A long-term budget fix includes Medicaid expansion

As Alabama lawmakers grapple to prevent devastating Medicaid cuts, the time is right to address a related threat to our state: the health coverage gap. Nearly 200,000 Alabama workers we depend on every day – in agriculture, food service, retail, home health and other fields – have no access to regular health care. They have no health insurance because their employers don’t offer it. They earn too much to qualify for Medicaid but too little to qualify for federal tax credits to buy private plans. As a result, they often struggle to work while dealing with health problems that sap their productivity, add stress to their households and get worse without timely care.

Closing the coverage gap would not only save lives and help working families; it would stabilize the budget and boost our economy. This fact sheet by policy director Jim Carnes takes a closer look at how Medicaid expansion would benefit Alabama's health, quality of life and economy.

Medicaid RCOs: Better care, better health, lower costs

Under the Medicaid reform plan approved by the Alabama Legislature in 2013, regional care organizations (RCOs) will manage patient care to improve efficiency, accountability and health outcomes. Federal approval of the plan in February 2016 was a huge vote of confidence in Alabama’s ability to achieve these goals. Below are short answers to basic questions about RCOs. (Click here for a PDF version of this overview of Alabama's RCO reforms.)

What are RCOs?

  • RCOs (regional care organizations) are networks of doctors, hospitals and other health providers serving Medicaid patients in each of five new Medicaid regions.
  • As community-based nonprofit organizations, RCOs are governed by boards representing a broad range of health care stakeholders and assisted by citizens’ advisory committees reflecting the diversity of the patients served in each region.
  • By law, Alabama Arise and the Disabilities Leadership Coalition of Alabama nominate consumer representatives for each RCO’s citizens’ advisory committee.

How are RCOs different from traditional Medicaid?

  • The new plan changes Medicaid from a system that rewards volume of medical services to one that rewards better care and cost savings.
  • Currently, Medicaid patients seek health care on their own, without case management, and Medicaid reimburses providers for services rendered. Under the new plan, RCOs will receive a “capitation payment,” or flat yearly amount, to manage and provide appropriate, quality care for each patient they serve.
  • Through case management, RCOs will work with patients to make sure they receive timely preventive and primary care, comply with doctors’ orders, keep chronic conditions under control and avoid expensive emergency room visits.
  • RCOs emphasize the right care, at the right time, in the right setting

What does this mean for Medicaid patients?

  • The RCO system builds upon Alabama’s successful Patient Care Network model, giving each Medicaid patient a primary care physician.
  • Better access to primary care means better coordination of medical services, better management of chronic conditions and better tracking of patients’ health progress.
  • Patients now will have a “home base” for all their health care needs.

How will RCOs impact the General Fund budget?

  • The capitated payment to RCOs will make the Medicaid budget more predictable.
  • The RCOs – not the state – will bear the financial risk for the cost of providing health care to Medicaid patients in that region.
  • As patients receive better coordinated and more efficient care, RCOs will “bend the Medicaid cost curve,” reducing long-term growth in the program’s budget.

What is the future of Medicaid in Alabama?

  • Medicaid is the cornerstone of the health care system on which we all depend.
  • RCOs are an important investment in Medicaid. With this approved reform, Alabama can move forward with its plan to enhance care coordination and bend the cost curve.
  • By properly investing in Medicaid and the RCO model, the Legislature can take the final steps in the reform process it began in 2013.

What’s next?

  • Health care providers and advocates are working with the Legislature to ensure that Medicaid’s budget is adequate to seize this unique opportunity for achieving better health care, better outcomes and lower costs.
  • After two years of design and development, RCOs are on track to begin operation by Oct. 1, 2016.

Posted Feb. 26, 2016.

Special enrollment periods for health coverage

Initial open enrollment for coverage in the Health Insurance Marketplace has ended, but you still may be able to sign up for a plan. Alabamians who experience certain life events may qualify for a Special Enrollment Period without waiting until the next open enrollment period (Nov. 15, 2014, through Feb. 15, 2015).

This issue brief looks at the life changes and other opportunities that may allow people to enroll in Marketplace coverage throughout the year.

How does the ACA mandate work?

The Affordable Care Act (ACA) requires almost everyone in the United States to have health insurance. Many people who have not begun to apply by March 31, 2014, will face a tax penalty, starting with 2014 income taxes they’ll pay in 2015. But some people will be exempt from the penalty, including people in poverty who do not qualify for Medicaid because their state has not expanded Medicaid eligibility.

This one-page overview looks at how the mandate works, who will owe the penalty, and who may be exempt from it. Check it out, then visit or call 800-318-2596 to learn more about your coverage options and requirements under the ACA.

