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Legislature Holds Public Hearing on Future of Medicaid

Brandon Moseley



By Brandon Moseley
Alabama Political Reporter

On Tuesday the Alabama Legislature held a public hearing to explain the Medicaid reform package introduced by Sen. Greg Reed (R) from Jasper.  The Chairman of the Alabama House Health Committee, Rep. Jim McClendon (R) from Springville presided over the meeting to explain the legislation drafted by he and Sen. Reed and endorsed by Governor Robert Bentley (R).
The new legislation is based on recommendations by the Alabama Medicaid Advisory Commission which was chaired by Alabama Health Officer and interim Alabama Medicaid Director Dr. Donald E. Williamson Dr. Williamson explained that the new law would divide Alabama into between six to eight Regional Care Organizations (RCOs).  The RCOs would be given the responsibility for administering the Medicaid program in their areas.  They would not be state agencies, but rather would be for profit or non-profit corporations which would administer the Medicaid program and would bear the risk for the program.
Currently Medicaid is set up on a Provider Fee For Service (PFFS) model where Medicaid beneficiaries purchase care from healthcare providers (doctors, hospitals, pharmacies, nursing homes, etc.) and they then bill the state.  With a PFFS model the state is at risk for whatever services the clients charge and there is very little coordination of care between providers for a Medicaid beneficiary.  The state can allocate money for Medicaid; but it has little real control on costs.
Dr. Williamson said, “We envision these being risk bearing entities. So must have capital.”  The capital providers would control 60% of the board of the RCO.  Dr. Williamson said, “We chose 60% because the people putting up the money should have control of the board.”  The Citizens advisory board has to be at least 20% Medicaid enrollees.
Much of the language comes from the Oregon Medicaid reform statute.  Medicaid spends about $2.5 billion in health care benefits.  That translates into about $300 to $500 million of business in each RCO.  The legislation protect the legislature from an RCO failing and the state having no way to pay providers.  Dr. Williamson said that the state has to be prepared in case an RCO fails.  The state will have to commit to implementing this by October 2016.  Dr. Williamson said the state will only proceed if this is cheaper than what we are doing now.  Alabama Medicaid is projecting that the RCOs would save the state $20 to $70 million a year and have better outcomes.
Williamson said that the RCOs may bleed into more than one region.  “What we envision is probationary licenses.”  The RCOs will have just over three years to go from probationary to full capitation.  The state must audit the RCOs to make sure they have solvency.   The proposed contract length is three years with two one year renewable options.
Medicaid providers must be willing to accept the payment and services set by the RCO.  Dr. Williamson said the state’s timeline is aggressive because it needed to be aggressive.  “By sept 30th we will have divided Medicaid into no more than 8 regions.”  The RCOs will be in place in one year.  By 2016 the RCOs must meet solvency standards must achieve capitation (i.e. the RCO has to have enough money in the bank to meet all the potential obligations.)  Not meeting the timeline is grounds for termination.
Williamson said that everyone acknowledges that we have to do something about long term care; but this plan does not specifically address the details of long term care reform.  The RCOs would handle the other Medicaid programs including, Medicaid services to poor families, Medicaid for poor children, and Medicaid benefits for poor seniors and the disabled.
Dr. Williamson said that the Alabama Attorney General’s office is involved in crafting the legislation to make sure that the state doesn’t violate any federal anti-trust statutes.
Sen. Greg Reed is the sponsor of SB 340. Sen. Reed said, “The goal of this meeting is to learn what issues that you have with my bill.  None of us feel that we have a Medicaid system that can’t be improved.”  Reed said that the goal is to wind up with a better system.
Rep. McClendon said that in order for an RCO to assume the risk they have to have money in the bank.  “Right now the taxpayers are at risk.” We need to move that risk for those claims to the RCOs.
