Resource: Fact Sheet

How to get involved in Alabama’s legislative process

By Jim Carnes

Most people recognize the vital role that voting plays in a democracy – even if they don’t vote. But fewer understand the citizen’s role in lawmaking. Using your power as a constituent to influence legislators is called lobbying.

Alabama Arise promotes its interest – the well-being of Alabamians with low and moderate incomes – not by “wining and dining” lawmakers but by presenting well-researched policy analysis and lifting up the strong voices of Arise members who live in their districts. We hope you can use the information in this fact sheet to sharpen your skills as a citizen lobbyist.

How the legislative process works

Alabamians elect their state officers (Governor, Lieutenant Governor, etc.) and members of the Legislature every four years. These elections occur during the even-numbered years that don’t feature a presidential election. The Legislature’s four-year cycle is called a quadrennium.

The Alabama Legislature has two chambers:

  • The Senate has 35 members (senators) from the 35 Senate districts. The presiding officer is the Lieutenant Governor. In his or her absence, the role is filled by the President Pro Tempore (president “for a time”) – called President Pro Tem for short – who is elected from the Senate by its members at the start of the quadrennium.
  • The House of Representatives has 105 members (representatives) from the 105 House districts. The presiding officer is the Speaker of the House, elected from the chamber by its members at the start of each quadrennium. The Speaker Pro Tem presides in the Speaker’s absence.

Regular sessions and special sessions

The annual period when the Legislature meets is called the regular session.

  • The regular session begins on the first Tuesday in March in the first year of a quadrennium. In the second and third years, it begins on the first Tuesday in February. And in the fourth and final year, it begins on the first Tuesday in January.
  • The Legislature meets, usually on Tuesdays and Thursdays, for a maximum of 30 meeting days within a period of 105 calendar days. Committees most often meet on Wednesdays.
  • The Governor may call a special session, indicating in a written “call” the subjects to be considered. No legislation on other subjects may be enacted during a special session without a two-thirds vote in both houses. A special session may last for up to 12 meeting days within a 30-day calendar span.

The Legislature’s main work is passing laws. Around 3,000 bills and resolutions are introduced each year. Some 40% of these are purely local in nature. About 180 to 200 general bills pass each year. Of these, only a small share affect the entire state. It often takes four years or more to pass a bill on a new subject.

How a bill becomes a law in Alabama

The process of proposing and passing laws is similar in the House and the Senate. Every new law must pass in both chambers.

  • A member of either chamber introduces a bill, which is a proposed new law. Sometimes members introduce identical bills in both chambers at the same time.
  • The bill gets a first reading (usually by title only) and is referred to a committee by the presiding officer.
  • The committee considers the bill – in a public hearing, if the committee chairman receives a written request for one. A bill that wins committee approval is “reported out” to the full chamber in a second reading (usually by number only) and placed on the General Calendar for the next meeting day.
  • On the next meeting day, the bill becomes eligible for its third reading and debate. The volume of bills, however, prevents most from being considered The Rules Committee places high-priority bills on the Special Order Calendar.
  • The bill gets its third reading (by number only unless a member requests a full reading, usually as a delaying tactic) when its number comes up in the assigned sequence on the Special Order Calendar or General Calendar. Debate in the full chamber begins at this time. When debate ends, the members vote on the bill.
  • After the bill passes one chamber, it goes to the other chamber and repeats the process.
  • Once a bill passes both chambers, it goes to the Governor to be signed (approved) or vetoed (rejected).
  • If vetoed, it goes back to the Legislature, where a simple majority vote can override (reverse) the veto.
  • If the Governor signs the bill or the Legislature overrides a veto, the bill becomes an act, or law.

How you can influence the process

Before a bill is introduced:

  • Stay informed about issues that are important to your group or community.
  • Work with organizations that research issues and recommend policy changes.
  • Talk to your legislators about introducing bills on issues important to your group or community.
  • Write a letter to your local newspaper concerning issues that are important to your group or community.

When a bill is in committee:

  • Contact committee members and ask them to support, reject or amend the bill – especially if your legislator serves on the committee.
  • Ask others to contact committee members.
  • Find out about and attend public hearings.
  • Testify for or against the bill. Arise lines up people to show a range of support or opposition.

When the bill is being debated on the floor:

  • Ask your legislators to support, reject or amend it.
  • Ask family and friends to contact their legislators and request that they support, reject or amend the bill.

