Alabama’s Medicaid enrollment has continued record growth because of the COVID-19 pandemic and an ongoing federal requirement that people can’t be removed from the rolls.

Enrollment in August, the latest month available, was 1,207,582, up from 1,103,184 in August 2020, according to information given to Alabama Daily News by the state agency.

In early 2020, in response to the pandemic, the federal government increased states’ Medicaid funding but said people couldn’t be unenrolled.

“We got that increased (Federal Medical Assistance Percentages) which really helped us with Medicaid, but one of the caveats was that we couldn’t take anybody off the rolls, even though they might be eligible to come off the rolls,” Rep. Steve Clouse, the House’s General Fund budget committee chairman said.

The only way recipients can now come off of Medicaid is if they die, move out of state or voluntarily remove themselves.

Prior to COVID-19, the federal government paid about 72% of Alabama Medicaid’s expenses. In response to the pandemic, that amount was increased to about 78%.

“It’s still to our advantage with the enhanced FMAP, even with the enrollment higher.”

Enrollment was about 1.05 million before the pandemic.

Medicaid is the state’s largest General Fund budget expense each year. This year, it’s $769 million, down from $820 million last fiscal year.

State agencies are now considering their fiscal year 2023 requests to be presented to lawmakers late this year.

“Medicaid’s leadership continues to monitor the (public health emergency), along with enrollment numbers and other factors to effectively plan for future budgets,” Medicaid spokesperson Melanie Cleveland told ADN recently.

Medicaid had a significant carry forward in state funding from fiscal 2021 to 2022 because of that increase in federal money and a decrease in the utilization of Medicaid-funded health services as more people stayed home during the pandemic.

Cleveland said several factors impact Medicaid’s budget each year. The 2023 request will be presented to Finance Director Bill Poole and Gov. Kay Ivey in the next couple of months.

Alabama’s restrictions on Medicaid enrollment do not allow for able-bodied adults without children to be on the rolls, so COVID-caused spikes in unemployment don’t translate into large numbers of adults now receiving its health coverage. Traditionally, more than half of the state’s enrollees are children.

Democrats and advocacy groups continue to plead with Republican leaders to use federal incentives to expand Medicaid coverage to about 300,000 Alabamians living in the health coverage “gap.” They earn too much to qualify for Medicaid under the state’s stringent income limit but too little to qualify for subsidized Affordable Care Act’s marketplace plans.

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Increased Federal Funding Renews Medicaid Expansion Push

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Meanwhile, the agency is reviewing requests that it extend postpartum coverage from the current 60 days to a total of 12 months, Cleveland said.

Information about that potential cost was not available.

At least one state budget maker is concerned about Medicaid’s possible costs in 2023.

“There has been an underutilization for more than a year, but it will go back up and costs will increase,” Sen. Greg Albritton, R-Range said. He’s the Senate General Fund budget chairman.

“I’m worried that we will have an increased demand on Medicaid,” Albritton said.