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Bentley Supports Medicaid Advisory Commission Recommendations

Brandon Moseley

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By Brandon Moseley
Alabama Political Reporter

On Tuesday Governor Robert Bentley (R) announced his support for legislation that he and the sponsors hope will transform the Alabama Medicaid Agency into a more efficient and more affordable program for the taxpayers of Alabama.

Governor Bentley said, “We now have a chance to turn Alabama Medicaid into a program that provides better care while making more efficient use of taxpayer dollars,” Governor Bentley said.  “The Alabama Medicaid Agency is also taking steps to prevent fraud and abuse of the system.  Improving Medicaid is a long-term process, and the recommendations provided by the commission will help us put the proper reforms into place, which will benefit patients and taxpayers alike.”

Medicaid is the costliest item in the Alabama General Fund and has been growing faster than state revenues, and this does not even include the cost of the massive Medicaid expansion associated with President  Obama’s costly health care reform legislation, the Patient Protection and Affordable Care Act of 2010, commonly referred to as Obamacare. Gov. Bentley has rejected the Obamacare Medicaid Expansion but the existing Medicaid program is not financially sound and is largely responsible for the need to raid the Alabama Trust Fund of $437 million to cover the general fund’s deficit.  The money will run out by October 2015.

The proposed legislation will be introduced by House Health Committee Chairman Jim McClendon (R) from Springville and Senate Health Committee Chair Greg Reed (R) from Jasper and incorporates recommendations made by the Alabama Medicaid Advisory Commission.

The Alabama Medicaid Advisory Commission was established by Gov. Bentley in October.  The  goal of the commission is to improve Medicaid’s financial stability while still providing high-quality patient care.  The 33-member commission submitted their final report to the Governor on January 30.

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The Alabama Medicaid Advisory Commission was chaired by Alabama State Health Officer Dr. Donald Williamson.  Dr. Williamson said, “We are providing a different Medicaid program, one that’s designed locally and implemented locally by people who best understand the local healthcare needs.   The commission appreciates the opportunity to serve the Governor and to offer our perspectives on the future of Alabama Medicaid.”

Currently Alabama Medicaid uses an outdated Fee For Service model where healthcare providers bill Alabama Medicaid for services rendered and there is very little coordinated done care between Alabama Medicaid, the clients, and the various health care providers providing services to the clients.

The legislation will create regional community led managed care networks that will coordinate the health care services of the Medicaid patients in that region.  The Regional care networks will become risk-bearing organizations that will likely be contracted with a commercial managed care organization to provide care, risk management, or other services in the region.

The Alabama Medicaid Advisory Commission recommends that the Legislature where appropriate shall authorize regional care networks throughout the state and establish an implementation timeline setting specific benchmarks that must be met by the networks. If a network fails to meet the benchmarks shall authorize state intervention.  The Alabama Medicaid Agency will seek an 1115 waiver from CMS to implement the transformation to managed care. The plan calls for legislation to create a Medicaid cap and provide adequate flexibility for Alabama Medicaid to deal with federal mandates, rules, and regulations as well as economic uncertainty, catastrophic health events, and changing medical provider rates.   The Commission encourages the renewal of the hospital and nursing home provider assessments.

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The Commission recommends that  Alabama Medicaid work with CMS to convert some or all CPEs to intergovernmental transfers (IGTs) to provide funding for the hospital program.  The Commission also recommends changing the current hospital payment system from a per diem and per encounter system to explore changing the current hospital payment system that pays for good outcomes.
Dr. Williamson reiterated that Medicaid is taking steps to improve fraud and abuse prevention and to shift to a payment system that rewards good outcomes and quality.

The regional managed care networks would work to provide better, more efficient care for patients while also working to control costs for the state.  State Health Officer Dr. Donald Williamson said that the legislation will need to be paired with private-sector efforts to create managed care networks that could contract with Medicaid to provide services to Medicaid beneficiaries.

Alabama has among the most restrictive Medicaid income limits of any state in the nation. Childless adults are not eligible for Medicaid in Alabama no matter how low their income.  Parents of children on Medicaid are eligible only if their income is 11% of the federal poverty level or less ($194 per month for a family of four).   All other groups with the exception of nursing home and home and community-based waiver clients are eligible only at the federally-mandated minimum level.  Children from the ages of 6 to 19 are covered if their family’s household income is equal to the federal poverty line or less.   Pregnant women and children ages 0-5 are covered only if they make 133% of the federal poverty line or less.   Medicaid covers the aged, blind and disabled if the make $730 a month or less (for an individual).  To qualify for nursing home assistance through Alabama Medicaid a senior must make $2130 a month or less (for individuals).

