Policy Watch: Alabama Medicaid presumptive eligibility for pregnancy services

By Kevin Joseph, LHC Student Assistant

Image courtesy of the Alabama Reflector.

Background

Established to provide health care coverage to low-income people, Medicaid is a state-delivered health insurance program jointly financed by the states and federal government. Medicaid covers over 80 million people nationwide, accounting for approximately a fifth of all healthcare spending nationally. The structure of the Medicaid program allows for state Medicaid agencies to decide (with some parameters) what populations and services are covered (Kaiser Family Foundation, 2024). Currently, pregnant people are eligible to receive Alabama Medicaid if their monthly income does not exceed 146% of the federal poverty limit, or $1,905 monthly (Alabama Medicaid, n.d.c). If the income limit is satisfied, Alabama Medicaid covers maternity and prenatal care services (Alabama Medicaid, n.d.a). Prenatal care can include physical exams, laboratory tests, and nutritional supplements to improve pregnancy health outcomes, such as reducing birth defects (NIH, 2017). However, the Medicaid agency must approve your application first, which can take weeks according to the agency (Alabama Medicaid, n.d.b.). In 2023, there were 57,858 recorded births in the state of Alabama according to natality information from CDC Wonder (2025). However, only 71% of those births received prenatal care in the first trimester of pregnancy. These metrics fare worse for pregnancies where the mother has a high school education/GED or less (61.8%), pregnancies where the mother is not White (66.1%), or pregnancies whose delivery was insured by Medicaid (60.3%) (CDC, 2025). Healthy People 2030 set a national target of 80.5% of pregnancies receiving “early and adequate” prenatal care by the end of the decade (DHHS, n.d.).

Proposed Legislation

HB89 and SB102, companion bills, of the 2025 Alabama Legislature Regular Session would require the Alabama Medicaid Agency to presumptively cover ambulatory prenatal care based on the determination of a medical provider for up to 60 days before a Medicaid application is accepted, if the income limit is met. It would require the provider making the presumptive eligibility determination to notify Alabama Medicaid within 5 business days of the determination and inform the person to apply for Medicaid no later than the last day of the following month after the determination. The new rule would begin October 1, 2025 and has a built-in “sundown” clause of October 1, 2028, which would end the initiative unless otherwise extended. HB89 is cosponsored by Representatives Lands (D-Madison County), Rafferty (D-Jefferson County), Drummond (D-Mobile County), Hall (D-Madison County), Ensler (D-Montgomery County), Clarke (D-Mobile County), Collins (R-Morgan County), Ross (R-Marshal County), DuBose (R-Jefferson, Shelby, and St. Clair Counties), and Wilcox (R-Mobile County). SB102 is cosponsored by Senators Coleman-Madison (D-Jefferson County), Figures (D-Baldwin and Mobile Counties), Kelley (R-Calhoun and Talladega Counties), Beasley (D-Barbour, Bullock, Henry, Houston, Macon, and Russell Counties), Smitherman (D-Smitherman), Albritton (R-Baldwin, Escambia, Mobile, and Washington Counties), and Stutts (R-Colbert, Frankli, Lawrence, and Limestone Counties).

Impact

If HB89/SB102 were to pass, pregnant people in Alabama who are eligible for Medicaid may receive more frequent and/or earlier prenatal treatment, leading to improved maternal and birth outcomes. Data from Healthy People 2030 indicates that only 74.9% of people receive “early and adequate” prenatal care nationally, with decreased frequency among racial/ethnic minorities and people who have received less education (mimicking trends in Alabama) (DHHS, n.d.). Tables 1 and 2 below show the prevalence of Alabama Medicaid payment for 2023 deliveries in the state among varying levels of maternal education and different maternal race. The following proportions were calculated using data from the CDC Wonder Natality data in 2023 (2025). Considering the disparities in Medicaid delivery payments by maternal race and education, an increased number of these births that receive adequate and early prenatal care with presumptive Medicaid eligibility may not only improve maternal and baby health outcomes overall but also reduce disparities in these outcomes.