When a bill awaits the Governor’s signature:

  • Call or write, urging the Governor to sign or veto.
  • Ask family and friends to contact the Governor.

Make your influence more effective

Plan your call. Before contacting your legislators by phone, prepare an informal “script”:

  • Give your name and where you live.
  • Identify the general reason for your call – for example, “I’d like to talk with you about Medicaid.”
  • Mention that you’re a member of Alabama Arise and that our members are interested in the issue. (To the legislator, this means voters!)
  • Refer to a specific piece of pending legislation, if there is one, including the bill number.
  • Make it personal. Tell a brief story or say why the issue matters to you.
  • Ask them to vote for the bill and where. (Mentioning a particular committee or floor vote suggests you may even be there to watch!)
  • Thank them in advance.

Try for direct contact

Legislators like to talk to voters. You can look up your lawmakers here, or get their contact information by calling 334-242-7600 (House) or 334-242-7800 (Senate). If you get a legislator’s secretary or answering machine, that’s OK! Your message still will get through. In this case, though, you must be even briefer: Leave out the story. No matter what kind of response you get, remain courteous. Anger doesn’t persuade.

Enlist other people to call with a similar message. Legislators know every phone call is the “tip of an iceberg.” For every person who takes the time to call, there are many others who share the caller’s concerns. Think of the number of voters you will represent if 10 or 20 people – or 50 or 100 – call on the same issue.

Take time to write a letter or email. Legislators do read their mail! Most legislators use email, and many are active on Facebook or Twitter as well. Keep your email subject line is simple and informative so it won’t resemble junk mail. You can write any legislator here: Alabama State House, Montgomery, AL 36130. Remember these tips:

  • Use your own words. Form letters are easy to recognize and less effective than personal statements.
  • Both handwritten and typed letters are fine.
  • Include the same information you would cover in a phone call, as noted above.
  • Limit your letter to one page in most cases.
  • Put letter-writing on your group’s agenda. Keep paper, envelopes, pens, stamps and addresses handy.

As long as you’re writing, remember your local newspaper. A letter to the editor will put your issue in the minds of many people. Some may be inspired to write their own letters, supporting your points. Legislators regularly read opinions sections to find out what their constituents are thinking.

Get to know your legislators personally

Make your voice more “real” with a face and a handshake:

  • Arrange a time to introduce your group as active constituents. Don’t wait until you have an issue to press.
  • Make a point to speak to them whenever you see them in public – at ballgames, the grocery store, etc.
  • Attend events where they are speaking.
  • Wear a name tag to every meeting.
  • Always tell them your name clearly and add a quick memory tag – for example, “My daughter goes to your child’s school,” or “I enjoyed your speech at the Kiwanis Club last Thursday.”
  • Invite them to your meeting – but remember how busy they are during the legislative session!
  • Help your group arrange a legislative reception.
  • Visit the State House during the legislative session.
  • Praise them when they deserve it, and respectfully express disapproval when they don’t.

For more information

Click here for an extensive, easy-to-use guide prepared by the Secretary of State. And please contact Alabama Arise at 334-832-9060 or info@alarise.org to learn more about speaking out and being heard on policies to make life better for Alabamians of all races, genders and incomes.

Why Medicaid expansion is a must for prison reform in Alabama

By Jim Carnes

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

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

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

The missing voices who need to be heard

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

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

Policy solutions should ease reentry, reduce recidivism

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

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

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

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

The path to a better corrections system

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

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

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

Meet the working men and women caught in Alabama’s health coverage gap

By Jim Carnes

As we celebrate Alabama’s workforce on Labor Day, here’s a fact that deserves special attention: More than 100,000 Alabamians are working without health insurance. They work in child care, construction, food services and other vital jobs. They’re the folks who keep things going.

Yet they’re trapped in the health coverage gap. They can’t afford employer-based coverage or private insurance. And they earn too much to qualify for Medicaid. As a result, many struggle with health problems that sap productivity, add household stress and get worse without timely care.

Here are the jobs employing the most working women in Alabama’s coverage gap:

And here are the jobs employing the most working men in Alabama’s coverage gap:

Think about the importance of these lines of work. Then think about what access to regular health care would mean in the lives of these workers and their families.

Across the country, 36 states have closed their coverage gaps, but Alabama is lagging behind. What’s holding us back?

