Alabama is one of 14 states not participating in the expansion of Medicaid. Alabama's 13 has been told that Governor Robert Bentley is weeks, perhaps days, away from making a decision about the future of the health care program in Alabama.
In Alabama, 53% of all births, 43% of all children and 2/3 of nursing home patients use Medicaid to pay for health care. It was originally designed as a program for the poor. Today the federal government uses income and other criteria to determine if someone is eligible to receive Medicaid benefits.
In February, a specially-called state commission sent its report to the governor on ways to fix the program.
Renee Millwood, 66, is one of Alabama's more than 900,000 Medicaid users. She received an HIV waiver which helps with prescriptions, and allows Emma, an aide, to help her out in her home five days a week, four hours a day. Once a radiation therapy technologist, the grandmother of nine also needed extra help after breaking her hip in January of last year.
Millwood said, "After that there was no vacuuming, there was no cleaning, there was no standing in there washing dishes." So her aide helps with that and more.
When asked where she would be if she had not qualified for medicaid, Millwood answered, "I'd wouldn't be here, I'd be under the bridge, sleeping."
Having an aide helps ease fears of day to day living obstacles, also of falling again, but Renee has a new fear.
Millwood said, "My fear of what's he's saying is that he would take it, the programs away, especially from an older person like me or somebody. I'm just afraid that it's gonna be gone."
Renee is talking about Alabama Governor Robert Bentley.
Right now, Alabama pays a third of the state's Medicaid costs. It eats up $600 million of Alabama's $1.7 billion annual budget. The federal government pays the rest.
In November the governor announced he would not expand Medicaid, because the state couldn't afford it, but he wanted to fix it instead.
Last month, his commission made recommendations to do just that, but also explained the Medicaid portion of the state's budget would be in the hole, 100 million dollars in just a couple of years.
Alabama's Public Health Officer, Don Williamson, MD said, "This is a little like changing a tire on a moving car."
The state's top public health officer, Dr. Don Williamson, led the commission.
Dr. Williamson said, "We have to change the way we pay for Medicaid. We have to move it from a volume based and counter based system to an outcome based system."
Dr. Williamson said the Alabama Medicaid Advisory Commission recommended the following changes:
-Allow managed care control on a regional level, similar to an HMO.
-Discourage ER visits
-Avoid what he calls unnecessary hospital admissions.
-Less pay for volume of care, which is how Medicaid is based now, and change the way Medicaid is paid to focus on quality of care and outcome.
Dr. Williamson said, "It can't survive as is. I think all of us Medicaid as we currently know it is not a sustainable proposition."
He agrees with the governor against expanding Medicaid. As part of the Affordable Care Act, Medicaid would expand to include more people meeting certain income levels -- like adults without children, pregnant women and children, which could add up to 400 thousand people.
Dr. Williamson said, "Simply adding another 400,000 people to a broken system in my judgment, will only make things worse, it won't make things better."
State Senate Majority Leader Jabo Waggoner from Vestavia Hills agrees.
16th District State Senator, Republican Jabo Waggoner said, "It's by far the most expensive agency that we have and we're getting to the point in Alabama, where we do not know how we're going to afford it."
On the other side of the debate - Minority Leader Craig Ford a Democrat from Gadsden believes Alabamians will suffer if Medicaid isn't expanded.
Rep. Ford said, "Let's quit making this a partisan deal, and let's be bipartisan. I think health insurance needs to be bipartisan."
John Archibald a columnist with Alabama Media Group also believes Alabama is making a poor choice in not expanding Medicaid. He said as much in a February column. His views haven't changed since higher profile Republican governors like New Jersey's Chris Christie and Florida's Rick Scott both decided to take the expansion dollars.
Archibald said, "Alabama already receives a $1.85 in federal funds for every dollar it sends to Washington. I mean we are already accepting more than we give. To make a political stand on the backs of our poorest people, is what to me seems to be out of whack."
Everyone Alabama's 13 talked to agrees that alhtough Medicaid could change, it is not going away.
That is of little comfort to Millwood who relies heavily on the program. She said, "I'm not really sure that I believe it."
It's a belief that may have to be spelled out when Governor Bentley makes his final decision about Medicaid in Alabama.
The governor has said publicly he will likely endorse the commission's specific recommendations to overhaul Medicaid. When he does, the state must ask for a waiver to make changes, get the state's lawmakers to get on board, and introduce new laws in order to implement the changes.
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