incentivize Medicaid expansion. And we have a community of more than 340,000 Alabamians who deserve access to affordable medical care.

We need your support now more than ever to support what we hope is our final push. Will you consider making a donation of any amount today to help Arise reach our goal? Please give today to support our Medicaid expansion campaign.

New Medicaid expansion incentive clears the path to a healthier Alabama

By Jim Carnes

The American Rescue Plan Act of 2021 answers a question Alabama policymakers have been asking for years: How can we pay for Medicaid expansion? It’s a solution that lawmakers should embrace immediately to build a better, healthier future for our state. And it’s a step you can urge the governor to take today.

An incentive in the new federal COVID-19 relief package means Medicaid expansion in Alabama effectively would pay for itself. Medicaid expansion would bring peace of mind to more than 340,000 adults with low incomes who are uninsured or struggling to afford health coverage. It also would save lives, create jobs and help protect rural hospitals across our state.

If Alabama agrees to expansion, the law will reduce the state’s costs to provide Medicaid coverage for the much larger non-expansion population for two years. This offer would add 5 percentage points of federal funding to the generous match Alabama already receives for Medicaid expenditures.

The enhanced federal match would create more than enough General Fund (GF) “breathing room” to cover the state’s 10% share of Medicaid expansion costs for the first two years, which are the most expensive. Since 2014, Alabama taxpayers have paid $4 billion in federal taxes to help support Medicaid expansion in other states. This new provision is an unprecedented opportunity to bring some of those tax dollars home to cover Alabamians.

How the new federal Medicaid incentives work

Alabama’s “regular” Medicaid match rate (known as the Federal Medical Assistance Percentage, or FMAP) adjusts slightly from year to year. It will be 72.37% for 2022. And the state already is receiving an additional 6.2-percentage-point boost until the COVID-19 public health emergency ends. That brings the overall federal share to 78.57%.

With the additional 5 percentage points, Alabama’s federal match to cover current Medicaid enrollees would increase to 83.57% until the emergency ends. (It would revert to 77.37% for the remainder of the two-year incentive period after the emergency.) An even higher federal match of 90% will apply permanently to coverage for people newly eligible under Medicaid expansion.

Estimates of the value of Alabama’s incentive over the two years range from $740 million (Kaiser Family Foundation) to $940 million (Center on Budget and Policy Priorities). Even at the lower end, the increase would free up far more than the state’s estimated net share of the first year of Medicaid expansion ($168 million).

Research findings from UAB – and other states’ experiences – suggest Alabama’s net costs will drop dramatically after Year 1. (A UAB study projects the state’s net cost for expansion will be around $25 million a year in Alabama.) That’s because the increased federal funding would produce new tax revenues and offset previous state spending on newly covered services.

Alabama is one of 14 states eligible for the new incentive. They include two states – Missouri and Oklahoma – that have passed expansion by referendum but haven’t implemented it yet. They also include the 11 other states, mostly in the South, that have not yet moved to expand Medicaid. Those states are Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

Why the time for Alabama to expand Medicaid is right now

Timing is a critical factor. While the two-year incentive offer remains available for 10 years, current conditions are especially favorable for Medicaid expansion in Alabama. Medicaid will enter the 2022 budget year with a $252 million “carryforward” from this year.

That surplus likely will allow lawmakers to reduce Medicaid’s GF appropriation next year and keep some funds in reserve. The 2022 GF budget that legislators are considering also was written before the new 5-percentage-point boost became available. So the difference truly would be a windfall.

Alabama can’t use federal funds to match federal funds. But hundreds of millions of dollars of additional, unanticipated federal money would relieve pressure on state budgets. And that would free up enough state funds to pay for Alabama’s share of Medicaid expansion for many years.

The Medicaid expansion incentive is a part of federal COVID-19 relief funding for a reason. The pandemic has tested our health care system to its limits. Besides killing more Alabamians than all modern wars combined, the crisis has revealed deep gaps in care and coverage that leave hundreds of thousands of Alabamians extra vulnerable to the virus and unable to pay for the care they need. A “lost year” has left local communities, businesses and families reeling.

The single biggest step our leaders can take to bridge Alabama’s health care gap and accelerate our economic recovery is to expand Medicaid. The new federal incentive removes the last hurdle in our way. It’s time to expand Medicaid now.

You can speak up now for this investment in a healthier future for Alabama. Click here to email Gov. Kay Ivey and urge her to save lives and create jobs by expanding Medicaid.

Arise legislative recap: March 12, 2021

By Alabama Arise

Arise’s Carol Gundlach breaks down the American Rescue Plan and what it means for Alabama families including expansions to the Child Tax Credit and EITC helping to reduce poverty across Alabama.