Lack of awareness plays a part. As folks go about their daily activities, they rarely stop to wonder who has health insurance and who doesn’t. It’s not something most people talk about – but it should be. Helping state leaders understand the real people who will benefit most from expanding coverage is an important step toward change.

Our entire state would benefit from Medicaid expansion. Broader access to regular care would improve the health of working families. Healthier families would mean higher productivity at work and better learning at school. And the additional federal funding would strengthen our health system and create jobs.

All these gains would spell a brighter future for Alabama. It’s time to expand Medicaid and make health coverage affordable for the workers we all depend on every day.

Alabama’s prison reform solution must include Medicaid expansion

By Jim Carnes

Alabama’s prison crisis is about more than overcrowding and understaffing. It’s about the generational impacts of a criminal justice system warped by racism, chronic poverty, inadequate education and poor health.

The solution will require both new revenue and broad policy reform. And one essential step is to extend health coverage to uninsured Alabama adults with low incomes. Expanding Medicaid would address the prison crisis in four ways:

  • Untreated mental illnesses and substance use disorders are major contributors to Alabama’s over-incarceration problem, and Medicaid expansion would tackle these challenges head-on. Strengthening these services would help more people stay out of prison.
  • When a person leaves prison, it’s hard to get a job that offers health coverage. But to get and keep a job, you need to be healthy. Medicaid expansion would help former inmates become productive members of the workforce.
  • Federal funding would cover 90% of the cost of Medicaid expansion. That would slash state costs for hospitalizing prisoners.
  • A stronger education system creates economic opportunity that, in turn, reduces crime. As new federal dollars for Medicaid expansion flowed into the economy, they would generate major new state and local tax revenues for schools.

Bottom line

Alabama is one of only 14 states that have not yet accepted Medicaid expansion. The 36 states that have embraced it show how this single policy decision can strengthen the health care system, make the population healthier, reduce racial health disparities and shore up state budgets.

Alabama’s legacy of failure on all four counts is a major contributor to the prison crisis. And Medicaid expansion is an essential part of the solution.

Investing in the Housing Trust Fund would create jobs and expand housing opportunities across Alabama

By Dev Wakeley

Alabama lacks more than 69,000 homes for households with incomes under $24,600. That means many hard-working Alabamians, seniors, students, veterans and folks on fixed incomes can’t afford a safe place to call home. State investment in the Alabama Housing Trust Fund (AHTF) would provide flexibility to meet a variety of housing needs across the state, such as development, rehabilitation, down payment assistance and disaster recovery.

HB 487, sponsored by Rep. Neil Rafferty, D-Birmingham, and SB 189, sponsored by Sen. Linda Coleman-Madison, D-Birmingham, would fund the AHTF by increasing the state mortgage record fee from 15 cents to 20 cents per $100 of indebtedness. This one-time filing fee has not changed since it was enacted in 1935. The increase would leave Alabama’s fee less than both Georgia’s and Florida’s.

The benefits would be enormous for Alabamians and our state’s economy. Strong investment in the Alabama Housing Trust Fund would:

  • Allow municipalities, nonprofits and groups like Habitat for Humanity to build or rehabilitate homes. Individuals cannot access the funds.
  • Address Alabama’s shortfall of more than 69,000 homes for low-income working families, veterans, and retirees living on fixed incomes.
  • Create thousands of jobs across the state over the next decade.

BOTTOM LINE: Hard-working Alabamians should be able to pay rent and still be able put food on the table. Every child deserves a safe place to call home. And veterans who have defended our country deserve to return to a safe and affordable place to call home. Investing in the Housing Trust Fund would help Alabama achieve all three of those goals.

Federal ability-to-repay rule protects payday borrowers, Alabama Arise tells CFPB

By Dev Wakeley

Director Kathleen Kraninger:

I read with disappointment your recent proposal to rescind the thoroughly considered, factually grounded Consumer Financial Protection Bureau (CFPB) rule provision mandating ability-to-repay determinations by lenders offering payday, title and balloon loans. As a policy organization working to advance the public good in a state with wholly insufficient consumer protections for borrowers, Alabama Arise knows the CFPB’s payday lending rule would help thousands of people in Alabama, if left as written and implemented in good faith.

