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Medicaid Referendum and Medicaid Expansion Two Completely Separate Issues

Susan Britt

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By Susan Britt
Alabama Political Reporter

By coincidence the subjects of Medicaid expansion and of funding of Medicaid with money from the Alabama Trust Fund monies are being discussed by state leaders at the same time leaving many people confused that they are one in the same. The only similarity they possess is the timeframe of the discussions. The two issues are vastly different but are only connected because they effect the same agency, Medicaid.

The constitutional amendment on the ballot in September will help fund the already existing Medicaid needs for the next three years, according to proponents, giving Alabama legislators the time to find a revenue solution.

Without the CA, Medicaid could potentially see a reduction of nursing homes, loss of healthcare providers who accept Medicaid, loss of jobs in medical fields, closing of rural hospitals, further reductions in provider payments and overall loss of services for Alabamians who depend on the program for their healthcare.

In April, Dr. Don Williamson took over the reins of Alabama’s Medicaid Agency. After which he identified that Alabama Medicaid needs $603 million to fund the state’s portion for fiscal year 2013. The General Fund was prepared to provide only $418 million leaving a shortfall of $184 million.

The Governor and legislators passed a proposed constitutional amendment to be voted on in a special election on September 18 asking Alabama’s voters to approve taking the shortfall from the Alabama Trust Fund (ATF). If passed the amendment will allow another two years of General Fund shortfalls to also be funded by the ATF.

The ATF is a fund that was set up as a savings account that pools royalties from Alabama’s oil and gas proceeds. One of the main contentions of the CA is that there is no plan to pay back the funds, however, it is estimated that the fund will replenish itself with only a few years.

Should the CA fail, it is speculated that the Legislature will be called into special session to try to find an alternative solution to fund the existing Medicaid needs.

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The Medicaid Expansion discussions are a direct result of the the Supreme Court upholding portions of the Patient Protection and Affordable Care Act. While the court upheld the individual mandate and the healthcare exchanges, it left the expansion of Medicaid up to the individual states as an option.

The individual mandate (which says citizens must be covered by some sort of healthcare insurance or face a federally imposed penalty in the way of a tax) remains because that has a role in what happens to individuals who need Medicaid. The healthcare exchanges remain because individuals are going to be driven to the exchange to purchase insurance to comply with the individual mandate.

Currently Medicaid covers pregnant women and children up to 6 years old at 133 percent of the federal poverty level. It also covers children from age 6 until their 19 birthday at 100 percent of the poverty level. The elderly in nursing homes are covered at 300 percent of the poverty level as are the disabled. But for childless adults, for parents whose children may be covered but they are not, and makes more than 11 percent of the federal poverty level, they are not eligible.

According to Dr. Don Williamson, interim Director of Medicaid, who spoke at the Tuesday Joint Legislative Committee on Medicaid Policy meeting, “With the Medicaid expansion to 133 percent of the poverty level for children less than 19 years of age remains mandatory [by the ACA] and begins January 1, 2014. For Alabama, that means is that by 2014, the 25,000 children who are currently in AllKids (between 100 and 133 percent of the poverty level) will be moved to Medicaid as part of the expansion.”

The big gap that remains is childless adults and parents. If Medicaid chooses not to expand then individuals below 100 percent of the poverty level will not be eligible for a subsidy through the health insurance exchange. Subsidies are available only to people between 100 percent and 400 percent of the federal poverty level. This will leave many people vulnerable because they do not qualify for a subsidy but yet will be responsible for the penalty. However, since the Secretary of Health has the authority to waive the penalty in certain instances.

“If you do not expand Medicaid, you are not making it worse. You are not taking people who have to buy insurance then making insurance not available and then taxing them,” said Williamson.

The ACA proposes for the years 2015-2016 to provide the expansion program will be 100 percent federally funded, 2017 Alabama will match at 5 percent, in 2018 at 6 percent match, in 2019 a 7 percent match and then in 2020 the match tops out at 10 percent. After that, 90 percent of the program will be federally funded with a 10 percent match from Alabama.

Williamson estimates that Alabama will spend $64 million over the next 6 years to take care of existing Medicaid eligibles that will come to the program even if it doesn’t expand Medicaid. “That only generates $173 million in federal funding. If expanded, it will swell to over $250 million over 6 years,” said Williamson.

If expanded he estimates it would increase from between $406-$440 million in new state dollars which will generate between $10.1-$10.8 billion new federal dollars.

“If we could go to 100 percent of the poverty level we could cover 355,000 of the 420,000 that might otherwise go in at under 133 percent. More than three-quarters of people that we could potentially add are below the poverty level. If we could simply get to the poverty level it would make a big difference and potentially cost us less,” said Williamson.

The Joint Legislative Committee on Medicaid Policy is currently considering the matter and will reconvene on September 12, 2012 to continue discussion.

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Health

Three firefighters, police officer in Mobile test positive for COVID-19

Eddie Burkhalter

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Three firefighters and a police officer in Mobile have tested positive for COVID-19, city officials said Tuesday.

James Barber, executive director of public safety with the city of Mobile, said during a press conference Tuesday that the four city employees tested positive.

The positives come after Mobile-based Synergy Laboratories donated 500 “test kits” and 131 asymptomatic first responders were given the 10-minute rapid blood tests on Monday.  

