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Alabama Medicaid "unwinding" review process to start in coming weeks


Health care advocates are working to get Alabamians prepared for the review process and possible loss of health coverage. This comes as COVID-19 safeguards surrounding Medicaid come to an end.

Pandemic-era protections that stopped states from dropping ineligible people from Medicaid rolls will expire next month. Starting April 1st, Alabama and other states across the county will resume reviewing all Medicaid enrollees' eligibility. Jennifer Harris, a health policy advocate for the non-profit advocacy group Alabama Arise, explained this process is referred to as “unwinding.”

“The reason we're calling it an “unwinding” is because a lot of states are now going to have to re-certify and redetermine eligibility for every single person that is on the Medicaid roll,” said Harris. “And in Alabama, approximately 800,000 people were on the Medicaid roll before the pandemic. And during the pandemic, those roles swelled up to approximately 1.2 million people.”

This review period for Medicaid coverage will eventually lead to ending coverage for those found ineligible. “During the public health emergency, there was a continuous enrollment process so that no one would lose coverage during that time. That is going to end on April the first,” explained Harris. “With the pandemic moving into an endemic, what we’re going to have to prepare for is that those eligibility rules are going to revert back to the original eligibility rules.”

The state will eventually begin dropping people who are no longer eligible due to a change in income. A family of two in Alabama earning more than $3,300 a year does not qualify for Medicaid. A member of the family must also be a primary caregiver to children to qualify. Participants can also get dropped if they have failed to update the state on a changed address.

But Alabama Arise health policy advocate Jennifer Harris said there is time to prepare. She explained the Medicaid “unwinding” period starting on April 1st does not mean Alabamians will begin losing coverage on that specific date. “What is going to happen is that Alabama Medicaid will be reaching out to everyone that currently has coverage,” Harris explained. ”And when they reach out, you want make sure that your address is current. If you have received any information from Alabama Medicaid to ask what your current address is, what your current income is... this is the time that they're going to be checking.”

Harris explained Alabamians may have received questions about Medicaid eligibility already. “You may have received that information during the pandemic and did not respond, and your coverage continued, but that is not the way that it is normally done,” she said. “So, when they reach out to you after April the first, that is going to help them make a determination as to whether or not you were still eligible for Medicaid services.”

Harris said once Alabamians receive any mail regarding Medicaid coverage, they need to respond as soon as possible. “So, if you are currently a Medicaid recipient or you are the caregiver of a child, an adult family member that is a Medicaid recipient, the first thing that you need to do is make sure that if you receive any mailing from Medicaid, that you respond.”

Alabamians who eventually receive letters saying they are no longer eligible for Medicaid coverage can appeal the decision. “What will happen is that if you are no longer eligible, then you will have an opportunity to receive information about possible coverage that may be available to you. We do not want you to lose coverage for lack of understanding, for lack of having materials.” said Harris. “We also want you to know what your options are. Just because you no longer are eligible for Medicaid, that does not mean that there are not other possible affordable options available.”

Harris said for those losing coverage, other insurance options could be buying insurance through the federal healthcare marketplace or possibly getting it through their job. “This is considered a life-changing event in which you can have other options that may be available to you that you can enroll in. Those options may be through your employer. Those options may be through a family plan that you're eligible for, but also those options may be on the healthcare marketplace,” she explained. “So, we are encouraging people to contact Enroll Alabama… to inquire about what potential options may be available for you.”

About 61,000 Alabamians are expected to lose Medicaid coverage by June of 2024 as a result of the pandemic-era protections being lifted. That’s according to a report by the Robert Wood Johnson Foundation and the Urban Institute.

Baillee Majors is the Morning Edition host and a reporter at Alabama Public Radio.
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