Astronomical and exploitative payday loan annual percentage rates (APR)[1] routinely trap borrowers in our state in inescapable debt cycles. Payday lenders have misled regulators and the public about the purpose of these loans since the day they were legalized in Alabama. Contrary to industry talking points, payday loans are not a short-term solution to emergencies. They are debt traps for people struggling to make ends meet, as the CFPB’s own 2014 report shows. A majority of payday borrowers in Alabama take out multiple loans every year. Thousands of borrowers in our state took out 30 or more payday loans last year.[2] Borrowing histories like that result from traps, not transactions between parties of equivalent power and legal sophistication.

For thousands of people who take out multiple loans a year, predatory loans are not an option. They are inherently destructive traps that destabilize families, and they destroy the lives of people throughout the United States who become trapped in intentionally created cycles of debt.

The American people overwhelmingly support regulation of payday loans. Eighty-four percent of Alabama respondents in a recent state survey[3] said they want significant reform to payday lending practices. Most Alabamians want to cap payday loan APR at 36 percent. That rate would be less than a tenth of the usurious 456 percent APR that Alabama allows on a 14-day loan, the most common loan period in our state. Further, a majority of the survey respondents said they want those reforms even if such changes cut into industry profits.

The Agency’s purported justification for rescinding the rule is a lack of data supporting the underwriting provision. The Agency bases this assertion on an arbitrary de-emphasis of the Mann study,[4] which was industry-funded yet nonetheless demonstrated that four in ten consumers had no knowledge of how they would repay loans. The Agency also de-emphasizes its own personnel’s expertise in determining the financial awareness of consumers.

The multi-page Agency justification for ignoring its own analysis could have been spun from a lending industry lobbyist. In it, the CFPB wrote, “Mann concluded that most borrowers anticipate that they will not be free of debt at the end of the initial loan term and instead will need to reborrow.” This sunny characterization of borrowers’ financial understanding ignores the 40 percent of borrowers who have no idea when they will escape the debt trap.

Moreover, the focused protections created by the CFPB’s rule have not yet been given a chance to work, even though the underwriting requirement falls short of the sweeping elimination of predatory loans the public wants. The Agency’s rhetoric surrounding this attempt to eliminate protections has relied heavily on the sort of talking points often repeated by the industry lobbyists we see lining the walls of the Alabama State House. Industry mouthpieces have claimed for years that regulation of any sort would bankrupt them. But reality shows these claims to be false. Procedural reform efforts focused on providing escape valves for trapped borrowers have not eliminated payday loans in the numerous states that have implemented them.[5]

The rule’s protections focus on borrowers who take out multiple loans over a short period and borrowers who spend much of their time in short-term loan debt. Lenders are conditionally exempt from the underwriting mandate for loans under $500, up to the third loan in a loan cycle. The rule is structured to prevent loan churn and stop cycles of debt. The payday lending business model relies on keeping borrowers in debt. One of the best ways to prevent that exploitation is to ensure that borrowers have a realistic way out of debt before they take out high-cost loans. The CFPB should protect borrowers, not the profits of an industry reliant on perpetuating human suffering to make its money.

Repeal of this protective provision would be a disservice to the fundamental mission of the CFPB. The Agency’s purpose is to protect consumers, not to clear the field of regulations to ensure lenders’ ability to prey upon on members of the public whose precarious financial positions leave them most vulnerable to predatory practices. The only support underlying the decision to eliminate this consumer protection is fanciful assertion by regulated parties that the regulatory costs of compliance would significantly damage their interests. Bald assertions of harm made by an industry with a history of operating in bad faith are wholly insufficient justification for an Agency rule. The CFPB should not engage in arbitrary determinations based on a dearth of evidence. Eliminating this protection is unjustified.

The CFPB’s rule in its current form would help mitigate the effects of the systematic exploitation of borrowers who can barely keep their heads above water. The ability-to-repay provision is not a complete reform of the usurious practices of predatory lending, but it helps rein in some of the worst abuses. Preventing lenders from issuing products structured to trap many borrowers in loans they are unable to repay is squarely within the Agency’s mission. The CFPB should implement the ability-to-repay rule as written. Anything less would be complicity in abusive practices and would be widely and correctly cited as an example of regulatory capture.

Footnotes

[1] Adam Hayes, Annual Percentage Rate (APR) Definition, Investopedia (2019), available at https://www.investopedia.com/terms/a/apr.asp (noting “[a]n annual percentage rate (APR) is the annual rate charged for borrowing,” and “[t]he formula for the Annual Percentage Rate (APR) is ((((Fees + Interest) / Principal) / [Number of days in loan term]) x 365) x 100”).

