MONTGOMERY — Since April 1, more than 1.2 million Alabamians who have relied on Medicaid for health care since 2020 have begun being reconsidered for the coverage.

The redetermination process comes after states were given an extra federal Medicaid funding in March 2020 through the Families First Coronavirus Response Act to maintain enrollment for most individuals during the pandemic.

Before the Act was passed, states re-evaluated Medicaid eligibility every year. That rule ended March 31, 2023, and states could begin the redetermination or “unwinding” Medicaid enrollment April 1.

Using various data points from Centers for Medicare & Medicaid Services, the Kaiser Family Foundation estimates that nearly 170,000 Alabamians could lose Medicaid coverage during the unwinding period; An estimated 79,000 of those are children.

Alabama is one of few states that has not reported data related to its Medicaid unwinding process on its Medicaid website.

CNHI used data published by the Centers for Medicare & Medicaid Services from periodic reports it has received from states.

The last available reporting period is June 2023, of which data is reported as of Aug. 16, 2023.

During that reporting period, more than 36,000 beneficiaries due for renewal in the reporting month had their coverage terminated. Nearly 128,000 were due for renewal that reporting month.

To qualify for Medicaid in Alabama, a resident must be pregnant, responsible for a child 18 years of age or younger, blind, have a disability or a family member in your household with a disability, or be 65 years of age or older. Income requirements must also be met.

For example, a pregnant woman must make less than $26,228 per year in a household size of two after deductions to qualify for Medicaid. For a caregiver of a child on Medicaid to qualify, their income has to be less than $3,552 in a household of two.

To qualify for Medicaid through Supplemental Security Income, the income limit for an aged, blind or disabled adult can’t exceed $934 per moth or $1,391 for a couple.

The Alabama Hospital Association said there are zero childless, non-disabled adults enrolled in Alabama Medicaid ages 19-64, calling Alabama “among the most restrictive Medicaid eligibilities in the country.”

Alabama is also among 10 states — including Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming — that have not expanded its Medicaid program despite federal incentives to do so.

Currently federal dollars cover 71 percent of Medicaid costs in Alabama, while the state covers 29 percent. If the state were to expand medicaid, the federal government would increase its coverage to 90 percent.

While Democrats, the minority party in the state, have expressed support for expanding Medicaid, Gov. Kay Ivey and Republican counterparts have cited concerns about paying for Medicaid expansion long-term.

“I think the overwhelming question is the amount of money, if the federal government ever pulled back, that we would be having to pay in and that sounds like the concerns of most of my colleagues,” Sen. Garland Gudger, R-Cullman, said in a previous CNHI interview. “We don’t want to approve something like that and it come back and bite us and the government comes back and pull it back and we don’t have that budget.”

States that have expanded Medicaid allow coverage for any household making as much as 138 percent of the federal poverty line to qualify. A non-disabled, single person making less than $20,120 would qualify.

According to a 2022 study by the Public Affairs Research Council of Alabama, expanding medicaid in Alabama would increase the state’s Medicaid expenditures by $225.4 million per year throughout the next six years. While some reports suggest expansion could cover 150,000 more adults, Public Affairs Research Council of Alabama estimates that Medicaid expansion could extend coverage to as many as 280,000 more Alabamians.

Advocates for Medicaid expansion said it could save hundreds of lives each year by offering health care coverage to residents who fall between the health care gap — those earn too much to qualify for the state’s strict Medicaid requirements, but earn too little to afford a private health care plan.

Representatives from Alabama Arise say Medicaid expansion also would bolster health care access for Alabamians before, during and after pregnancies in a state among the country’s highest maternal mortality rates, especially among Black women.

“Alabama took an important step to help families stay healthy by extending Medicaid postpartum coverage last year,” Alabama Arise executive director Robyn Hyden said. “However, that step alone was not enough to meet our state’s numerous health care needs. Policymakers should pursue numerous solutions to make Alabama a better place for parents and babies. At the top of that list should be expanding Medicaid to ensure Alabamians of all ages can stay healthy before, during and after conception.”

During the Medicaid redetermination period, Medicaid recipients should expect to receive their renewal letter in the mail usually one year from the date they signed up for Medicaid. Receipts can update their address through the Medicaid or CARES portals, or by calling the Alabama Coordinated Health Networks Recipient Call Center at 800-362-1504.