What does Medicaid not cover in Alabama?

Alabama Medicaid is a health insurance program for certain low-income and needy people paid with federal, state, and county dollars. It is the largest program providing medical and health-related services to Alabama's poorest people – including children, the aged, blind, and/or disabled, and people who are eligible to receive federally assisted income maintenance payments.

Eligibility Requirements

To be eligible for this Medicaid program, you must be a resident of the state of Alabama, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.

You must also be one of the following:

• Pregnant
• Be responsible for a child 18 years of age or younger
• Blind
• Have a disability or a family member in your household with a disability
• Be 65 years of age or older

Annual Household Income Limits (before taxes)

*For households with more than eight people, add $6,038 per additional person.

Available Services Include:

Copayments

You do not have to pay a copayment if you are a Medicaid recipient who is:

• In a nursing home
• Under 18 years of age
• Receiving pregnancy-related services
• Receiving family planning services
• A Native American Indian with an active user letter from Indian Health Services (IHS)
• The following services do not require a copayment:
• Birth control (family planning) services
• Case management services
• Chemotherapy
• Dental services for children under 21 years of age
• Doctor fees if surgery was done in the doctor’s office
• Doctor visits if you are in a hospital or a nursing home
• Emergencies
• Home and community services for people who are intellectually
• Disabled, or the elderly and physically disabled
• Home health care services
• Mental health and substance abuse treatment services
• Preventive health education services
• Physical therapy in a hospital outpatient setting
• Radiation treatments
• Renal dialysis treatments

What is Medicaid?

• Medicaid is a state program that gets federal money. It helps low income people.
• It pays for doctor visits, medicines, hospital care, nursing homes and other medical care.
• Medicaid pays doctors, hospitals, druggists and others directly.
• Unlike insurance, if you pay the bills yourself, you can't get paid back.
• Do not confuse Medicaid with Medicare. Medicare is a separate federal program for people who are disabled, over 65 or in need of dialysis.

Who is eligible for Medicaid?

• Everyone who receives SSI
• Everyone who receives Family Assistance. Many call Family Assistance "ADC" or "welfare".
• Some people who can't get Family Assistance because of 1996 changes in the law
• Children who lost SSI in 1996 because of changes in the law
• Babies up to one-year-old who were born to a mother on Medicaid
• Children under 19 in families with income below 146% of the federal poverty level. Once eligible, they remain eligible for at least a year. See Free or Low-Cost Health Insurance for Pregnant Women and for Children.
• Families that lose Family Assistance because of an increase in child support. They can get four months of transitional Medicaid.
• Families that lose Family Assistance because of work income. They can get at least a year of transitional Medicaid.
• Someone in a nursing home with total monthly income below three times SSI level
• Someone who is only able to stay out of a nursing home by getting special care
• Someone who used to get SSI but got taken off because they:
  • got a raise in their Social Security checks; or
  • started getting Social Security checks as a widow or widower after 50, but before 65; or
  • started getting Disabled Adult Child's benefits when they turned 18.

What other help can Medicaid give me?

• Transportation to medical care
• Prenatal care for pregnant women
• Children can get more benefits after they are screened through the EPSDT program. See A Parent's Guide to Medicaid Screening (EPSDT Benefits)
• Medicaid "QMB Program" pays Medicare premiums, deductible and co-insurance for people on Medicare with income below the federal poverty level.
• Medicaid "SLMB Program" pays Medicare Part B premiums for people on Medicare with income below 120% of the federal poverty level.
• Qualified Disabled Working Individuals can get Medicaid to pay their Medicare Part A premium.

Where do I apply for Medicaid?

• Babies whose mother was on Medicaid get Medicaid automatically for up to one year. During that year, the mother should apply at the welfare department or the health department.
• People who are on Family Assistance or SSI don't have to apply. They get Medicaid cards automatically.
• If you could get Family Assistance, but you decide not to get it, you can apply for Medicaid for your family. You can go to the DHR (welfare) office to apply for Medicaid when you apply for food stamps.
• Children under 19 and any pregnant woman can apply at the county health department or at most hospitals and rural clinics. Call Medicaid to learn the nearest location.
• To apply for Medicaid in a nursing home, call Medicaid to learn the nearest Medicaid District Office.
• People who used to get SSI but got cut off should call Medicaid to learn the nearest Medicaid District Office.
• People on Medicare who want to apply for QMB or SLMB should call Medicaid to learn the nearest Medicaid District Office.

Where can I get more information?

• You can call Medicaid at 1-800-362-1504.
• If you are deaf, call the TDD number: 1-800-253-0799.
• You can visit Alabama Medicaid's website to get A Medicaid Primer (PDF).

AlabamaLegalHelp.org offers legal information, not legal advice. This website provides information on your rights and options. However, the site does not apply the law to your personal facts. For legal advice, you should call a lawyer. To apply for free legal services in Alabama, call the Legal Services Alabama office that is closest to where you live OR call toll-free 1-866-456-4995. You can also apply online HERE.

