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Alabama Medicaid: Guide to Coverage and Eligibility

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.

Have Questions? Ask a Benefits Advisor in Your Area

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.

Alabama Medicaid Eligibility Checklist

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 2018 Alabama Medicaid eligibility requirements and are subject to change each year.

All Kids Alabama and Alabama CHIP

Alabama kids with Medicaid have coverage for most of the same services that adults do, with the addition of dental and EPSDT (Early Periodic Screening and Diagnosis Treatment program).

  • Under the age of 19
  • Household income (legal parents, step-parents, etc.) after deductions cannot exceed:
    • Family of 1 - $1,478/month
    • Family of 2 - $2,003/month
    • Family of 3 - $2,529/month
    • Family of 4 - $3,054/month

Parents and Caretaker Relatives

  • Have a child under 19 who is a close relative and lives in the home
  • Not have a non-government funded form of health insurance coverage
  • Household income after deductions cannot exceed:
    • Family of 1 - $183/month
    • Family of 2 - $247/month
    • Family of 3 - $312/month
    • Family of 4 - $377/month

Pregnant Women

  • Household income after deductions cannot exceed:
    • Family of 1 - $1,478/month
    • Family of 2 - $2,003/month
    • Family of 3 - $2,529/month
    • Family of 4 - $3,054/month
Have Questions? Ask a Benefits Advisor in Your Area

Elderly and Disabled

  • Must be receiving Social Security Income (SSI) and not exceed:
    • Income $770/month if single
    • Income $1,145/month if married
    • Resources $2,000/month if single
    • Resources $3,000/month if married

Nursing Home Residents

  • Must medically require nursing home care
  • Must have been a resident of an approved nursing home or institution for at least 30 days unless you are already receiving SSI
  • Cannot exceed Income of $2,250/month and Resources of $2,000/month

Breast and Cervical Cancer

Women who qualify can receive free breast and cervical cancer screenings, pelvic exams, pap smears, mammograms, ultrasounds, colposcopies, and biopsies.

  • Cannot have other insurance that would cover the procedures and tests
  • For breast cancer screenings, must be aged 40-64 or under 40 with high risk and must either have a breast mass and other evidence of risk or a personal history of breast cancer.
  • For cervical cancer screenings, must be aged 40-64 or 30-39 with history of a tubal ligation
  • Income cannot exceed:
    • Family of 1 - $2,529/month
    • Family of 2 - $3,429/month
    • Family of 3 - $4,329/month
    • Family of 4 - $5,229/month
    • Family of 5 - $6,129/month
    • Family of 6 - $7,029/month
    • Family of 7 - $7,929month
    • Family of 8 - $8,829/month
    • Add $900/month for additional household members

Family Planning "Plan First Program"

Plan First Alabama covers family planning, birth control, and sterilizing services to those who qualify. It is not a full Medicaid program.

  • Women must be between the ages of 15 and 55
  • Men must be at least 21
  • No history of vasectomy, tubal litigation, or hysterectomy.
  • Household income after deductions cannot exceed:
    • Family of 1 - $1,478/month
    • Family of 2 - $2,003/month
    • Family of 3 - $2,529/month
    • Family of 4 - $3,054/month
Have Questions? Ask a Benefits Advisor in Your Area

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.

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 benefits advisors 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 benefits advisor near you, click here or call 833-438-3676.

Have questions? Ask a Benefits Advisor!