Category: News Releases

Alabama’s proposed new Medicaid work requirement waiver would be costly, counterproductive, ineffective and harmful to thousands of families who live in deep poverty, Arise Citizens’ Policy Project wrote in official comments submitted to state Medicaid officials on Thursday, March 22, 2018.

“Threatening loss of health care in an attempt to force work efforts, without providing the supports that would make those work attempts successful, is flagrantly cruel and will result in no outcome other than poorer, more desperate and less healthy Alabama families,” Arise’s comments concluded.

Medicaid covers about 1 million Alabamians. Of that total, the waiver would target 7.5 percent of them – about 75,000 adults with extremely low incomes who qualify for Medicaid as parents or other caretaker relatives of children. Alabamians in this group are ineligible for Medicaid if their incomes exceed 18 percent of the federal poverty level (about $312 a month for a family of three).

Because Alabama has not expanded Medicaid to cover adults with incomes below the poverty level, the state’s work requirement plan would create a “catch-22 that forces people into the coverage gap,” Arise wrote. About 300,000 Alabamians already are caught in the coverage gap, earning too much for Medicaid but too little to qualify for federal subsidies for Marketplace plans.

Parents who work just 10 hours a week at minimum wage earn too much to qualify for Medicaid. But the state’s proposal would require them to engage in work-related activities between 20 to 35 hours a week. That would leave thousands of Alabama parents in a no-win situation: They would lose their Medicaid coverage if they don’t work – and also if they do. Virtually all of them would end up uninsured, without access to employer-provided coverage or an affordable private plan.

Alabama’s proposal does not project the state’s cost to track Medicaid enrollees’ work activities and exemptions. It also does not identify whether or how the state would invest in child care, job training, transportation and other supports that low-income parents need to get and keep work.

Arise’s full comments on Alabama’s proposed Medicaid work requirement waiver are available here.

Alabama’s bid to impose a work requirement on parents receiving Medicaid could cost as many as 8,700 people their health coverage in the first year, mainly affecting mothers whose children also would feel the impact, according to a new analysis by the Georgetown University Center for Children and Families (CCF) and Arise Citizens’ Policy Project (ACPP).

The proposal would create a Catch-22 for these families who already live well below the poverty line: Any parent working the 20 to 35 hours required under the state proposal would make too much money to qualify for Medicaid – but likely not enough to afford private insurance. These harsh new restrictions would disproportionately hurt families living in Alabama’s rural communities and small towns where jobs are scarce.

“Alabama’s proposal creates more barriers to Medicaid coverage and will not help families rise out of poverty. In fact, the opposite is true – many parents and children are likely to lose health coverage, which exposes them to greater financial instability,” said Joan Alker, director of the Georgetown University research center. “It’s hard enough to raise a family on such a limited income without someone putting more roadblocks in the way.”

Alabama is not the first state to seek a work requirement, but it is one of the first to do so without accepting federal funding to expand Medicaid to adults with incomes slightly above the poverty line (138 percent of the federal poverty level). Around 300,000 Alabamians are caught in the coverage gap, earning too much to qualify for Medicaid but too little to qualify for subsidies for marketplace coverage through the Affordable Care Act.

In Alabama, only the poorest parents and caregivers, those making 18 percent of the poverty level or less – $3,740 a year for a family of three, or about $312 a month – now qualify for Medicaid. That is the strictest eligibility requirement in the nation (along with Texas). Because Alabama has not expanded Medicaid, the work requirement would apply only to parents with extremely low incomes.

The analysis found that among this population:
•    More than 85 percent are women.
•    60 percent are not in the workforce, in many cases because they are caring for someone else or have an illness or disability; 24 percent describe themselves as unemployed. The remainder are already reporting some work.
•    58 percent are African American; 40 percent are white.
•    35 percent are young parents under age 30.

A proposal for a Medicaid work requirement, now undergoing a state public comment period before submission to the federal government, could prove disastrous for many Alabama families, ACPP policy director Jim Carnes said.

“The goal of this cruel, counterproductive plan is to take health insurance away from thousands of Alabamians who are living in desperate poverty,” Carnes said. “By creating barriers to coverage rather than promoting it, Alabama’s work requirement fails the most fundamental test for Medicaid policy changes.”

Alabama’s proposal also seeks to trim eligibility for Transitional Medical Assistance – despite the fact that TMA is designed specifically to provide stability in health coverage for families whose incomes are increasing because they are working more.

In addition, the proposal could fuel an increase in the number of Alabama children without health coverage, according to the report, because uninsured parents are more likely to have uninsured children. Alabama’s rate of uninsured children – just 2.4 percent – is the lowest in the South. Overall, children and families in Alabama’s rural communities and small towns are more likely to use Medicaid coverage to meet their health care needs than those in metropolitan areas, a 2017 Georgetown University CCF/University of North Carolina study showed.