[2] Veritec Solutions, Report on Alabama Deferred Presentment Loan Activity For the Year Ending December 31, 2018 (2019).

[3] Public Affairs Research Council of Alabama, Alabama Public Opinion Survey (2018), available at http://parcalabama.org/wp-content/uploads/2018/09/PARCA-2018-Public-Opinion-Survey.pdf, 18.

[4] Ronald Mann, Assessing the Optimism of Payday Loan Borrowers, 21 Sᴜᴘʀᴇᴍᴇ Cᴏᴜʀᴛ Eᴄᴏɴ. Rᴇᴠ. 105 (2013), http://www.columbia.edu/~mr2651/AssessingPayday.pdf.

[5] See, e.g., Fla. Stat. § 560.404(22) (2018).

Removing the FIT deduction would allow Alabama to untax groceries, expand Medicaid

By Alabama Arise

Alabama’s federal income tax (FIT) deduction provides a huge tax break for high-income individuals – but at what cost? $719 million to be exact.

The FIT deduction is one big reason Alabama’s tax system is upside down. For those who earn $30,000 a year, the deduction saves them about $27 on average. But for the top 1% of taxpayers, the FIT break is worth an average of more than $11,000. The higher the income, the more the FIT deduction is worth for those who can most afford to pay more to fund education, health care and other vital needs.

Only two other states offer a full FIT deduction like Alabama does. (Three other states offer a partial deduction.) Ending the FIT deduction would bring in an additional $719 million a year, the Institute on Taxation and Economic Policy estimates. That would be enough to allow Alabama to remove the state sales tax on groceries. For most people in our state, the net result would be a tax cut.

This proposal would make it easier for everyday Alabamians to make ends meet, but its benefits wouldn’t end there. Alabama also could use the new revenue to expand Medicaid, ensure full funding for the Children’s Health Insurance Program (CHIP) in 2021 and make critical investments in education and other areas. CHIP supports health coverage for more than 170,000 children through Medicaid and ALL Kids.

Alabama’s constitution dedicates income tax revenue to education, and the FIT deduction is written into the document as well. So this plan would require the Legislature and the public to approve a constitutional amendment. But ending the FIT deduction would be a good way for Alabama to begin prioritizing public investments that benefit everyone over tax breaks that primarily benefit a select few.

Alabama Medicaid reforms aim for better care, lower cost

By Jim Carnes

Alabama is making some big changes in the way Medicaid members get their care. Alabama Arise believes the new plans, if carried out well, will be a significant improvement over the current Medicaid system. One way to improve the chances for success is to have a strong consumer voice at the policy table.

The changes are happening on two tracks:

  1. Primary care for children, pregnant mothers and family planning.
  2. Long-term care for people who need assistance with activities of daily living.

Alabama Coordinated Health Networks (ACHNs) for primary care, maternity care and family planning

Under the new plan, seven regional Alabama Coordinated Health Networks (ACHNs) will coordinate primary care for Medicaid children, pregnant mothers and people who receive family planning services. Primary care includes well-child visits; EPSDT (Early Periodic Screening, Diagnosis and Treatment); adult screening, diagnosis and treatment; and preventive care. Each member will choose a primary care doctor to be their “patient-centered medical home.”

(Note: A “medical home” is not a live-in care facility, like a nursing home. It’s more like a “home base” you stay in touch with for all your health care needs.)

Your ACHN will have a phone line to call when a Medicaid member has a health problem. The basic idea is that nurses, social workers and care coordinators working with the primary care doctor can help people get the right care for the right problem without going straight to the emergency room (ER) whenever they get sick.

ER services are important when there’s a real emergency (like a broken bone, chest pains or other critical need). But they’re also very expensive. So going to the ER for routine problems like a sore throat or upset stomach is a drain on the Medicaid budget. And it’s not the best way to get the right care for ordinary health needs. Getting checked first by your primary care doctor or nurse leads to better care at lower cost.

The ACHN can help patients identify health goals, create a care plan and connect with community resources that promote better health. Another feature aimed at improving care is bonus payments for doctors who reach quality benchmarks.

