Alabama Medicaid is the access point for many low income individuals in the state to acquire a health insurance plan. However, the program is somewhat limited by its eligibility guidelines, and will not allow all people struggling to make ends meet to enroll. The current state requirements target a specific, very low-income group, and assist others who need additional help in certain cases. The Medicaid program in Alabama is currently offered to the following groups: low-income families, children, pregnant women, Medicare members, and SSI beneficiaries.
Each group has its own income limit assigned by the state, which cannot be exceeded if one wants to be approved for coverage. For pregnant women and children, the limits are more liberal, though low-income parents have to be working part-time on minimum wage to make the cut. In the future, there is a possibility that the income limits could expand so that more adults have access to coverage. This is only a prospect at the moment, however, and heavily depends on the state’s decisions in the next few months, which will likely leans towards “no.”
Medicaid Income Guidelines
According to the current federal poverty level (FPL), percentages of monthly and annual income is evaluated to determine eligibility for the Medicaid program. Each group must have income less than or equal to their specified guideline in order to be considered. In Alabama, like other states, there is a vast separation between children who may be accepted by the program and their parents. Below are the various categories a person can fall into in order to qualify for benefits.
SOBRA Medicaid: Pregnant Women & Children under age 6
133% of FPL
Family of 1: $1239 per month
Family of 2: $1677 per month
Family of 3: $2116 per month
Family of 4: $2555 per month
SOBRA Medicaid: Children ages 6 -19
100% of FPL
Family of 1: $931 per month
Family of 2: $1261 per month
Family of 3: $1591 per month
Family of 4: $1921 per month
Medicaid for Low Income Families (MLIF)
Employed Parents: 24% FPL
Family of 1: $223 per month
Family of 2: $302 per month
Family of 3: $382 per month
Family of 4: $461 per month
Unemployed Parents: 11% FPL
Family of 1: $111 per month
Family of 2: $137 per month
Family of 3: $164 per month
Family of 4: $194 per month
Medicare Savings Programs
Qualified Medicare Beneficiary (QMB)
Individual: $951 per month
Couple: $1281 per month
Specified Low Income Medicare Beneficiary (SLMB)
Individual: $1137 per month
Couple: $1533 per month
Qualified Individual (QI-1)
Individual: $1277 per month
Couple: $1723 per month
SSI Beneficiaries: Aged, Blind, or Disabled
Individual: $718 per month, $2000 resource limit
Couple: $1068 per month, $3000 resource limit
Nursing Home Medicaid
Individual: $2094 per month, $2000 resource limit
Home & Community Based Waivers
- Elderly & Disabled Waiver: $2094 per month
- Independent Living Waiver: $2094 per month
- Person(s) with Intellectual Disabilities Waiver $2094 per month
- HIV/AIDS Waiver: $2094 per month
- Technology Assisted Waiver for Adults: $2094 per month
- Program of All-Inclusive Care for the Elderly: $2094 per month
Each waiver has a $2000 resource limit per month.
Medicaid covers a number of benefits for free, and if not, for a very small copayment. A comprehensive level of medical services are available, from dental to emergency care and regular access to a primary care doctor. The following are services paid for by Medicaid in Alabama.
- Ambulance services
- Dental care: checkups and cleanings every 6 months, some crowns, extractions, roots canals, X-rays, fillings, and TMJ surgery.
- Doctor’s office visits: 14 per year, including health care clinics and emergency room visits or 16 days in of physician care when hospitalized.
- Eye care: exams and glasses once every 2 years for adults and once a year for members under 21.
- Family planningservices: birth control pills, IUDs, shots, implants, diaphragms, and sterilization for members over age 21.
- Preventive Health Education
- Hearing services: one exam per year and hearing aids
- Home health care
- Hospice care
- Hospital care (Inpatient): 16 days per year in a semi-private room
- Hospital care (Outpatient): 3 non-emergency visits per year, no limit for lab work, X-rays, radiation or chemotherapy.
- Hospital care (Psychiatric)
- Laboratory and X-ray services
- Maternity care
- Mental health care
- Nurse midwife services
- Nursing home care
- Prescription medications
Several services offered through Medicaid are offered for a small fee, though others are free of charge. These select services are the only ones with a meager copayment required at the time of your visit. However, there are exceptions to the copayment rule, as you do not have to pay if you are in a nursing home, under age 18, receiving family planning services, or a Native American Indian. The remainder of services mentioned above do not require a copayment.
- Doctor visits: $1 per visit
- Visits to health care centers: $1 per visit
- Visits to rural health clinics: $1 per visit
- Inpatient hospital: $50 each time you are admitted
- Outpatient hospital: $3 per visit
- Prescription drugs: $0.50 to $3 per prescription
- Medical equipment $0.50 to $3 for each item
- Supplies and appliances $0.50 to $3 for each item
- Ambulatory surgical centers $3 per visit
1. Alabama Medicaid Agency. “Qualifying for Medicaid”. http://medicaid.alabama.gov/CONTENT/3.0_apply/3.2_Qualifying_for_Medicaid.aspx.
2. Alabama Medicaid Agency. “Covered Services”. http://medicaid.alabama.gov/CONTENT/4.0_Programs/4.2_Covered_Services.aspx.