Brandon Moseley is a senior reporter with eight and a half years at Alabama Political Reporter. You can email him at [email protected] or follow him on Facebook. Brandon is a native of Moody, Alabama, a graduate of Auburn University, and a seventh generation Alabamian.

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Jones says Senate race a choice between “substance and leadership, and nothing”

“One of the great disappointments in this campaign is that Alabama is not really getting choices between substance and substance,” Jones said.

Eddie Burkhalter

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Incumbent Sen. Doug Jones speaks at a rally in Anniston. (EDDIE BURKHALTER/APR)

Speaking outside the Calhoun County Democratic Party headquarters in Anniston on Friday, Sen. Doug Jones, D-Alabama, told a group of supporters that Alabamians haven’t gotten a look at what his Republican opponent might do if he wins the Nov. 3 election. 

“One of the great disappointments in this campaign is that Alabama is not really getting choices between substance and substance,” Jones said. “They’re getting a choice between substance and leadership, and nothing — nothing. We have not heard anything from Tommy Tuberville about what he really wants to do.” 

While Jones has held numerous interviews with the media, and regular web briefings over the summer and in recent weeks, Tuberville’s campaign seems to prefer the safety of keeping Tuberville from making possible gaffs or damaging statements in interviews. 

Tuberville hasn’t agreed to interviews with traditional media outlets, or to debate Jones, and instead has focused on conservative talk radio spots, speaking to smaller Republican groups and at private parties.

Tuberville’s campaign has ignored or denied our numerous attempts to interview Tuberville, including another request on Friday. He also declined to attend a student forum held at Auburn University on Wednesday, which Jones attended. The forum was sponsored by the Auburn College Republicans and College Democrats.

“If you ever hear something Tommy Tuberville says, it is just simply this: ‘Build a wall. No amnesty. Drain the swamp.’ That ain’t him. That’s Donald Trump,” Jones said. “He cannot think for himself. He doesn’t think for himself.” 

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Jones spoke of his record of working to help veterans through legislation. And he referred to Tuberville’s nonprofit for veterans and reporting that indicates, through tax records, that less than a third of the money raised for Tuberville’s charity went to help veterans. 

“I don’t just create charities and send only pennies on the dollar. I do things for the veterans of this state and this country,” Jones said. 

Jones also made a case for Alabamians to remember the contributions past Democrats made in the state. Jones said it was Democratic Sen. John Sparkman who helped build Alabama’s Redstone Arsenal. 

“It was a Democrat, Lester Hill, who built the rural hospitals around here that Donald Trump and Mitch McConnell and Tommy Tuberville are trying to destroy,” Jones said. “It was Howell Heflin who built up agriculture in this state. Those are the Democrats. It was Franklin Rosevelt that put electricity in this state. We’re going to do the same thing for broadband. People forget those things. They forget those things because we’ve let other people define us with lies.”

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Jones plans to visit Jefferson County on Saturday, then on to the Black Belt and Mobile on Sunday with another stop in Birmingham on Monday afternoon. 

“The goal is to get everybody out. That’s the thing if we want to continue to ensure Alabama moves forward — moves forward and not backwards, to continue to have somebody, if I do say so myself, somebody that’s just not going to damn embarrass us,” Jones said.

Supporters of Democratic Sen. Doug Jones rally in Anniston on Oct. 30, 2020. (EDDIE BURKHALTER/APR)

“We’ve had too much of that in Alabama,” Jones said, “and I bet you it won’t be a year that Tommy Tuberville would be an embarrassment to this state because he doesn’t know the issues. He doesn’t know what to do, and he’s dang sure not going to know what to do when Donald Trump is not president of the United States.” 

Jones encouraged supporters to be skeptical of recent polling. One such recent poll, by Auburn University at Montgomery, puts Tuberville ahead of Jones by 12 percentage points, 54 to 42.1. An internal poll by Tuberville’s campaign puts Tuberville ahead by 15 percentage points, while an internal poll from the Jones camp put Jones ahead by one percentage point. 

“Don’t listen to these polling folks that come in, and they don’t know Alabama, and they don’t know what they’re doing. We’re tracking this race, and I can tell you, everything has been moving in our direction the last two months,” Jones said. 

People standing along roadsides holding his signs and showing support, Jones said, is “the energy we’ve got out there. That’s what you can’t poll.”

Ellen Bass of Anniston, standing outside the Calhoun County Democratic Party headquarters just after Jones spoke, told APR that she has numerous Republican friends who are voting for Jones.

“My hat’s off to them because they’re coming out,” Bass said. “They recognize that he is a better candidate.”

Ciara Smith, 21, newly elected to the Anniston City Council, told APR outside the headquarters building that Jones is the better candidate.