More than 15,000 Alabamians sign up for Marketplace health coverage in January

Enrollment in health plans through the Alabama Health Insurance Marketplace rose by more than 15,000 in January, for a four-month total of nearly 44,000, the U.S. Department of Health and Human Services (HHS) reported this week.

Alabama’s increases followed the trend of nationwide enrollments, which increased by 62 percent last month to a total of 3.3 million. The Marketplace, created in the Affordable Care Act and accessible at, enables people to compare health insurance plans, learn about financial assistance for which they may qualify, and sign up for coverage.

“January’s enrollment numbers are great news,” ACPP executive director Kimble Forrister said. “Thousands of people in Alabama are getting access to affordable health coverage for the first time, and we expect those numbers to continue to grow in the months ahead.”

Many Alabama organizations offering enrollment assistance are planning intensive outreach activities between now and March 31, when the first open enrollment period ends. A statewide list of enrollment assisters, searchable by ZIP code, is available in the new Bama Guide at, a student leadership initiative focused on health coverage enrollment.

Forrister said he was encouraged to see more young Alabamians obtaining health coverage through the Marketplace. About 27 percent of Americans who signed up last month were between the ages of 18 and 34. That share was up from 24 percent in December. Alabama's figures followed a similar trend.

Better timing for open enrollment in future years could make enrollment in the Health Insurance Marketplace easier, a national health policy expert said. “Given the cash flow pinch at the holidays, most lower- and middle-income consumers wait for their tax refund before they take on new financial obligations,” said Brian Haile, a vice president for health policy at Jackson Hewitt Tax Service who previously helped set up Tennessee’s health exchange.

In 2013, consumers wanting their Marketplace health insurance coverage to begin Jan. 1 had to sign up between Oct. 1 and Dec. 24. After early technical problems at subsided, the December enrollment numbers far exceeded those of the first two months. But in a different season, the first half of the open enrollment period might have been stronger, Haile’s analysis suggests.

Haile said a better time for HHS to set future enrollment deadlines would be when lower- and middle-income people are likelier to have more money on hand. In January, people start getting their income tax refunds, and holiday spending is behind them. That means they are more able to focus on signing up for health insurance, Haile said. HHS is still considering dates for next year’s open enrollment period.

Health advocates are pushing to make sure Alabamians know they still can sign up for coverage by the March 31 deadline. People interested in more information on Marketplace plans can go to or call 800-318-2596.

By M.J. Ellington, health policy analyst. Posted Feb. 14, 2014.

Health security for Alabama's working families

Hundreds of thousands of uninsured Alabamians would qualify for Medicaid if Alabama expanded eligibility to adults with incomes up to 133 percent of the federal poverty level. (That's about $15,000 a year for individuals and $31,000 a year for a family of four.) Many hard-working Alabamians have no health coverage because they earn too much to qualify for Medicaid and too little to afford private health insurance. This fact sheet examines what's at stake for Alabama in deciding whether to expand Medicaid under the Affordable Care Act.

A brighter day for women's health

Alabama's women have enjoyed a whole year of new health protections, thanks to the Affordable Care Act (ACA). Guaranteed insurance benefits that went into effect last August for new and renewing health plans include an array of preventive services at no cost.

This fact sheet outlines the ACA's health benefits for women, as well as new protections coming in 2014.

Alabama's Medicaid reform should put patients first

ACPP appreciates the opportunity to represent consumer interests on the Alabama Medicaid Advisory Commission. Toward that end, we have assembled a coalition of advocacy organizations to provide consumer input on the reform process. The coalition has identified eight core principles of consumer-centered Medicaid reform.

Read principles here.

What happens if I can't pay? A guide to hospital financial assistance

For thousands of low-income Alabama workers, delayed health care and rising medical debt have become hard facts of life in recent years. The Great Recession, with its record unemployment and attendant reduction in health coverage, has added thousands to the ranks of the uninsured and underinsured. Many Alabama hospitals have a long history of offering free or reduced-cost care, also called charity care, for patients who can't afford to pay their hospital bills. Such care is a critical part of the health care safety net, as well as a key component of a hospital's community benefits program.

View our slideshow on hospital financial assistance in Alabama.

Read our handout on new requirements for nonprofit hospitals in the Affordable Care Act.

Homegrown Solution: Alabama's Health Insurance Exchange

Alabama's readiness to implement the Affordable Care Act (ACA) remains uncertain as key deadlines in the federal health care reform law approach. Alabama is one of 26 states that have asked the U.S. Supreme Court to declare the ACA unconstitutional. But the state also applied for and received federal funding to plan for an Alabama Health Insurance Exchange. States that fail to create their own Exchange will default to a federal version.

This updated fact sheet examines the planning, structure and timeline for a state-based Exchange.

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