Table 1. Proportion of Births by Maternal Race covered by Alabama Medicaid, 2023 CDC Wonder Natality Data

Maternal Race	Percentage of Deliveries Covered by Medicaid
American Indian or Alaska Native* (n=184)	59.8%
Asian* (n=870)	21.6%
Black or African American* (n=15762)	65.0%
Native Hawaiian or Other Pacific Islander* (n=106)	62.2%
White (n=39690)	36.7%
More than one race* (n=1226)	52.0%

Table 2. Proportion of Births by Maternal Education covered by Alabama Medicaid, 2023 CDC Wonder Natality Data

Maternal Education	Percentage of Deliveries Covered by Medicaid
8th grade or less* (n=2705)	83.9%
9th to 12th grade, no diploma* (n=5022)	84.0%
High school graduate or GED* (n=19447)	63.5%
Some college, no degree* (n=10206)	44.9%
Associate degree* (n=5092)	24.6%
Bachelor’s degree* (n=9396)	9.1%
Master’s degree (n=4565)	3.8%
Doctorate or Professional degree* (n=1274)	2.4%

*For some educational attainment and racial categories, the number of people having certain payors for delivery is low (less than 10) that the data totals are suppressed due to risk of identification. These percentages of Medicaid payment are estimates, as the true total number of deliveries may be slightly different.

Fiscal notes on HB89/SB102 estimate the increase coverage would cost about $1 million annually in fiscal years 2026, 2027, and 2028, with $726,300 in federal funding and $273,700 in state funds. However, Representative Marilyn Lands, the primary sponsor on HB89, believes the bill will save money in net through the reduced hospital and healthcare expenses associated with better health maternal and baby health outcomes (Gann, 2025). Due to the range of services prenatal care can entail, general cost-effectiveness analyses are difficult to conduct and further research is needed.

Next Steps

HB89 and SB102 have both been read for second time in the second House, passing each respective chamber unanimously. If both chambers pass their counterpart’s bill, Governor Kay Ivey can sign the bill into law. If you want to make your voice heard on this or future legislation, click here to identify your elected officials. Don’t know what to say? Check out this guide from the American Civil Liberties Union on drafting a letter to your government officials.

References

Alabama Medicaid. (n.d.a). Covered Services. https://medicaid.alabama.gov/content/4.0_programs/4.1_Covered_Services.aspx

Alabama Medicaid. (n.d.b). Frequently Asked Questions. https://medicaid.alabama.gov/content/9.0_Resources/9.5_FAQ_Pages/9.5.2_FAQ_Applying.aspx

Alabama Medicaid. (n.d.c). Qualifying for Medicaid. https://medicaid.alabama.gov/content/3.0_Apply/3.2_Qualifying.aspx

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. (Accessed March 25, 2025). Natality Information. [Natality for 2016-2023 (expanded)]. U.S. Department of Health & Human Services. https://wonder.cdc.gov/natality-expanded-current.html

Department of Health and Human Services (DHHS), Office of Disease Prevention and Health Promotion. (n.d.) Increase the proportion of pregnant women who receive early and adequate prenatal care – MICH-08. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/increase-proportion-pregnant-women-who-receive-early-and-adequate-prenatal-care-mich-08.

Gann, H. (2025, February 13). Alabama House passes presumptive Medicaid for pregnant mothers but only until 2028. https://www.al.com/politics/2025/02/alabama-house-passes-presumptive-medicaid-for-pregnant-mothers-but-only-until-2028.html

Kaiser Family Foundation. (2024, May 28). Medicaid 101. https://www.kff.org/health-policy-101-medicaid/?entry=table-of-contents-introduction

National Institutes of Health (NIH). (2017, January 31). What is prenatal care and why is it important? https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care

Policy Watch: Evaluating the Impact of Medicare Negotiated Drug Prices in Alabama

By Kimberly Randall, Miriam Calleja, Kevin Joseph, Sean McMahon

Introduction

Prior to 2022, the federal government was legally unable to negotiate with pharmaceutical companies on the prices for prescription drugs for Medicare Part D. In recent communications discussing prescription drug prices, Senator Bernie Sanders of Vermont named pharmaceutical companies as whom to blame, stating, “big drug companies, through massive lobbying and campaign contributions, regulate Congress.” Many Medicare recipients often pay hundreds or thousands of dollars out of pocket for medications to treat prevalent conditions. If and how to address the financial burden related to prescriptions has been a political point of contention for some time. The Inflation Reduction Act (IRA) provided relief by giving Medicare the authority to negotiate prescription drug prices for select drugs, offering relief to vulnerable populations.

Background

Medicare is a government-sponsored health insurance program founded in 1965 available for individuals aged 65 and older and those with disabilities or specific medical conditions. The federal program provides standard coverage for hospital care (Part A) and outpatient services (Part B), and users can add additional prescription drug coverage (Part D) at their own expense.