“I think that he’s educated. I think that he speaks with passion and heart,” Smith said. “And he knows what he’s talking about, which is important, and which is more than we can say about the other candidate.”

Speaking to APR after his speech to supporters, Jones said that he feels very good about the state of his campaign.

“Everything we’re seeing is moving in our direction,” Jones said. “And the more he stays hidden, the better it is for us.”

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Crime

Inmate assault injures two St. Clair prison correctional officers

The assaults happened at approximately 7:30 p.m. and both officers were taken to a local hospital and treated for those non-life-threatening injuries.

Eddie Burkhalter

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(STOCK PHOTO)

Two correctional officers at St. Clair Correctional Facility were injured in an inmate-on-officer assault on Monday, the Alabama Department of Corrections confirmed to APR.

Among the two officers who sustained non-life-threatening injuries was a basic correctional officer (BCO), a position created in May 2019, who are not Alabama Peace Officers Standards and Training Commission (APOST) certified and who cannot transport inmates, work perimeter fencing or in towers.

The other officer injured was a full correctional officer, Alabama Department of Corrections spokeswoman Samantha Rose told APR in a message Friday. The assaults happened at approximately 7:30 p.m. and both officers were taken to a local hospital and treated for those non-life-threatening injuries and subsequently released, according to Rose.

“The ADOC condemns all violence in its facilities, and the actions taken by the inmate against ADOC staff are being thoroughly investigated,” Rose said. “As the investigation into this incident is ongoing, we cannot provide additional detail at this time. More information will be available upon the conclusion of our investigation.”

The ADOC created the new basic correctional officer position to bolster the state’s woefully understaffed prisons. The creation of the position was also at the suggestion of experts ordered by a federal court to study the department’s staffing problems, ADOC attorneys wrote to the court in a filing in 2019.

The ongoing lawsuit is over the state’s handling of mental health in prisons.

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The Southern Poverty Law Center and the Alabama Disability Advocacy Program filed the 2014 suit arguing the state was indifferent to the health of inmates dying by suicide in greater and greater numbers.

Attorneys for the plaintiffs in June argued that ADOC was far behind on the court-ordered hiring new additional officers. It has been more than two years since U.S. District Judge Myron Thompson ordered the Alabama Department of Corrections to hire an additional 2,000 correctional officers by 2022.

U.S. District Judge Myron Thompson in a previous opinion wrote that prison understaffing “has been a persistent, systemic problem that leaves many ADOC facilities incredibly dangerous and out of control.”

“Taken together, ADOC’s low correctional-staffing level, in the context of its severely overcrowded prisons, creates a substantial risk of serious harm to mentally ill prisoners, including continued pain and suffering, decompensation, self-injury, and suicide,” Thompson’s previous opinion continued.

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The SPLC in court filings late last year expressed concern over the use of basic correctional officers in Alabama’s overcrowded and understaffed prisons. ADOC attorneys have argued to the court, however, that BCO’s are adequately trained to do their jobs and are needed for the department to hire the necessary number of officers per the court’s timeline.

In a court filing on Thursday, attorneys for the plaintiffs asked the court not to again delay site visits to Alabama prisons by two experts who are tasked by the court to determine which positions should be filled by correctional officers and which by BCO’s and which by another new position, called cubical correctional officers, who are to have no direct interaction with inmates.

Those visits were to begin in May, but both parties in the suit agree to wait due to the COVID-19 pandemic and the threat it posed to the experts, who are particularly vulnerable to the disease due to “age and other factors,” according to court records.

Both parties again agreed to postpone those visits in June for those same reasons, those records show. ADOC seeks a third extension but attorneys for the plaintiffs argue that the experts can visit the prisons while keeping themselves, prison staff and inmates safe from harm of COVID-19 and that thousands of employees and contractors enter Alabama prisons daily.

The plaintiff’s attorneys argue in the court filing that the expert guidance is needed because ADOC wishes to use BCO’s and cubical correctional officers to comply with the court-ordered hiring of additional staff by Feb. 20, 2022.

“Ensuring adequate staffing is of upmost importance to address the constitutional violations underlying mental health care within ADOC,” the plaintiffs’ attorneys wrote to the court Thursday.

ADOC in May was employing 494 BCO’s, a 57 percent increase in the number of BCO’s employed in Oct. 2019, according to ADOC’s staffing numbers. The number of correctional officers working in Alabama prisons fell by two percent during that time, dropping from 1,319 to 1,287.

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Elections

Slow absentee voting in Tuscaloosa sparks outrage, possible legal action

Among the issues were incredibly long lines that left some voters waiting more than five hours and an inefficient process that managed to take in fewer than 100 absentee ballots in six hours. 