One hospital administrator for a chain of three hospitals in northwest Alabama employing 1500 people thought that 180 miles is too large a diameter for some regions of Alabama.  Specifically he felt that Northwest Alabama deserves its own RCO.  He commended Gov. Bentley, the Alabama legislature and the Medicaid commission for the work that they did.
The Executive Director of the Alabama Dental association, Dr. Zack Studstill said that RCOs was not the ideal way to handle Medicaid dentistry and said that Florida had attempted the same thing and it did not work real well.  Utilization decreased, quality decreased, and the cost was the same.  He said that Dentistry is unlike medicine.  The possible unintended consequence is less Dentists participating in the Medicaid program.
This plan calls for a study of long term care services.  The spokesman for the Alabama Nursing Home association said, “We look forward to working with you.”
The Commissioner of the Alabama Department of Senior Services Neal Morrison said that he was supportive of the effort.  “We are here to help you.”
The Director of Business Development and State Relations with Centene Corporation (a managed Medicaid Corporation) Ryan Sadler said that this was a positive step forward but that the legislature should address the risk timeline.  “The focus must remain on the patient, but if we do not achieve budget savings what have we accomplished?”  Sadler said that the state should require that entities operate at full risk since day one instead of starting the RCOs with probationary licenses.  He also felt that the state should move much quicker and that are “very sophisticated players” who are eager to come run managed Medicaid services in Alabama. He also favored allowing competition.
The spokesman for Alabama Appleseed said that they have been working on making Alabama Medicaid stronger for several years.  He said they favored longer license renewal times and greater consumer involvement on the boards of the Regional Care Organizations.
Dr. Hammock with the University of South Alabama said that the Alabama Hospital Association is in support of this bill.  “We can’t do it (Medicaid) the way we have been doing it.
Kimble Forester with Alabama Arise said that they support the intent of the legislation but still have some concerns.  Their chief concerns is if one person on the board can properly represent consumers interests.
Lynn Williams with Melina Healthcare said that her company has successfully implemented Managed Medicaid in other states.  The traditional HMO model was not the best model in their experience.  “We believe that Alabama is not ready at this point for a full capitation model.”   She said that the Governor’s committee produced a very balanced study that took advantage of the lessons learned in other states and that this legislation meets Alabama’s needs.   “Melina strongly supports this legislation.  We believe this is a major first step.”
Dr. Jack Bradford representing the AARP said that his group represents a half a million Alabamians.  He said, “This is a wonderful first step.”
Rep. Laura Hall (D) from Huntsville and a House Health Committee member said that she didn’t see any African Americans or Hispanics testifying before the committee.  Hall said that the RCOs needs to have inclusive and diverse venders and boards.
Rep. Joe Hubbard (D) from Montgomery and a member of the House Health Committee said, “This piece of legislation appears to be an important first step to address the Medicaid crisis in this state.”  “I am proud of this body for bringing this forward.”
Senator Reed said that he was appreciative of everybody who spoke and who contributed to the debate.  Areas that they needed to look at going forward are the positives of the current Medicaid dental providers, incorporating Patient Care Networks (PCNs), and how to reform long term care.  “We are interested in this process.  Reed said they are still working on how the states can we offload that risk so that the state has budget clarity.  “How or are RCOs going to compete?”   Reed said that the legislature and the Governor have been working on this issue for 14 months.
Chairman McClendon said that the health committees will be meeting the week after Spring Break.  He encouraged that everyone with an interest in this to submit their comments and ideas in writing to the House and Senate Health Committees.