“As a pediatrician practicing in rural Alabama for 37 years, I have seen firsthand what happens when parents cannot access health care: Their children’s health suffers,” said Dr. Marsha Raulerson, who is a pediatrician in Brewton and a member of the American Academy of Pediatrics. “If approved, the Alabama Medicaid work requirement would be a step backwards for a state that has been a national leader in covering children.”

Arise Citizens’ Policy Project policy director Jim Carnes issued the following statement Monday, Jan. 22, 2018, in response to the U.S. Senate’s vote to renew federal funding for the Children’s Health Insurance Program (CHIP) for six years:

“The parents of more than 85,000 children with ALL Kids coverage finally received some overdue good news today: Their kids aren’t about to lose health insurance. Congress’ agreement to renew CHIP funding for six years will allow ALL Kids to avoid an enrollment freeze and continue providing life-saving coverage for Alabama children.

“Families across Alabama deserve to breathe a sigh of relief, but it never should have come to this. CHIP funding deserved a quick, straightforward renewal before it expired nearly four months ago. Delaying the renewal and tying it to other important issues was unnecessary and irresponsible.

“A big untold story is the stress that Congress’ inaction placed on millions of hard-working parents across the country who lost the certainty that their children would be able to get the health care they needed. Instead of protecting children’s health coverage, congressional leaders spent month after month trying to undermine the Affordable Care Act. Then they focused on passing a tax bill that disproportionately benefited rich people and large corporations.

“CHIP, known as ALL Kids in Alabama, is a proven success story that played a big part in cutting our state’s uninsured rate for children from 20 percent to just 2.4 percent over the last two decades. Other states have seen similar improvements.

“Letting CHIP funding expire and remain in doubt for months was an attack on families. Congress should make sure this sad chapter can’t be repeated. It’s time to fund CHIP permanently and guarantee that all children can receive the health care they need to grow and thrive.”

Arise Citizens’ Policy Project policy director Jim Carnes issued the following statement Friday, Jan. 13, 2017, after the U.S. House approved a resolution that would make it easier for Congress to repeal portions of the Affordable Care Act:

“Protecting access to quality, affordable health care is more important than ever. Congress voted this week to make it easier to repeal parts of the Affordable Care Act, but that wasn’t the end of this debate. Now comes the hard work of ensuring that tens of millions of Americans don’t lose their health coverage and important consumer protections in the process.

“The Affordable Care Act has helped millions of people and saved thousands of lives across Alabama. Nearly 200,000 Alabamians have gained insurance through the ACA, and the vast majority of them receive tax credits to make their coverage more affordable. About 2 million Alabamians have pre-existing conditions that would have made it hard or impossible for them to get full coverage before the ACA lifted coverage caps and guaranteed their access to insurance. And the ACA has significantly reduced the number of uninsured young Alabamians by allowing 35,000 of them to remain on their parents’ plans until age 26.

“We urge Alabamians to continue pressuring their members of Congress not to repeal the Affordable Care Act without an immediate replacement that offers comparable coverage and consumer protections. ‘Repeal and delay’ is a dangerous and unacceptable path.”

Arise Citizens’ Policy Project policy director Jim Carnes issued the following statement Monday, Dec. 18, 2017, in response to the announcement of ALL Kids’ pending termination:

“Tens of thousands of Alabama working families learned today – one week before Christmas – that their children will lose health insurance Feb. 1 if Congress continues to delay funding for the Children’s Health Insurance Program (CHIP), known here as ALL Kids. Alabama officials had been holding their breath since Congress failed to reauthorize CHIP funding by Sept. 30. They were hoping reserve funds could tide the coverage over for a few months – surely enough time for Congress to act. But today those hopes were dashed.

“ALL Kids’ announcement that it would stop enrolling children in new coverage on Jan. 1 and end the program entirely a month later strikes a painful blow not only to 84,000 ALL Kids children and their families but also to Alabama’s nationally praised gains in children’s health coverage. In the two decades since ALL Kids became the first state CHIP authorized by Congress, our uninsured rate for children has dropped from 20 percent to 2.4 percent. That record has earned Alabama’s program national recognition as the ‘Star of the South.’

“Ending ALL Kids also places a strain on Alabama’s threadbare General Fund. CHIP funds now pay for the health care of around 75,000 children enrolled in Medicaid, who will continue to receive coverage but at new cost to the state.

“In this shameful development, Congress has turned children’s health care – a vital part of family well-being – into a political football. Toying with children’s coverage creates a health hazard in its own right – and an entirely preventable one. Alabama’s hard decision today is a sign of things to come as other states face the grim realities of Congress’ failure to address children’s health needs. Our lawmakers must come to their senses and act now. Every wasted day puts children’s health in greater danger.”