Alabama's Governor Again Hints at Medicaid Expansion

Alabama Governor Robert Bentley suggested earlier this week that Medicaid expansion might offer a way for the state to address its funding crisis for adult mental health services.

But as quickly as the Republican governor dropped the hint Monday, during a visit to BayPointe Hospital in Mobile, he waved off a reporter’s question to elaborate; Bentley told al.com his visit was focused on a $541 million tax plan to fund programs for the elderly, the disabled, and children.

It’s not the first time Bentley has suggested he might support a form of Medicaid expansion. The topic came up right after he won re-election last fall, but he offered no details. Since that time, the state’s mental health system faced a near meltdown in February, when its largest provider could not reach a contract renewal with Blue Cross Blue Shield of Alabama. In a matter of weeks, the state’s mental health system absorbed 300 layoffs and the need to find new providers for 28,000 clients.

It was a watershed moment for Alabama mental health, with many service providers writing letters and sounding the alarm about years of neglect and low reimbursements. And it seemed to resonate with the state’s governor, who proposed a tax plan aimed squarely at the most vulnerable residents in one of the nation’s poorest states.

Still, Democrats in Alabama’s legislature have asked why Medicare expansion is not part of the equation, and it remains their top priority. Bentley’s administration has said that no changes will be proposed until after the US Supreme Court rules in King v. Burwell, which will determine whether consumers in states without exchanges—such as those in Alabama—can continue to receive tax credits to subsidize coverage purchased under the Affordable Care Act (ACA).

Bentley’s specific comments involved an exchange with hospital CEO Tuerk Schlesinger, who described how Alabama and other non-expansion states were competing for federal dollars in a pilot program to treat adult mental health patients. The expansion states saw a spike in clients and were drawing down more federal dollars, at the expense of states like Alabama.

The governor responded that expansion might be sought under an “Alabama plan,” whenever King v. Burwell is resolved.

Alabama is among the states—21 in all—that have not expanded Medicaid as permitted under the ACA. In some states, such as Tennessee, Republican governors have sought expansion but could not win over legislators in their own party. In several non-expansion states, such as Florida, business leaders have pushed for expansion to shore up hospital finances, because emergency rooms must still treat uninsured patients who show up without a way to pay.

Because the law did not envision states declining expansion, an estimated 4 million adults nationwide are in a “coverage gap.” They make too much to qualify for traditional Medicaid in their states, but they earn less than 138% of the federal poverty line and cannot access tax subsidies on the exchanges.

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