The number of Alabamians on Medicaid has topped 1 million, officials of the state Medicaid Agency said Monday.
The state's numbers show enrollment jumping by nearly 30,000 early this year as the Affordable Care Act came online — and they seem to contradict earlier reports showing Alabama's Medicaid enrollment in decline.
"No, enrollment has not gone down," Robin Rawls, a spokeswoman for the Alabama Medicaid Agency, said Monday.
Since the 2008 recession, Alabama lawmakers have struggled yearly with ways to pay for Medicaid, a joint state-and-federal program that provides health insurance for some people living in poverty.
Fewer than 800,000 people were enrolled in Alabama's program before the 2008 stock market crash, and numbers have climbed steadily since, even as the economy seemed to improve post-recession. Medicaid has taken up an increasing share of the state's $1.8 billion General Fund budget, and lawmakers in 2011 transferred more than $400 million from a state trust fund to help pay for the program.
Medicaid officials predicted last year that the number of people eligible for the program would top 1 million, or roughly one Alabamian in five.
Those officials also fretted about the "woodwork effect" under the Affordable Care Act, also known as Obamacare. New Medicaid clients would come out of the woodwork, the theory went, once they applied for Obamacare and found out they were eligible for Medicaid all along. Gov. Robert Bentley had already declined an optional expansion of Medicaid, paid for mostly by the federal government, arguing that the state still couldn't afford to pay for its share of the expansion. New "woodwork" enrollees, however, couldn't be turned away.
A report released earlier this month by the federal Centers for Medicaid Services suggested that Alabama might not have seen a woodwork effect after all. That report showed Alabama's enrollment declining 4 percent between February and April.
The CMS report counted only full enrollees in Medicaid — not people with partial Medicaid coverage, such as the birth control coverage the state provides to some low-income women. But even some of the state's own statistics, outdated but available on the Medicaid Agency's website, seemed to show a decline in enrollment this year.
Rawls said the state now has two systems for counting enrollment, a new system that the state adopted to comply with the Affordable Care Act and an older system the state is slowly transitioning away from. The seeming decline appears only in the older system, which is no longer accurate, she said.
"It's underreporting the numbers," she said.
Rawls sent The Star numbers from the newer system. They show roughly 972,000 people on Medicaid in October, when enrollment for insurance under the Affordable Care Act first opened. Enrollment jumped to 1 million in January, after ACA's first enrollment deadline passed. In March, the latest month for which numbers were available, 1,020,000 people were enrolled in Medicaid.
Rawls said around 23,000 of those new enrollees were children who had been enrolled in the state-funded AllKids insurance program, and were moved to Medicaid because the Affordable Care Act required the change.
Just how many others came on board because of the woodwork effect is hard to say, said Robin Rudowitz, an analyst for the Kaiser Family Foundation, a nonprofit which studies health care issues.
Rudowitz said there are a number of reasons why enrollment could go up or down, including seasonal changes and fluctuations in the economy. In states where Medicaid wasn't expanded, she said, officials weren't always keeping count of "woodwork" enrollees.
“In states that are expanding, there's a need to keep close track of the new enrollment numbers because of the match rate," she said, referring to the federal matching funds for Medicaid expansion. Rudowitz said Medicaid expansion states showed much larger increases in enrollment than non-expansion states — something experts had long expected.
Of the million Alabamians on Medicaid, most don't have the option of getting employer-provided insurance. Children in poverty-level households make up nearly half of the total, with nursing home residents and people with disabilities making up much of the rest of the total.
Roughly more than 100,000 women are enrolled in a state Medicaid program that provides birth control to low-income women — but that program doesn't cover other services.