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Alabama Medicaid is a federally and state-run health insurance program for low-income Alabama residents. The purpose of Alabama Medicaid is to provide access to health care for those who do not receive coverage through work or cannot afford a private health plan in Alabama. Although many people on Alabama Medicaid are over 65 years old, the program is open to people of all ages.
Healthcare providers provide medical services, while Medicaid insurance pays for the treatment. Individual healthcare providers may or may not accept Alabama Medicaid.
An Alabama Medicaid card grants the holder coverage under the Alabama Medicaid program. Each card has the holder’s name, sex, date of birth, 13-digit plan ID number, and double-digit card number.
Plan members present their Alabama Medicaid ID number when they submit an insurance claim to pay for medical care. You cannot receive care without an appropriate ID number. Alabama law forbids Medicaid recipients from sharing their card or ID number with other people.
You can apply for Alabama Medicaid in person at one of the state’s Medicaid offices or via print and mail. If you choose to file a paper application by mail, you will need to send it to the closest state Medicaid office. You can also apply online at medicaid.alabama.gov, fax a completed application to a Medicaid office, or call 1-800-362-1504 to speak to the Third Party Health Insurance Section for assistance with the application process.
After you send your application via your preferred method, it will take about 45 days for the state to process and respond. You can check the status of your application on the Alabama Medicaid online portal. Once you are accepted, you can check your plan details, coverage, and any notifications on your Medicaid account dashboard.
To be eligible for Alabama Medicaid, you must be a legal resident of Alabama as either a US citizen, legal alien, or permanent resident who can demonstrate a need for health care due to low income. Eligible residents also must meet one of the below conditions:
Additionally, you must fall below the designated income limit, depending on the size of your household. The table below shows applicable income limits according to the number of household members as of 2023.
| Size of Household | Max Income Eligibility Limit |
|---|---|
| 1 | $19,392 |
| 2 | $26,228 |
| 3 | $33,064 |
| 4 | $39,900 |
| 5 | $46,737 |
| 6 | $53,573 |
| 7 | $60,409 |
| 8 | $67,245 |
For each additional member of your household, the income limit increases by $6,836. These income limits are subject to change.
Please note that you cannot transfer Medicaid eligibility from one state to another because different states have different eligibility requirements. You are not guaranteed Alabama Medicaid coverage if you are eligible for Medicaid coverage in another state.
If the state finds you guilty of fraud or abusing the program, it can revoke your membership and eligibility. Examples of Medicaid fraud include:
Once you send your application and the state office approves it, the office will send your Alabama Medicaid card to you in the mail. It will take a few weeks for your card to reach your mailbox. If you need healthcare services in the meantime, you can either show your Alabama Medicaid acceptance letter with your ID number or get a temporary Medicaid ID card here.
Please note that not everyone accepted to Alabama Medicaid receives a card, such as those who do not yet have a social security number (e.g., foster children or unborn children). If you have just had a baby, you can receive a card for your child after you submit your baby’s name, birthday, and social security number to a Medicaid worker.
You must renew your Alabama Medicaid plan every year to retain coverage. The state will assess your income and assets each year to determine whether you still fall under the maximum income limits. After renewal, the Alabama Medicaid office will send you a new card for the next year of your coverage.
If you never received your Alabama Medicaid card, you can call a state Medicaid office to request a new one. If you lose your card, the state of Alabama will replace it free of charge. If someone tries to charge you to replace your member ID card, you should contact your local Medicaid office to report fraud.
