From our Policy and Organizing Director, A'Niya Robinson
To Whom It May Concern:
Thank you for the opportunity to comment on the Presumptive Eligibility amendment to the Alabama State Plan for Medical Assistance. The amendment would provide care for up to 60 days to pregnant women who have not been formally approved for Medicaid coverage but who submit proof of pregnancy and household income information to a qualified provider. This would allow her to begin prenatal care while the Medicaid approval process is ongoing.
On behalf of the ACLU of Alabama, we strongly support this amendment. People should not have to die while bringing new life into this world. We have highlighted maternal health as a priority issue area for our office, and since then, we were instrumental in the passing of SB102 and have spent much of this year traveling across the state to hear from women about their pregnancy and childbirth experiences.
1. Presumptive eligibility would allow pregnant women to access care sooner.
At our listening sessions, we’ve heard stories from women who had pregnancy conditions that threatened their and their baby’s lives, and they first learned of these conditions well into their pregnancy. If presumptive eligibility was fully implemented and the mother could have accessed her prenatal care without waiting on Medicaid approval, those conditions could have been diagnosed and treated sooner, eliminating that additional pain and stress. Unfortunately, this story is too familiar: In 2019, 1 in 4 pregnancies in Alabama had inadequate prenatal care.
2. Maternal mortality cases are higher among women with late or no prenatal care.
Women died from pregnancy-related causes in Alabama at more than twice the national rate in 2023, according to data from the Alabama Department of Public Health (ADPH). The maternal mortality rate nationwide was 18.6, compared to 43.3 in Alabama. Receiving prenatal care, especially in the first trimester, can offset poor outcomes and save millions by diagnosing and treating conditions that may worsen over time without medical attention, thereby reducing risk for maternal and infant death or severe complications.
3. Implementing presumptive eligibility should not result in an administrative burden on the State of Alabama.
To determine if they can be presumed eligible for care, the applicant, not the State or the provider, must supply income information. Later, during the full application process, the applicant still must supply all information. Furthermore, implementing this amendment would only cost the State $273,700, a minimal number when considering the many women and babies that can be properly cared for when this amendment is put in place.
Please take these points into consideration when making any adjustments for the amendment.