Barber said the four employees have been quarantined at home until swab tests confirm the virus and physicians provide further guidance.

The rapid blood tests search for antibodies in the blood, which could show a past infection, but not necessarily active infections that are still contagious.

The swab tests will confirm an active infection if one exists. It’s possible the first responders have already recovered from the virus and are no longer contagious.

“That testing continues today,” Barber said of the rapid blood testing of first responders.

Barber said he didn’t have results from Tuesday’s testing yet, but that Monday’s testing resulted in just more than 3 percent of those tested showing positive results for COVID-19. 

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There were 53 confirmed cases of COVID-19 and one death from the virus in Mobile County as of Tuesday evening, according to the Alabama Department of Public Health. 

As of Tuesday evening, there were 999 confirmed COVID-19 cases across Alabama, 13 confirmed deaths from the virus and 23 total reported deaths, some of them not yet confirmed as being caused by the virus.

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Economy

Freelancers, gig workers can begin filing unemployment claims

Chip Brownlee

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Stock Photo

Employees like freelancers and the self-employed can now file for an unemployment claim in Alabama, the Alabama Department of Labor said Tuesday, under the CARES Act, the coronavirus response bill passed by Congress and signed by the president last week.

The Alabama Department of Labor is encouraging employees who believe they may qualify for programs under the CARES Act to file a claim.

These employees will also need to certify weekly to continue to let the department know that they remain unemployed.

Although ADOL does not yet have technical guidance or a start date regarding the CARES Act programs, benefits may be paid retroactively from the time the employee separated from his or her job or otherwise became eligible under the federal CARES Act, not from the time the application was submitted or approved.

In Alabama, many freelancers, independent contractors and the self-employed are not typically able to file for unemployment insurance.

Last week, more than 70,000 people filed an initial jobless claim. Claims can be filed online at www.labor.alabama.gov or by calling 1-866-234-5382.

The Department of Labor is asking for patience when trying to file a claim.

ADOL says employees who may be affected include:

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  • The self-employed
  • Church employees
  • Non-profit and governmental employees
  • Independent contractors
  • Gig economy workers
  • Those who have exhausted their regular UI benefits.

These employees should also meet one of these conditions:

  • The individual has been diagnosed; or
  • A member of the individual’s household has been diagnosed; or
  • The individual is providing care to a household or family member; or
  • A child or other person for which the individual has primary caregiving responsibility is unable to attend school or another facility as a result of COVID-19; or
  • The individual is unable to reach the place of employment because of a quarantine imposed as a result of the COVID-19 public health emergency; or
  • The individual is unable to reach the place of employment because the individual has been advised by a health care provider to self-quarantine; or
  • The individual was scheduled to start work and does not have a job as a result of COVID-19; or
  • The individual has become “the breadwinner or major support for a household because the head of the household has died as a direct result of COVID-19”; or
  • The individual has to quit their job because of COVID-19; or
  • The individual’s place of employment is closed because of COVID-19.

This list is not exhaustive.

Further details regarding the CARES Act programs will be forthcoming, the department says, including information regarding Federal Pandemic Unemployment Compensation, which provides for an additional $600 a week in unemployment compensation benefits.

The additional $600 weekly benefit will only be available for weeks beginning March 29, 2020

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Health

Two hospital employees in Huntsville test positive for COVID-19

Chip Brownlee

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Stock Photo/Huntsville, Alabama

A physician and another employee at Crestwood Medical Center in Huntsville, Alabama, have tested positive for the novel coronavirus that causes COVID-19, the hospital said Tuesday.

“Crestwood Medical Center learned that 2 of our associates (one physician and one employee) have tested positive for COVID-19,” spokesperson Lori Light said in a statement Tuesday.

One is in the hospital for care while the other is at home under quarantine.

The hospital has also had two patients test positive in the Emergency Department, but neither of the patients needed inpatient care, the spokesperson said.

“Working in coordination with the health department, we are following established CDC procedures to identify and communicate directly with any potentially exposed staff and patients,” the Crestwood Medical Center spokesperson said.

Overall, there are at least 13 COVID-19 patients in Madison County, the hospital’s CEO Dr. Pam Hudson said Tuesday during a briefing.

There are 11 inpatients at Huntsville Hospital’s facilities, according to Huntsville Hospital spokesperson Susan Esslinger.

In Alabama, the number of positive cases is nearing 1,000. At least 23 deaths related to COVID-19 have been reported. The Alabama Department of Public Health has officially confirmed 13.

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Crime

Alabama inmate killed by another inmate at Ventress Correctional

Eddie Burkhalter

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via the Alabama Department of Corrections

A Birmingham man serving at Ventress Correctional Facility in Clayton was killed by another inmate, according to the Alabama Department of Corrections. 

Dennis Benson, 40, who was serving a 36-month sentence for possession of a controlled substance and receiving stolen property, died March 30 after being attacked by another inmate, ADOC said in a statement. 

“The ADOC condemns all violence in its facilities, and the fatal actions taken against Benson by another inmate are being thoroughly investigated,” the department said in a statement.

Benson’s cause of death is pending a full autopsy, and more information will be available upon the conclusion of the investigation into his death, according to the department. 

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