Brandon Moseley is a senior reporter with six and a half years at Alabama Political Reporter. You can email him at [email protected] or follow him on Facebook.



Feds resolve complaint over “discriminatory” Alabama emergency ventilator policy

Eddie Burkhalter



The federal government on Wednesday said it had resolved an investigation into an Alabama’s policy regarding triage of pandemic patients and use of ventilators that a federal agency called “discriminatory” against those with intellectual disabilities and older people. 

The U.S. Office of Civil Rights in a statement Wednesday said the Alabama Department of Public Health (ADPH) had agreed to remove all mention of the 2010 document from state websites and that the department would comply with all civil rights laws. 

There were 2,472 confirmed COVID-19 cases across Alabama as of Wednesday afternoon, 67 reported deaths and 314 hospitalizations form the virus.

Of the 144 COVID-19 patients in Alabama intensive care units as of Tuesday, 93 were hooked to the life-saving ventilators, according to ADPH. Ventilators are in short supply in Alabama and in most other states as each is vying to stockpile the machines.

The federal agency was acting on a complaint filed on March 24 by the Alabama Disabilities Advocacy Program and The Arc of the United States that said ADPH’s emergency operations plan violated disabled persons’ federal disability rights laws. 

According to the state’s plan, last updated in 2010, under a “last resort” condition hospitals are ordered to not offer mechanical ventilator support for patients, including children, with “severe or profound mental retardation,” “moderate to severe dementia,” and “severe traumatic brain injury.” 

An ADPH spokesman on March 26 told APR that the 2010 document had already been replaced and that the new document covers a much broader scope of topics than just ventilators, and was developed by a much larger group of people. 

The new document, dated Feb. 28, 2020, does not contain the same language about restricting use of ventilators for the intellectually disabled or older patients, but it also doesn’t clarify how, exactly, ventilators are to be used during an emergency triage situation. 


OCR notes the lack of clarity on that in the statement Wednesday. 

“OCR is aware that on February 28, 2020, Alabama released new Crisis Standards of Care (CSC) Guidelines. The 2010 Criteria, however, were still available on some state webpages, and it was not clear whether any of their potentially problematic provisions could still be applied under the new Guidelines,” the U.S. Office of Civil Rights said in a statement. 

But OCR said in the statement that Alabama has agreed to comply with civil rights laws and that the old provisions won’t be used in the future. 

“The state has agreed to remove all links to the 2010 Criteria from its websites and to comply with applicable civil rights law. It has further agreed to clarify publicly that the 2010 Criteria are not in effect; that it will not, in future CSC guidelines, include similar provisions singling out certain disabilities for unfavorable treatment or use categorical age cutoffs; and that it will also not interpret the current Guidelines in such a manner,” OCR said in the statement. 

OCR director Roger Severino in a statement Wednesday commended Alabama for “quickly disavowing problematic triage plans and coming into compliance with federal civil rights laws within days of being contacted by our office. 

“Alabama and other states are free to and encouraged to adopt clear triage policies, but they must do so within the guardrails of the law,” Severino said.

“We are pleased that the state of Alabama has rescinded this illegal policy and given notice to hospitals across the state that they may not rely on this policy and cannot discriminate against people with disabilities in accessing lifesaving care,”
said Shira Wakschlag, Legal Counsel for the Arc of the United States, in a statement Wednesday.

Rhonda Brownstein, legal director of the Alabama Disabilities Advocacy Program, in a statement said Wednesday’s actions are an important first step, and the organization “appreciates that Alabama acted quickly to withdraw its discriminatory policy.”

“We call on the Governor to work with ADAP and others in the disability community to develop transparent and clear guidance on how to implement these non- discrimination requirements in the event that rationing of ventilators becomes necessary,” Brownstein said.

“All people deserve compassion and equal respect, and with this in mind, the allocation of care cannot discriminate based on race, color, national origin, disability, age, sex, exercise of conscience or religion,” said Alabama state health officer Dr. SCott Harris said in OCR’s statement. “This includes the use of ventilators during medical emergencies in addressing the needs of at-risk populations in Alabama.”

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Jones asks for faster emergency loans to small businesses

Eddie Burkhalter



U.S. Sen. Doug Jones, D-Ala., and a ranking Republican colleague led other lawmakers in a request that the Treasury Department and the Small Business Administration speed up loans to small businesses amid the COVID-19 pandemic. 

