Alabama Medicaid Statistics

Eligibility

  • In 2013, 22.5% of Alabama’s total population was eligible for Medicaid.
  • The total adult population that was eligible for Medicaid in 2013 was 14.7%.
  • Alabama is one of 23 states that did not accept the Medicaid expansion.

Costs Covered

  • Alabama’s total Medicaid expenditures in 2013 were $5.55 billion.
  • The overall federal funding percentage of Medicaid in 2013 was 67.6%.
  • The overall state funding percentage in 2013 was 32.4%.

CHIP  

  • 42.8% of children are eligible for CHIP.
  • The total number of children who enroll in CHIP in Alabama is 112,972. 

1) What is Medicaid?

In the United States, the Medicaid program provides health insurance coverage to almost 60 million families, children, pregnant women, elderly citizens and persons with disabilities. Medicaid does not only cover American citizens though, as the program’s reach extends to immigrants who meet certain criteria.

Medicaid is both a state program and a federal program designed to provide health insurance coverage for individuals and families who meet a certain income requirement. The determining factors in whether or not someone will be deemed eligible for Medicaid are income and household size. The income requirement fluctuates based on household size. One of the biggest benefits of the Medicaid program is that it allows children to receive a full set of services, which includes preventive care, screenings, treatments, immunizations, visits to the hospital and doctor, vision care and dental care. Furthermore, all of these services are offered to families at no cost.

Under the Affordable Care Act’s individual mandate, all Americans are required to have health insurance. Fortunately, being on Medicaid meets the criteria of coverage. Individuals and families who are currently receiving assistance from this medical program do not have to worry about buying coverage in the Health Insurance Marketplace.

2) How do I apply for Medicaid in Alabama?

If you believe you qualify for Medicaid in Alabama, learn how to apply for Medicaid as soon as possible. There are two simple options available to you. Your first option is to apply for Medicaid online. Using the Alabama Medicaid Agency, you will be able to create an account and find out if you qualify for this federal/state assistance by answering some questions about personal information. Simply follow the prompts and you will be finished with your application in minutes and on your way to receiving the necessary health coverage. Begin the process to apply here.

If you prefer to apply for Medicaid in person, you can also fill out a physical Medicaid application and mail it in to the address listed in the form. The Alabama Medicaid website features a wide variety of different forms specifically designed for different groups, which range from women without children to individuals with disabilities, the elderly and more. Pay close attention to the address, as it will differ based on your group. The questions that you can expect to encounter on these applications concern personal information, family information, your job and your income. For your convenience, joint Medicaid applications are available for families of two or more.

3) What does AL Medicaid cover?

Since Medicaid is a federal program in addition to being a state program, there are a number of services that the government requires coverage for, including:

  • Inpatient and outpatient hospital services.
  • Physician services.
  • Services from nursing homes.
  • Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT).
  • Services from rural health clinics.
  • Home health services
  • X-ray and lab services.
  • Family planning services.
  • Transportation to a medical car facility.
  • Tobacco counseling for pregnant women.
  • Midwife nursing services.
  • Services from certified Pediatric and Family Nurse Practitioners
  • Services from federally qualified health centers
  • Freestanding Birth Center services, if licensed or recognized by Alabama.

More specifically in Alabama, recipients enjoy the following benefits after filing a successful Medicaid application:

  • You qualify for up to 14 visits to the doctor per year.
  • You qualify for up to 16 days in the hospital per year.
  • Children under the age of 21 can receive eye exams and eyeglasses once per year, while adults enjoy this privilege once every three years.
  • Children under the age of 21 receive routine preventive services and restorative care under the Alabama Medicaid Dental Program.
  • Medicaid in AL pays for three non-emergency outpatient visits to the hospital for each calendar year.
  • Medicaid covers “emergency outpatient services” when the situation is considered a certified emergency.
    • A certified emergency is when someone has a serious health issue that they believe could damage their health if they do not receive medical care immediately.
  • Five total drugs (up to four brands) are allowed per month, per adult when it comes to outpatient pharmacy prescriptions.