Alabama Medicaid includes specific medical services and procedures for coverage. In this section, we will go over the medical treatments and circumstances Alabama Medicaid covers, as well as what Alabama Medicaid does not cover. The services and procedures covered by Alabama Medicaid include a wide range of medical treatments, including doctor visits, hospital stays, laboratory tests, X-rays and more. Additionally, the program covers specific services like family planning, dental care, mental health treatment, and substance abuse treatment. Here is a closer look:
Alabama Medicaid will cover dental services for recipients under the age of 21, provided they are eligible for Medicaid. It’s important to note that dental coverage through Alabama Medicaid is not automatic for all recipients. In order to receive dental services, individuals under the age of 21 must be eligible for Medicaid and must visit a dentist that accepts Medicaid. Medicaid will not cover dental care for adults, regardless of their eligibility status. For those in Alabama over the age of 21, it is wise to consider affordable, private dental plans in Alabama to ensure the health and wellness of their teeth.
Alabama Medicaid will cover most drugs that a doctor orders. Medicaid might limit the total amount of brand drugs prescribed every month, and Medicaid must approve certain medications beforehand. Medicaid may also pay for medical equipment for managing an illness or a condition. Drugs on Alabama Medicaid’s preferred drug list (PDL) do not require prior authorization.
More specifically, adult Medicaid recipients may receive up to five prescriptions a month, four of which can be brand-name drugs. Alabama Medicaid does not limit the number of prescriptions for children under the age of 18. Alabama Medicaid can waive prescription limits in the event of adverse or allergic reactions to a specific drug that was originally covered by Medicaid.
Additionally, drugs under the Three-Month Maintenance Supply Program are exempt from prescription limits. Under the three-month maintenance program, Medicaid recipients can receive three months’ worth of a covered drug for a single co-payment.
Alabama Medicaid will cover specific types of extended healthcare that a doctor prescribes, such as nursing home room and board care and nurse midwife care for delivery, family planning, and gynecology. Medicaid may also cover in-home post-hospital extended care (PEC) in cases where the patient is out of the hospital and is in the process of transitioning into a nursing home.
Alabama Medicaid will cover hospice care for recipients who receive a terminal diagnosis. There is no limit to the number of days of hospice care Medicaid will cover. Hospice services include nursing care, doctors’ services, medicine, home health aide, therapy/counseling, and short-term hospital care.
In certain cases, Alabama Medicaid will cover out-of-state treatments. For Alabama Medicaid to cover out-of-state treatments, at least one of the below health conditions must be true:
Alabama Medicaid will have to approve services before an out-of-state provider gives treatment. Medicaid does not provide additional travel medical insurance for traveling out of the country. In this case, investing in travel insurance is the best course of action for those leaving the country.
Alabama Medicaid does not provide specific coverage for recipients who are students or enrolled in an educational program unless they meet other eligibility requirements. Alabama Medicaid provides coverage to non-disabled adults over the age of 65 and covers a wide range of senior care, including nursing home care, hospice care, doctor’s services, and in-home care.
In certain states, coverage for subgroups such as Aboriginals and Military personnel are covered by the state's health program. In the case of Alabama, they are not.
Alabama does not offer special coverage for aboriginals.
Alabama does not offer special coverage for military service members or veterans. However, the website for Veteran Affairs in Alabama can point vets in the right direction in terms of how to apply for a benefit program.
Alabama Medicaid coverage has specific limits. Below is a partial list of services and treatments that Alabama Medicaid will not cover. Check with your healthcare plan provider if you are not sure about coverage limitations:
Alabama Medicaid rules and regulations can be difficult to parse, and it may be hard to tell whether it will cover a specific procedure. Below is a breakdown of common procedures and whether Alabama Medicaid will cover the cost of treatment.