The process of including the ability to negotiate drug prices for Medicare recipients in the IRA began in early 2021, building on the momentum from the 2020 U.S. presidential race where the idea gained significant traction. With the Biden-Harris administration taking office, initial discussions emerged among legislators, advocacy groups, and policymakers to explore the potential of allowing Medicare to negotiate drug prices. During this period, various stakeholders, including healthcare experts, patient advocacy groups, and some members of Congress strongly advocated for this policy as a crucial component of broader healthcare reform.

By mid-2021, congressional committees, including the Senate Finance Committee and the House Energy and Commerce Committee, were actively considering proposals to incorporate drug price negotiation into a larger legislative package. The committees conducted hearings, collected expert testimony, and engaged in talks with key stakeholders, including the pharmaceutical industry. A compromise was reached to limit the number of drugs eligible for negotiation to 10 in the first year and 15 for the following years to phase in the program over several years.

In August 2022, President Biden signed the Inflation Reduction Act into law, including the Medicare drug price negotiation provision. This landmark legislation officially authorized the Secretary of Health and Human Services (HHS) to negotiate prices for certain high-cost drugs over the coming years. Following the signing of the Act, the Centers for Medicare & Medicaid Services (CMS), under HHS, initiated the implementation process, which involved developing specific rules, guidelines, and procedures for the negotiation framework. Throughout 2023 and 2024, CMS engaged in rulemaking, sought public comment, and held stakeholder meetings to finalize these rules. CMS was tasked with identifying the initial list of 10 drugs subject to negotiation, with the new negotiated prices set to take effect in 2026. An estimated 9 million seniors are expected to be affected by the first 10 negotiated drug prices. However, the pharmaceutical industry is pushing back with multiple lawsuits that may impact the implementation of the program.

Policy

The legislation establishes the negotiation process between CMS and drug manufacturers to determine the Maximum Fair Prices (MFPs), referring to the upper limit that Medicare will pay for certain prescription drugs, in order to make the high-cost drugs more affordable. The negotiations consider several factors, including the clinical benefit of the drug, its development and production costs, research and development expenses, and whether it represents a therapeutic advance over existing treatments. The goal is to arrive at a price that balances affordability for Medicare beneficiaries and provides a reasonable return for the manufacturer.

To qualify for price negotiation with CMS, small molecule drugs need to have been on the market for 7 years and have no generic versions. For biologics, drugs made from living organisms instead of chemicals, they must be available for 11 years without any similar alternatives, known as biosimilars, on the market. Federal officials chose 10 drugs from the top 50 that Medicare Part D spends the most on and are widely used by its members following a public comment period.

Impact

Alabama is home to over a million Medicare beneficiaries, with about 650,000 enrolled in Medicare Part D prescription drug plans. Many of these residents face high out-of-pocket costs for medications, especially for managing prevalent chronic conditions such as cardiovascular disease, diabetes, and cancer, which are among the leading causes of death and disability in the state. Nearly 30% of Alabama’s Medicare beneficiaries have diabetes, compared to the national average of 26%, and around 40% have a history of cardiovascular disease, underscoring the critical importance of affordable medications for these conditions.

In 2023, the total spending on prescription drugs for Medicare Part D beneficiaries was estimated to be around $216 billion. Of this amount, an estimated $48 billion (approximately 20%) was spent on the first 10 high-cost drugs targeted for negotiation under the Inflation Reduction Act. Alabama residents with Medicare Part D coverage faced an estimated $80 million in out-of-pocket costs for these specific medications, reflecting the state’s higher-than-average rates of chronic disease and medication use.

If the negotiated prices agreed upon between CMS and participating drug companies had been in effect in 2023, the federal government would have saved an estimated $6 billion in net prescription drug costs after accounting for rebates, certain fees, and payments. This would have represented a 22% reduction in net spending for covered prescription drugs. Looking ahead to 2026, when the negotiated prices are set to take effect, Medicare beneficiaries are projected to save an estimated $1.5 billion under the standard benefit design. These projected savings from the Negotiation Program will be in addition to other cost-saving measures in the IRA, such as the first-ever cap on out-of-pocket drug costs for Medicare beneficiaries.

Given that approximately 16% of Alabama’s population is aged 65 or older, and with 12% of these residents living below the federal poverty line, the impact of these cost reductions will be significant. It could allow more Medicare beneficiaries in Alabama to access essential medications without facing substantial financial hardship, contributing to better health outcomes and a reduction in overall healthcare spending in the state.

