By Brandon Moseley
Alabama Political Reporter
On Thursday the Alabama Senate passed Senate Bill 340, which is a comprehensive reform of the Alabama Medicaid program, by a margin of 27 to 3.
Rep. Mac McCutcheon (R) from Capshaw said on Facebook, “A major victory in the Senate was the passage of Sen. Greg Reed’s Medicaid overhaul bill. He offered a substitute (SB 340) Thursday and it passed overwhelmingly with bipartisan support. This is certainly a credit to Sen. Reed’s leadership and diligence. The bill modifies the delivery model of healthcare to the more than 900,000 Alabamians who participate in the Medicaid program by dividing the state into regions and allowing doctors, hospitals, and other healthcare providers to set up Regional Care Organizations (RCO). It also provides incentives for the RCOs to improve patient care to reduce costs. Medicaid is a valuable service to many Alabamians, but has grown at an unsustainable rate.”
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 told a packed joint public hearing 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.”
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.
Medicaid reform has been a goal of the Republican majority since coming into office after the historic 2010 election which gave Republicans unprecedented control of state government. Alabama Medicaid is by far the most expensive item in the troubled Alabama General Fund and is almost entirely responsible for the raid of the Alabama Trust Fund last year. The federal government dictates what services Alabama has to offer and to whom which gives the state very little control on how much the program costs each year.
Rep. McCutcheon said, “If passed in the House, the new delivery model will be phased in over the next few years. I am confident we will see positive and effective change to the program that will help ensure the continuation of this essential service.”
House Health Committee Chairman Jim McClendon (R) from Springville is carrying the bill in the House.
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.
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.”
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.”
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.
“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.”
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.
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.
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.
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.
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.
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.
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.”
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.
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.”
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.