Josh Moon

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(STOCK PHOTO)

Long lines and slow absentee ballot processing in Tuscaloosa County have left voters outraged and incumbent Sen. Doug Jones’s campaign threatening legal action. 

On Wednesday, Jones’s campaign attorney, Adam Plant, sent a letter to Tuscaloosa County Circuit Clerk Magaria Bobo, outlining a number of issues with ongoing absentee voting and promising to take legal action if Bobo doesn’t improve the process on the final day, Friday. Among the issues documented by Plant were incredibly long lines that left some voters waiting more than five hours and an inefficient process that managed to take in fewer than 100 absentee ballots in six hours. 

Additionally, Plant noted that Bobo has hired her family members to help process absentee ballots and at least one family member had made disparaging remarks on social media about voters. 

“You and those acting on your behalf are suppressing the vote of qualified Alabama voters,” Plant wrote in the letter. “If you are unable or unwilling to execute your duties competently, and allow Tuscaloosa voters to exercise their voting rights without undue burdens, we will take further action.”

In an interview with the Montgomery Advertiser on Wednesday, Bobo noted that her office had received more than 13,000 requests for absentee ballots — a remarkable uptick from the 3,000 or so her office usually receives — and there had been problems in managing that number of ballots while also adhering to social distancing guidelines within the office. 

However, as Plant’s letter notes, the massive increase in absentee ballots for this election shouldn’t have been a surprise. Also, Secretary of State John Merrill had made additional funds available to absentee managers to facilitate hiring extra staff, purchasing additional computers and staying open for longer hours to accommodate the anticipated increase. 

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In a press release on Wednesday, the Alabama Democratic Party criticized Bobo and her family members, and the release included screenshots of Facebook posts from Bobo’s daughter lashing out at voters who complained about the long wait times. 

“No voter should have to wait in line for hours to exercise their rights,” said ADP executive director Wade Perry. “We should leverage every tool we have to make voting easier, not harder. Also, it should go without saying that election workers should not insult the very people they are employed to serve. If Ms. Bobo is incapable of processing voters quickly, someone else needs to do the job.”

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Elections

Jones campaign calls Tuberville a “coward” after no-show at Auburn forum

“Tuberville is hiding because he knows that on every front — policy, experience, character, competence — he loses to Doug Jones. Hands down,” Jones’s campaign said.

Brandon Moseley

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Sen. Doug Jones, left, and Senate candidate Tommy Tuberville, right.

There are only four days left before election day, and incumbent Democratic Sen. Doug Jones’s re-election campaign is slamming Republican challenger Tommy Tuberville, accusing him of “hiding” and calling him a “coward.”

On Wednesday, Jones addressed an Auburn University forum. Tuberville did not attend.

“Tonight, the College Democrats and College Republicans at Auburn University co-hosted a debate between Doug Jones and Tommy Tuberville, offering students a chance to ask the candidates about the issues that matter most to Alabama,” the Jones campaign said in an email to supporters. “But Tuberville never showed up – he’s too scared to face Doug… even on his own home turf. Tuberville has repeatedly refused to debate Doug Jones. He’s consistently refused to be interviewed by the press. He’s refused to tell Alabama the truth about who and what they’re voting for – and it’s clear why.”

“Tuberville is hiding because he knows that on every front — policy, experience, character, competence — he loses to Doug Jones. Hands down,” the campaign continued. “If he won’t tell the truth, we will. Tuberville expects to win this race off of his blind allegiance to the President and his party affiliation. But Alabamians know better.”

“People deserve to know who they’re really voting for if they vote for Tuberville: someone who … won’t protect our health care, doesn’t believe in science, has no idea what the Voting Rights Act is, and doesn’t care about the lives and livelihoods of Alabamians,” the Jones campaign concluded. “Alabama will never elect a coward. Pitch in now and help us spread the truth about the man hiding behind the ballot.”

“I am disappointed that Tommy Tuberville is not here,” Jones said. “I think it is important that people see two candidates side by side answering the same questions.”

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Tuberville meanwhile is canvassing the state, speaking to rallies and Republican groups to turn out the Republican vote for himself and President Donald Trump. Tuberville spoke at Freedom Fest in Madison County on Thursday and at the Trump Truck Parade rally in Phenix City.

“It’s time Alabama had a U.S. senator who represents our conservative beliefs and traditional values,” Tuberville said in Phenix City. “It’s time Alabama had a U.S. senator who supports the Second Amendment, the right to life, and putting God back in the classroom.”

Polling consistently shows Tuberville with a commanding lead over Jones. Real Clear Politics lists the race on their current board as a likely Republican win. FiveThirtyEight’s election model gives Tuberville a 79 percent chance of defeating Jones.

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