Researchers and advocates warned last week that proposed Medicaid cuts in the massive tax-and-spending package that passed the U.S. Senate on Tuesday would devastate a region that relies heavily on the federal program.
In 2023, 21 of the 24 counties that comprise the region had some of the highest percentages of Medicaid enrollees in Alabama.
“About 28% of people living in the average Black Belt county are covered by Medicaid, compared to 20% in non-Black Belt counties and 23% overall in the state,” said Garrett Till, a graduate research assistant with the Education Policy Center at the University of Alabama.
The bill that passed the Senate on Tuesday includes nearly $1 trillion in cuts to Medicaid, which provides health insurance to low-income individuals. In Alabama, most of those covered by Medicaid are children, the elderly and those with disabilities. Non-disabled adults only qualify for Medicaid if they have qualifying children and make 18% of the poverty line or less — about $2,800 a year for an individual and about $4,800 for a family of three.
According to the report published by the Education Policy Center, 38% of Perry County’s residents were enrolled in Medicaid in 2023, the highest in the state. The Black Belt county with the lowest percentage of Medicaid enrollees was Lamar County at 20%, the only one that is equivalent to the average of a non-Black Belt counties.
“What is in the air is not spelling out well for rural situations here,” Till said. “As we see with all these counties in the Black Belt, which are going to be predominantly, if not all rural counties, are going to be hurting the most.”
About 38% of Medicaid dollars are allocated to hospitals, according to a report from the Alabama Medicaid Agency. Rural areas, like much of the Black Belt, struggle with retaining hospitals after several medical centers have already closed in the past several years.
According to the report from the Education Policy Center, 10 have already closed since 2005. Further cuts, the report says, will endanger the future viability of those that continue to operate. The report states that 27 are reportedly in danger of closing their doors, while 19 are at immediate risk of closing.
Presenters during a press briefing last week spoke of the Medicaid provision that allows the state to impose a tax on providers that is then used to help pay for the state’s portion of the cost it shares with the federal government. The budget proposal places a cap on the provider tax, which would limit the amount the state can generate to pay for its share of the federal program.
That shortfall becomes an additional cost that Alabama must bear on behalf of residents who are eligible for the program.
Till said the freeze would “just in turn is going to kick more and more people off Medicaid, period.”
Areas in the Black Belt have some of the worst outcomes for diabetes, heart disease and infant mortality. Twelve counties in Alabama with the highest rates of diabetes are located in the Black Belt. In Bullock County, about 20% of the residents suffer from the disease.
Medicaid reimbursements for physicians and other medical providers also remains low.
“The issue is if a provider, a new doctor, comes to Thomasville, Alabama, because of that lowest cost reimbursement per claim per patient in Alabama being the lowest in the nation, guess what, they go to Georgia or they go to North Carolina or they go to Arizona, or they go to another state,” said Sheldon Day, mayor of Thomasville, which is in the Black Belt. “They can see the same 40, 30, 40, 50 patients a day in their practice and probably make $100,000 more a year for the same work.”
Presenters provided several policy recommendations to address the issue. Among them is to oppose the reductions to Medicaid and the freeze to the tax on providers. They also urged communities to invest in health literacy and community initiatives along with finding solutions to the provider shortage.
Read more at AlabamaReflector.com.