The new ACHN plan will begin Oct. 1, 2019. It will serve about 750,000 Medicaid members across seven regions. Each ACHN will have a consumer representative on its board, as well as a Consumer Advisory Committee (CAC). Arise is working to recruit Medicaid members, parents and caregivers to serve in these important roles. We also are urging Medicaid to add a second consumer representative to each regional ACHN board.

Integrated Care Network (ICN) for long-term care

On the long-term care side, Medicaid already has started a new plan called the Integrated Care Network (ICN). The ICN coordinates care for Medicaid members who live in nursing homes or receive certain home- and community-based waiver services. There are only about 25,000 of these members across Alabama, so one statewide ICN serves all of them. Right now, about 70% of people served by the ICN live in nursing facilities, and 30% are living at home. The program’s goal is to help more people get long-term care services in their home and community, if that’s what they want. The ICN works with 13 Area Agencies on Aging across Alabama to coordinate long-term care for Medicaid members who qualify.

The ICN has a strong consumer voice at the policy table. Four consumer advocates serve on the governing board. And the Consumer Advisory Committee includes eight consumer representatives, including Alabama Arise, along with a long-term care doctor.

What triggered reform?

Since it began in 1970, Alabama Medicaid has operated on a fee-for-service basis, with patients seeking care on their own from providers who then bill Medicaid for services rendered. For healthy patients, such a system can provide sufficient care at a reasonable cost. But many Alabama Medicaid patients have complicated health problems, involving one or more chronic conditions that are difficult and expensive to treat. Care providers often have difficulty monitoring patient care over time and educating patients on prevention and healthier lifestyles.

As Medicaid costs rose with enrollment growth during the Great Recession of 2008, state officials began to consider program changes that would both control budget growth and improve health outcomes.

In 2011, a few regional pilot projects began providing care coordination for people with chronic conditions, such as diabetes, cancer or substance use disorder. These successful experiments laid the groundwork for the regional care organizations (RCOs) that the Legislature authorized in 2013. Under the RCO plan, Alabama offered care coordination to people with chronic conditions statewide. Technical delays and other problems led Gov. Kay Ivey to cancel the RCO plan shortly after she took office in 2017, but the care coordination system remained in place. This time around, Medicaid will expand it even further – to serve not just patients with chronic illness but the majority of Medicaid members.

Long-term care reform took a different but parallel path. Alabama has long relied mainly on nursing homes to provide Medicaid long-term care services, even though home- and community-based services are far less expensive. The aging of the Baby Boom generation poses big challenges for the old system. A surge in nursing home patients would strain state budgets, and a movement for greater patient choice is changing the long-term care business. Alabama’s ICN has the potential to become a national model for expanding options in long-term care.

Bottom line for members

  • Regional ACHNs open Oct. 1, 2019. Through their primary care doctor, children, pregnant moms and family planning patients can get new services focused on prevention, care coordination and health improvement.
  • The primary care doctor is the patient’s “medical home” – the first place to contact for ordinary health needs. The goal: Reserve ERs for true emergencies.
  • A new focus on improving patient health gives doctors bonus payments for better outcomes. Special projects will target substance use disorders, infant mortality, and obesity and obesity prevention.
  • The ICN now gives long-term care patients more coordination of services and more choice in their care setting.
  • Consumer representatives give Medicaid members a new voice at the policy table.

Map of Medicaid ACHNs

Keywords in Medicaid reform

A basic understanding of these keywords will help Alabama Medicaid members navigate the changes that are underway and help advocates and others follow ongoing developments in the program:

ACHN (Alabama Coordinated Health Network) – beginning Oct. 1, 2019, any of seven regional organizations that administer Medicaid services for children, pregnant women and family planning patients in Alabama, with a special focus on care coordination to eliminate barriers to adequate health care.

Area Agency on Aging (AAA) – any of 13 regional offices that serve older Alabamians by coordinating state and federal services such as senior centers, Aging and Disability Resource Centers and the Alabama Cares caregiver support network. The AAAs provide case management for Medicaid long-term care in the home, community and nursing facilities through the new Integrated Care Network (ICN).

Care coordination – the practice of organizing patient care activities and sharing information among all parties concerned to achieve more effective and efficient care. Care coordination has a narrower focus than case management.

Case management – a collaborative process of assessment, planning, coordination and advocacy for options and services to meet a person’s health needs. Case management has a broader reach than care coordination, also addressing social determinants of health like housing, nutrition and transportation.