Jones and Sen. Ben Cardin, D-Md., and other legislators in a letter Wednesday to U.S. Treasury Secretary Steven Mnuchin and Small Business Administration Administrator Jovita Carranza asked that payroll processing companies be allowed to disburse CARES Act small business loans to speed up payments to those small businesses and to get workers paid quickly. 

“Payroll processors have the needed existing infrastructure that will enable businesses to quickly pay their workers and pending bills. Given they originate approximately 40 percent of all the payroll checks in the country and mostly cater to small businesses with 500 employees or less, involving these companies will ensure a deeper dissemination of funds nationwide to the businesses that need it most to keep their doors open,” the letter reads. 

 “It is critical that all tools be used to distribute federal funds effectively and expeditiously, including payroll processing companies used by many small businesses,” they continued. “Please consider permitting payroll processors to partner with small businesses and banks to help alleviate any potential complications for many small businesses during this tumultuous time, the letter continues. 

 Jones in a separate letter Tuesday to Mnuchin asked that the federal government expedite direct assistance payments to citizens amid the COVID-19 outbreak by allowing some to receive the money quicker through debit cards rather than paper checks. 

Senators Kyrsten Sinema, D-Ariz., Chris Van Hollen, D-Md., Mark Warner, D-Va. and Bob Menendez, D-N.J. also signed the Wednesday letter.

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More than half of Alabama COVID-19 deaths are among black people

Chip Brownlee



More than half of the deaths so far in Alabama from COVID-19 have been among black people, according to the Alabama Department of Public Health. Black Alabamians make up only 27 percent of the state’s population.

New data released Wednesday shows that the number of deaths among black people infected with COVID-19 in Alabama is higher than initially reported Tuesday, worsening an already disproportionate death rate.

The Alabama Department of Public Health is releasing new demographic data daily, and the numbers could shift again, but the early data show the virus is disproportionately killing black Alabamians.

Black people account for 52 percent of 48 verified deaths in Alabama, up from 44 percent of the verified deaths reported Tuesday. White people, who account for about 69 percent of the state’s population, make up 37.5 percent of the state’s deaths so far. At least 60 deaths have been reported, but not all of them have been investigated by the ADPH’s epidemiology staff.

Public health experts, including Dr. Selwyn Vickers, the dean of the UAB School of Medicine, have said that a lack of access to health care, higher uninsured rates and more underlying chronic illnesses like cardiovascular disease are contributing to the higher number of deaths among black Alabamians.

Rep. Anthony Daniels, the minority leader in the Alabama House of Representatives and a member of Gov. Kay Ivey’s coronavirus task force, told APR Wednesday that the state cannot wait to issue an after-action report on the disparities. It must start collecting and reporting as much data as possible now — on testing, on hospitalizations, on deaths and on outcomes in general.

All Alabamians, not just black Alabamians, have higher rates of underlying disease and chronic illness, making the state particularly susceptible to severe health effects caused by the virus. Men of all races have also made up a disproportionate number of the early deaths in Alabama. At least 64 percent of those who have died so far have been men, though women have made up more of the early confirmed cases at about 56 percent. Men are also more likely to have cardiovascular disease and other chronic conditions that make people particularly vulnerable to COVID-19.

Alabama also has a higher rate of poverty, especially in black communities, which results in worse health outcomes. According to the U.S. Department of Health and Human Services, the death rate for black people is higher than that of whites for heart disease, stroke, cancer, asthma, influenza and pneumonia, diabetes and HIV/AIDS — not because of biology but because of socioeconomic inequalities.


“There are underlying health conditions in poor communities period, whether you’re black or white,” Daniels said. “I don’t know that there is enough data out there to definitely say that underlying health conditions are the sole indicator.”

Black people in Alabama, and across the United States, suffer worse health outcomes in a variety of areas — not just from this virus. Black women in Alabama have much higher rates of maternal mortality than white women, and studies have shown that people of color have more limited access to health care and higher uninsured rates than white people.