| Dental | |
|---|---|
| Alabama Medicaid provides dental coverage for children under the age of 19 and adults under the age of 21 who are otherwise eligible for Medicaid. Dental services covered and not covered by Alabama Medicaid for those eligible are: | |
| X-Rays | Yes |
| Sealants | Yes |
| Root canals | Yes |
| Space maintainers | Yes |
| Root planing periodontal scaling | Yes |
| Fillings | Yes |
| Fluoride treatments | Yes |
| Extractions | Yes |
| Buildups and crowns | Yes |
| Checkup every six months | Yes |
| Cleaning every six months | Yes |
| Periodontal or gum surgery | No |
| Routine partials, bridgework or dentures | No |
| All-porcelain crowns | No |
| Routine orthodontic care, such as braces | No |
| Vision | Alabama Medicaid provides coverage for several vision services. These are as follows: |
|---|---|
| Eye Exams | Alabama Medicaid will cover up to one eye exam every two calendar years for adults over 21 years old and one exam per year for children under 21. |
| Glasses | Alabama Medicaid pays for one pair of glasses per two years for adults over 21 and up to two pairs of glasses per year for children under 21. |
| Laser Eye Surgery | Alabama Medicaid will not cover laser eye surgery as it is considered a cosmetic procedure. However, Alabama Medicaid will cover cataract surgery if a doctor determines it is medically necessary. |
| Surgery | |
|---|---|
| Rhinoplasty | Alabama Medicaid will not cover rhinoplasty surgery unless it is medically necessary. Because a rhinoplasty technically qualifies as a cosmetic procedure, Medicaid will generally not cover it. |
| Breast Reduction | Alabama Medicaid will not cover a breast reduction or enlargement unless a physician deems it medically necessary. You must obtain prior authorization before Medicaid will cover a medically necessary breast reduction. |
| Hospital | |
|---|---|
| Hospital stays | Alabama Medicaid will cover in-patient and out-patient hospital stays for as many days as are medically necessary. Medicaid will not cover costs for a private hospital room. |
| Ambulance transportation | Medicaid will cover ambulance transportation if medically necessary at the time of transport. It will not pay if the recipient can use another method of transportation without harm. |
| Giving birth | Medicaid will cover prenatal, delivery, and postpartum care for parents. It will also cover prenatal vitamins and other maternity services. |
| Sexual Health | Medicaid will cover a wide range of sexual health treatments and conditions. The following are a few examples of what it will and will not cover: |
|---|---|
| Gynecologist visits | Medicaid covers routine gynecological exams and services, such as pap smears. |
| Erectile Dysfunction | Alabama Medicaid will not cover drugs for erectile dysfunction unless a physician prescribes them to treat pulmonary hypertension. |
| Birth Control | Alabama Medicaid will cover birth control pills, implants, and IUDs for childbearing women of any age. Medicaid will also cover tubal ligation and vasectomies for women and men over the age of 21. |
| Fertility Treatment | Alabama Medicaid will not cover fertility treatments. |
| Specialist Services | |
|---|---|
| Dermatology | Alabama Medicaid covers dermatological visits for medically necessary treatments. |
| Physiotherapy | Alabama Medicaid will cover both in-patient and out-patient physiotherapy. There is no limit to covered physical therapy sessions. |
| Massage Therapy | Alabama may cover specific massage therapy or chiropractor sessions for qualified Medicare beneficiaries (QMBs) and children with a referral. |
| Podiatry and Foot Care | Alabama Medicaid will cover podiatric care for QMBs and children who receive a referral after an EPSDT. |
| Allergy Testing | Alabama Medicaid will cover allergy testing if there is documentation of medical necessity. Food allergy testing is only covered for patients who have documented symptoms after ingesting a specific type of food. |
| Sleep Physician Services and CPAP Machines | Alabama Medicaid will cover CPAP machines for children under the age of 21 after an EPSDT screening. Medicaid will not cover sleep therapy equipment for adults older than 21. |
Alabama does not restrict Medicaid recipients from purchasing private insurance. Medicaid eligibility is based only on income. When you apply for Medicaid, you will have to tell the state whether you have another insurance plan and update the state on changes in your health insurance plan. If you do have a private insurance plan, they will have to pay for coverage first before Medicaid will kick in. You can also maintain your employer-sponsored health insurance plan if you qualify for Medicaid.
In many cases buying an additional private health insurance plan can supplement any gaps in Medicaid coverage. For example, purchasing a long-term care policy can help cover any long-term care medications or equipment that Alabama Medicaid will not cover.
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