EPSDT (Early Periodic Screening, Diagnosis and Treatment) – comprehensive and preventive health services guaranteed for children under age 21 who are enrolled in Medicaid.

Home- and community-based services (HCBS) – Medicaid long-term care services for qualifying members who choose to live at home or in a community care setting. In Alabama, these services are delivered through seven waiver programs. Two of these – Elderly & Disabled (E&D) and Alabama Community Transition (ACT) – are part of the new Integrated Care Network.

ICN (Integrated Care Network) – Alabama Medicaid’s long-term care reform program promoting person-centered care in the least restrictive setting of the patient’s choice.

Long-term care – health care, personal care and social services provided to people with chronic illness or disability, either in institutional or home and community settings.

Medicaid – federal and state health insurance program for people with low incomes and few resources. Alabama Medicaid covers mainly children in families up to 146% of the federal poverty level (FPL), pregnant women up to 146% FPL, low-income people with disabilities, and low-income people in nursing homes. Parents are eligible in Alabama only if their income is 18% FPL or lower.

Medicaid member – any individual enrolled in a Medicaid program.

Patient-centered medical home – a health care setting that offers patients comprehensive, coordinated primary care; an ongoing relationship with a primary care doctor; and referrals for necessary additional care.

Preventive care – health care that emphasizes healthy behavior, regular testing and screening aimed at early detection and treatment.

Primary care – routine health care, including diagnostic, therapeutic and preventive services, as well as management of chronic conditions.

Waiver – permission granted by the federal government that allows the state to “waive” or change ordinary Medicaid rules to provide specific services to a targeted group, such as long-term care patients.

Revenue options for Medicaid expansion

By Jim Carnes

Alabama’s budget is an expression of our values. Medicaid expansion means healthier families, thriving communities and a stronger economy. Policymakers have a range of options for making this bold investment in a brighter future. Now is the time to choose.

Remove the state deduction for federal income taxes (FIT)

► $719 million in new revenue per year

► Only two other states offer a full FIT deduction

► This money would allow Alabama to achieve multiple goals:

— Expand Medicaid (cost: $168 million in first year, $25 million per year thereafter)*

— Remove the state sales tax on groceries (cost: approximately $400 million per year)

— Secure long-term funding for ALL Kids (cost: $38.4 million for 2020, approximately $90 million for 2021)*

Remove the state deduction for FICA payroll taxes

► $261 million in new revenue per year*

► Only one other state offers a full FICA deduction

Raise the cigarette tax by $1 per pack

► $180 million in new revenue in 2020

Other revenue options include:

► Make large landowners pay their fair share of property tax

► Tax sugar-sweetened beverages and vaping-related products

► Close corporate tax loopholes – for example, enact combined reporting*

 

* Would require transfer from Education Trust Fund to General Fund

30 days to pay: A simple but important step forward on payday lending reform in Alabama

By Alabama Arise

Alabama borrowers pay interest rates of 456 percent a year on payday loans. These high-cost loans trap thousands of struggling Alabamians in a debt cycle that deepens poverty and hurts the state’s economy.

SB 75, sponsored by Sen. Arthur Orr, R-Decatur, along with a House version sponsored by Rep. Danny Garrett, R-Trussville, would extend the time that payday borrowers have to repay to 30 days, up from as few as 10 days now. This one step would reduce the maximum annual percentage rate (APR) on payday loans in Alabama from 456 percent to about 220 percent. This bill would ease financial pressure on Alabamians who are struggling to make ends meet, letting them keep more money to take care of basic needs.

The 30-days-to-pay bill would help borrowers and preserve access to credit. Lengthening the repayment period for payday loans would:

  • Boost Alabama’s economy by reducing the amount of fees (more than $100 million last year alone) taken out of our communities every year to benefit primarily out-of-state corporations.
  • Bring payday loan repayment periods in line with repayment schedules for other loans and monthly bills, such as mortgages, rent, car loans, student loans, credit cards and utility bills.
  • Grant needed relief to tens of thousands of working Alabamians and allow them to use their hard-earned money to better their own lives.

BOTTOM LINE: Exorbitant interest rates on payday loans are devastating for families and communities across Alabama. SB 75 would take a simple, important step to reduce the damage from these high-cost loans. That would be good for consumers, good for the state’s economy and good for Alabama.