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Message from the State Health Officer

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Support Adequate Funding of Alabama Medicaid

Our mission in public health is to serve the people of Alabama by assuring conditions in which they can be healthy. A fundamental prerequisite for an individual to achieve optimal health is to have access to healthcare. Medicaid provides such access to Alabama’s most vulnerable residents - pregnant women, infants, children, the disabled, and the elderly, covering more than half the births and almost half our children’s healthcare. Our eligibility thresholds reflect the bare minimum allowed by the federal government for individuals to qualify. There are essentially no frills or excesses in the program.

Medicaid requested funding of $785 million to continue existing services in 2017. The $700 million appropriation represents a shortfall of $85 million which translates into a much larger amount due to federal matching dollars at 3 to 1. Cuts to live within the appropriation began this month with discontinuation of the “primary care bump.” Non-bump rates paid to private physicians are very low, barely covering the cost for many providers to see Medicaid patients.

With these cuts, physicians serving a high number of Medicaid patients may struggle to stay in business if they cannot afford to run their offices. Some are expected to reduce or eliminate Medicaid caseloads. Others may choose to leave the state, compounding Alabama’s longstanding shortage of primary care physicians which is already severe in our rural areas.

Medicaid may have to stop paying for eyeglasses and outpatient dialysis, among other services. As each cut looms, the infrastructure of our state’s healthcare delivery system becomes more precarious. Lack of access to pediatricians and family medicine physicians will further burden emergency rooms and patients will be sicker when they show up. Many rural hospitals rely on Medicaid to stay afloat and several have closed in recent years. Having fewer physicians and hospitals impacts more than just Medicaid patients. Those with private insurance may be forced to seek care elsewhere if their current provider goes out of business.

Of particular concern to public health is the impact on our infants and children. For years, Alabama has struggled with one of the nation’s highest infant mortality rates. Covering over half the births in the state, Medicaid is absolutely critical to our efforts to improve infant mortality. For example, the American Academy of Pediatrics recommends newborn follow-up care 48 to 72 hours after hospital discharge to assess the baby’s progress and answer questions for the family. Issues addressed during this important visit include normal infant behavior, feeding, weight, jaundice, and safe sleeping. Missing this and other recommended visits will result in infants not receiving important follow-up care and may lead to serious illness, neonatal intensive care unit admission, or even death, further worsening our infant mortality rate.

As a bright spot, Alabama ranked high on children’s vaccination rates with the 2014-2015 National Immunization Survey showing 93.5 percent of kindergarteners completely up-to-date. Immunization is a vital component of well-child care and has prevented countless deaths. With routine childhood vaccination, pediatricians in our state saw vaccine-preventable diseases either eradicated or significantly decline over the past 60 years. Although many younger pediatricians have never seen these deadly diseases, we cannot rest in the belief that they are no longer a problem and represent no danger to Alabama’s children. We must maintain high immunization rates. Vaccine-preventable diseases such as tetanus, whooping cough, and measles are top causes of death in children worldwide.

Medicaid is a major cornerstone of infrastructure for health in Alabama. Adequate funding helps protect those who depend on it for healthcare, especially our children and other vulnerable citizens. The alternative is allowing them to suffer preventable disease, disability, or death.

Thomas M. Miller, M.D.
State Health Officer

(August 2016)

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