On the other hand, there are a number of services that Medicaid in Alabama will not cover. These include:

  • Sitter services.
  • Cosmetic procedures, including surgery.
  • Dental services (routine work, crowns, braces, etc.).
    • Dental services are not available for adults 21 or older or pregnant women who are only eligible for services related to their pregnancy.
  • Meal trays or cots for visitors in the hospital.
  • TV or VCR rentals in hospital rooms.
  • Infertility treatment or services.
  • Supplies, equipment or drugs for recreational or experimental therapy.
  • Respiratory, speech or occupational therapy for adults 21 or older.
  • Hearing services for adults 21 or over.
  • Any services for people in prison or jail.
  • Any services to people who do not qualify for Medicaid.
  • Any services that are not explicitly covered under the Alabama Medical Assistance plan.

4) Who is eligible for Medicaid in Alabama?

Within the state of Alabama, there are four agencies that determine who qualifies and whether or not a person should apply for Medicaid:

  • The Social Security Administration: The SSA determines eligibility for the aged, blind or disabled applicants through the Supplemental Security Income (SSI) program.
  • The Alabama Department of Human Resources: This department examines the eligibility of foster children and kids who currently receive state or federal adoption assistance.
  • Catholic Social Services: This group certifies the qualifications of refugees through the Refugee Resettlement Program.
  • The Alabama Medicaid Agency: This agency determines eligibility for the elderly, the disabled, parents, caretaker relatives, pregnant women, children under the age of 19 and aliens in emergency situations. The AL Medicaid Agency also runs the Plan First (Family Planning) Program and the Breast and Cervical Cancer Program.

In order to be eligible and apply for Medicaid, you need to:

  • Be a United States citizen or someone legally living in the country.
  • Live in the state of Alabama.
  • Meet the income and age criteria, which will vary based on the program and the applicant.
    • Elderly and disabled individuals must also meet medical criteria in addition to a resource limit.
    • Pregnant women must have their pregnancy medically verified.

Review the 2015 Alabama Medicaid income requirements below:

  • 1 person = $11,770
  • 2 family members = $15,930
  • 3 family members = $20,090
  • 4 family members = $24,250
  • 5 family members = $28,410
  • 6 family members = $32,570
  • 7 family members = $36,730
  • 8 family members = $40,890
  • Add $4,160 for each additional person for families with more than eight family members.

Some examples of people in the United States who are eligible to receive Medicaid include:

  • Recipients of Supplemental Security Income (SSI).
  • Children between 0 and 18.
  • Infants born to pregnant women who are eligible for Medicaid.
  • Those who receive adoption assistance.
  • Households with children under 19 who have a very low income.
  • Some protected groups, such as those who lost financial assistance because of a boost in earnings or support.
  • Some Medicare beneficiaries.
  • Children in foster care or in the custody of the Alabama Department of Youth Services.

5) What are the consequences if Alabama does not elect Medicaid expansion?

Obamacare, also known as the Affordable Care Act, has allowed states to choose whether or not to expand Medicaid to cover all adults below the age of 65 whose income is up to 133 percent of the federal poverty level. The state of Alabama is one of the 23 states in the country that has chosen not to accept the Medicaid expansion at this time. This decision does not affect individuals and families that are currently receiving coverage under Medicaid. As long as residents continue to meet the criteria necessary to be covered under the Alabama Medicaid program, you will receive health insurance under the state medical program and the federal medical program. But if you do not currently have insurance, then your coverage options are likely limited.

Currently, the federal poverty level that determines Medicaid eligibility in Alabama is 146 percent. If your income is more than 100 percent of the federal poverty level, which is $11,670 per year as an individual, or approximately $23,850 for a family of four, then you can buy health coverage through the Health Insurance Marketplace, and you may qualify for tax credits and other savings, which will be determined based on your income and household size.

6) How do I contact Alabama Medicaid?

If you would like to find out more about Medicaid, or are just having trouble with your Medicaid application, you always have the option of visiting a nearby Medicaid office. Office locations are situated all across the state of Alabama, so you should have no trouble finding one near you, and if you would rather not take the trip, residents also have the option of calling the Alabama agency’s Medicaid phone number at: 1-334-242-5000. There is also a phone number specifically suited for people who have questions about eligibility, as well as those who are elderly, disabled, have children, or are pregnant: 1-800-362-1504.

One of the most common reasons why you would have to get in touch with a Medicaid representative is if you are unsure if you qualify for the federal medical assistance. Many times, individuals do not think that they meet the income requirements, but do not realize that the size of their household coupled with their income makes them eligible to receive aid. Another reason you may contact the Alabama Medicaid agency is if you have found a better source for income, such as a new job, and are notifying your employer that you no longer need Medicaid.

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