Alabama: ACA-enabled Medicaid enrollment up 122K even without expansion??

Hat Tip To: 
Esther Ferington

This one is a bit squirrelly to suss out, and I'm not sure that I've done so correctly, so bear with me. According to the (very short) article:

MONTGOMERY, Ala. (AP) — State officials say Alabama Medicaid's monthly enrollment has topped 1 million for the first time.

Officials said Thursday that a review of data for the first five months of the year show the milestone happened in February. Officials attribute the increase to a federally required transfer of children from the state's All Kids program and changes in how Medicaid eligibility is determined. Officials say the numbers also reflect the first enrollment of individuals who applied for coverage through the federal health exchange under the federal Affordable Care Act.

Enrollment has remained above 1 million in March, April and May.

OK, I took a look at the most recent CMS report, which includes the state-by-state enrollment numbers for Medicaid/CHIP as of September 2013, just before the ACA exchanges opened. For Alabama, the number was right around 800,000. According to preliminary data from the same report, AL's Medicaid/CHIP enrollment as of April had actually gone down by about 35,000.

However, according to the article above, actual enrollment has since been determined to be over 1,000,000 for 3 months straight. They seem pretty sure about this, so what's going on?

Well, the article also states that the main reason is because of a "federally required" transfer of kids from Alabama's "All Kids" program over to Medicaid...presumably CHIP, the children's version of Medicaid. However, according to the official All Kids website, "All Kids" is Alabama's CHIP program. So...I'm actually a bit confused here; it sounds like this is purely a program classification change more than anything else. According to, Alabama had about 113,000 kids enrolled in CHIP (All Kids?), so that would explain about half of the 235K increase.

As for the remaining 122,000, the article above also specifies that these appear to be Woodworkers--people who already qualified for Medicaid even without ACA expansion, but only followed through with enrolling thanks to the streamlined process provided for by (along with the massive outreach/awareness program that accompanied it).

I honestly don't know why the CMS report has the total number listed as only 765K in April; even with the "preliminary" caveat, that seems like a pretty big margin to be off by. However, the AP/WTVA article seems pretty damned confident about the "1M+ in March/April/May" statement, so it sounds like AL has indeed added 122K woodworkers.

Now, here's where things get really confusing: Also according to, Alabama only had about 107,000 uninsured people eligible for Medicaid at all as of last October (since they didn't enact ACA expansion), which, if accurate, suggests that a minimum of 15,000 people fell on hard times in the state over the past 8 months or so.

If all of the numbers above are accurate, it sounds like Alabama has now enrolled pretty much everyone in Medicaid who is legally eligible to do so without expansion...but there are so many contradictory/confusing numbers being thrown around, I'm not positive about this.