“We’ve known that the maternal mortality rate is an example of where we are,” Daniels said of health care disparities for people of color. “We’ve got to look at this. Is this quality or standard or care? There are so many underlying things that we have to think about.”

Daniels also said he worries that the number of cases and deaths in vulnerable communities is being undercounted because these people, especially early on in the outbreak, may not have been able to get a test or get to a hospital.

He called on the state to provide emergency funding to the Department of Public Health to gather more data and expand the response to the virus.

“We’ve got to look at the data more broadly,” Daniels said. “We cannot wait on an after-action report to determine what we could have or should have done. Alabama has so many smart people.”

The cause does not seem to be a lack of seriousness among people of color. Black people, at 46 percent, and Latinos, at 39 percent, are nearly twice likely to view the coronavirus as a major threat to their health, compared to about 21 percent among white people, according to Pew Research.

Demographics as of April 7.

The disproportionate number of deaths could also be stemming in part from geography. The virus has ravaged areas of the country with larger black populations, in part because cities tend to have a higher number of black residents. The virus is affecting several cities in the state with large black populations. At least 480 cases and 13 deaths have been confirmed in Jefferson County, where the largest city, Birmingham, has a majority black population.

The area of Alabama with the least access to health care, the Black Belt region, is also the area of the state with the largest black population. Many of the counties in this region of the state have no hospital. Expanded testing in this region has identified growing rates of infection.

“You could also worry that they just don’t get access,” Vickers said Saturday. “They don’t get to the hospital as early, and so it’s probably multiple reasons.”

Black people are also being disproportionately infected with the virus, according to the Department of Public Health. Though black people make up about 27 percent of the state’s population, about 37 percent of those with a confirmed case of the virus are black; 49.4 percent are white. The race of about 10 percent of the cases is unknown.

The data in Alabama mirror data in other states like Louisiana and Illinois, where black people have made up a disproportionate number of deaths caused by COVID-19.

“These communities, structurally, they’re breeding grounds for the transmission of the disease,” Sharrelle Barber, an assistant research professor of epidemiology and biostatistics at Drexel University, told The New York Times. “It’s not biological. It’s really these existing structural inequalities that are going to shape the racial inequalities in this pandemic.”

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AlabamaWorks releases business survey to identify COVID-19 impact





AlabamaWorks has announced a new tool for all businesses, large and small, related to the COVID-19 impact and future focus of the workforce in the state.

The Alabama COVID-19 Workforce Response Survey is designed to help the state fully understand the impact of this pandemic on the state’s workforce as well as provide a clear path forward for businesses, industry and state government.

“I am grateful to the Alabama Workforce Council for developing and deploying this much needed and user-friendly survey,” said Governor Kay Ivey. “As we work together to combat COVID-19’s impact, this tool will allow us to identify the needs of business and industry, resources that can help them and how we can best support Alabama’s businesses owners and hardworking Alabamians and their families.”

The official survey, which is critical for helping individual industry sectors recover from COVID-19, is available here:

“While these are challenging times, we fully understand that now, more than ever, business and industry leaders must continue to work together with Governor Ivey’s administration and various state agencies to move us all forward together,” noted Alabama Workforce Council Chairman Tim McCartney. “Rest assured there is an unwavering commitment to do everything we can to minimize the negative impact COVID-19 has on our businesses, our economy, the state and all of its citizens. Using the results from this survey, I know we can all make a difference in combating the challenges from this pandemic facing so many throughout Alabama.”

Responses to the survey will be accepted through Tuesday, April 21 at 5 p.m. All businesses are highly encouraged to participate as the responses will help to protect Alabama’s workforce, manage the impact of COVID-19 and guide the allocation of various resources.

Additionally, another tool was released earlier this week for hard-working Alabamians from Governor Ivey’s office to help connect people to resources and resources to people. is a one-stop-shop for all Alabamians meant to connect businesses, nonprofits, and people that need help with the available resources during this time.

For more information and resources on Alabama’s COVID-19 workforce recovery efforts please visit

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