All across the nation, Medicaid covers about one out of every six dollars spent on health care and about half of all dollars spent specifically on long-term care. In the state of Alabama, Medicaid covers one out of every seven adults, four out of every nine children, two out of every three nursing home residents, and two out of every five disabled persons. About 13% of Alabama state funds are spent on Medicaid costs.

What You Should Know about Alabama Medicaid Includes:

Medicaid Alabama Coverage

Medicaid in Alabama covers most of your basic health care needs with the exception of dental, which is only covered for those under 21. Otherwise, if you have Medicaid Alabama, you will have access to vision, hearing, lab services, radiology, renal dialysis, transplants, maternity care, mental health, family planning, hospital services, transportation, and prescription drugs.

Vision and Glasses

AL Medicaid beneficiaries over the age of 21 are eligible for one eye exam and one pair of glasses every three years. Those under 21 can get an eye exam and a pair of glasses every year. Contact lenses must be approved head of time and are usually only allowed in special circumstances.

Hearing and Cochlear Implants

Those between the ages of 5 and 21 can get one Medicaid-covered hearing screening each year. If you find that you or your child needs a cochlear implant, you’ll need to have a surgeon sign this authorization form. In most cases, hearing services and hearing aids are not covered for adults. This is a circumstance where those who are eligible for Medicare will want to invest in a Medicare Advantage policy.

Renal Dialysis for Kidney Failure (ESRD)

For those with kidney failure, AL Medicaid will cover 156 yearly outpatient dialysis treatments per year, which amounts to three per week. Keep in mind that if you are diagnosed with kidney failure (ESRD, End Stage Renal Disease), you will also qualify for Medicare! That means that you can get double the benefits with a “D-SNP,” or “Dual Special Needs Plan.”

Alabama Medicaid Formulary

While you may be able to get coverage for other prescriptions, there is an Alabama Medicaid preferred drug list. The drugs on this list do not require any prior authorization. In most cases, all generic drugs are considered “preferred,” so you shouldn’t have a problem unless there is a reason that you need to have a brand-name drug, which is rare. Brand name and generic drugs usually have the same effect.Back to Top

Alabama Medicaid Providers

To find Alabama Medicaid providers in your area, you can use a doctor search tool like ZocDoc or doctor.com. You can also log into your Alabama “My Medicaid” account to change providers.

Alabama Medicaid Dentist List (Smile Alabama)

Medicaid Alabama only covers dental services through Smile Alabama for those who are under 21 and fully eligible for Medicaid. Beneficiaries can receive six-month cleanings and checkups,  crowns, extractions, fillings, fluoride, space maintainers, sealants, root canals, and x-rays. Orthodontic services, hospitalization, and non-surgical periodontal treatment require prior authorization by Medicaid (at least two weeks before the procedure). In general, braces, dentures, gum surgery, and all-porcelain crowns are not covered.

Click here to view a list of Public Health Dental Clinics in Alabama. For a local Alabama Medicaid Dentist list, click here and enter your zip code.

Compare Plans from All Carriers in 1 Minute!

There are seven Alabama Medicaid eligibility categories: Children, Parents and Caretaker Relatives, Pregnant Women, Elderly and Disabled, Nursing Home residents, Breast and Cervical Cancer, and Family Planning.

To qualify for any of the categories, you must be an Alabama resident and either a U.S. citizen or in satisfactory immigration status. You must also meet the income requirements according to the Federal Poverty Level as well as the resource requirements. Resources refer to cash, life insurance value, checking and savings accounts, loans, mortgages, real estate, stock and bonds, etc. Do you qualify for any of the listed categories?*

*All numbers reflect 2019 Alabama Medicaid eligibility requirements and are subject to change each year.

The Alabama Medicaid Application

You can apply for All Kids Alabama, Plan First, and/or Medicaid at insurealabama.org. If you prefer, you can download the Alabama Medicaid application and mail it in. If you’re having trouble, you can call 1-800-362-1504.Back to Top

Having both Medicare and Medicaid in Alabama

If you are above the age of 65 or if you have been diagnosed with ALS or ESRD, you probably qualify for Medicare. If you also meet any of the eligibility requirements listed above, you can qualify for both Medicare and Medicaid in Alabama. If you can get benefits from both, Medicare will pay first, then Medicaid will help cover the rest. Plus, with both Medicare and Medicaid, you won’t have to rely purely on Alabama Medicaid providers. You will also have access to the Medicare network. To start, complete the Alabama Medicaid application.

Both programs can be confusing and difficult to navigate, but we have experienced and licensed agents in 38 U.S. states who can answer your questions and help you select the best coverage option for you and your needs. To get started and find a licensed agent near you, click here or call 833-438-3676.Back to Top