See below for the full list of medications and their newly negotiated costs:

Source: CMS

Policy Watch: Alabama Launches Childcare Tax Credit System for Workforce Development Initiative

May 31, 2024 | Kimberly Randall

Background

Childcare costs are one of the most widespread barriers to preventing parents from re-entering or staying in the workforce. According to the Economic Policy Institute, in Alabama, the average cost of childcare for a single child is over $6,000 per year, accounting for almost 12% of a median family’s income of $50,335. According to a study by Alabama State University, those numbers are unlikely to improve, as roughly 17% of childcare facilities surveyed said they increased prices due to the pandemic, and prices in those facilities went up by an average of 17%.

An estimated 13,000 parents who are work-eligible are currently unemployed due to childcare restrictions. As Alabama’s economic infrastructure continues to grow, offering affordable solutions for childcare in the state is necessary to access the workforce needed to sustain corporate development. While Alabama has a historically low unemployment rate of 2.2%, workforce participation is among the lowest in the country at just 57.1%, continuing a trend of being under the national average that goes back to the mid-1970s.

Proposed legislation

According to the bill text, HB358 “serves a public purpose by conferring a direct public benefit … through the promotion of public health, safety, morals, security, prosperity, contentment, and the general welfare of the community [by] increasing the quality of childcare to the general public, which has the effect of encouraging high-quality care and education for children and facilitating greater workforce participation throughout the state.” Through a series of tax credits to businesses, the legislation hopes to have more Alabamians enter the workforce and gain employment by improving the quality and availability of childcare options for working parents.

At its core, the legislation offers an incentivized tax credit to employers who assist with the childcare needs of their employees. The tax credit is eligible for employers for:

The construction, renovation, expansion, or repair of a childcare facility, or for the purchase of equipment for such facility, or for the maintenance and operation thereof.
Payments made to childcare facilities or employees for the provision of childcare at childcare facilities for children of employees.
Payments made to childcare facilities to reserve services for children of employees.

The bill specifically defines children as direct dependents under the age of 5 and restricts the tax credit to individuals who make less than $80,000 per year before overtime or bonuses. Additionally, the tax credit is tiered depending on the quality rating of the childcare providers, pressuring facilities to increase or maintain their ratings for increased funding opportunities. Each decreasing quality rating results in a decreased tax credit:

(1) Five-star quality rating – two thousand dollars ($2,000) per eligible child.
(2) Four-star quality rating – one thousand seven hundred fifty dollars ($1,750) per eligible child.
(3) Three-star quality rating – one thousand five hundred dollars ($1,500) per eligible child.
(4) Two-star quality rating – one thousand two hundred fifty dollars ($1,250) per eligible child.
(5) One-star quality rating – one thousand dollars ($1,000) per eligible child.

Companies are eligible to apply for 75% of their expenses as a tax credit if a medium or large-sized organization, and 100% of their expenses in this area if they are small businesses. The bill provides special consideration of funding for small businesses, rural providers, and grants for non-profits. The total tax credits awarded shall not exceed $15,000,000 in its first year but have steady increases year over year until its sundown clause in 2027.

Impact

Many solutions for childcare accessibility have been suggested over the years, however, Alabama elected for an employer-first method rather than a direct-to-employee method, largely because of the vast number of Alabamians who file taxes using the standard deductions rather than itemized where the tax credit would appear. Because of this, a large portion of the intended population had the potential to not receive the benefits. Childcare has been highlighted as one of the key barriers in increasing Alabama’s workforce participation rate, alongside transportation and vocational training.

Women are more dominantly affected by childcare limitations. A growing body of research shows that access to quality childcare in early development results in long-term health outcomes for children, such as improved cardiovascular and metabolic health, and reduced smoking in adulthood. Center-based care, specifically, shows an increase in kindergarten readiness and social skills, allowing for potential educational benefits of this program.

At an economic level, the childcare tax credit is expected to offer a $1.3 billion of economic activity in the state.

Next Steps

HB358 was largely bipartisan, with public support from both the Speaker of the House and the Minority House Leader, who was also the champion, and passed on April 18 unanimously. It was signed into law by Governor Ivey on May 8th.

The legislation will go into effect on January 1, 2025, and has a current sundown clause of December 31, 2027, if not renewed. The legislation text specifically states that a review of the data collected during this initiative must be analyzed and considered prior to any extensions.

Policy Watch: Volunteer Licenses for Nonresident Dentists Practicing in Alabama

May 16, 2024 | Kimberly Randall

As the 2024 legislative session comes to an end in Alabama, the Lister Hill Center is diving into the most influential bills passed with substantial public health impact. As a part-time legislature, the Alabama House of Representatives and Senate operate over a 100 calendar-day period, usually beginning on the second Tuesday of February. During the regular session, there are no restrictions on bills that can be brought to the floor. Unless a special session is called, where a single topic is the subject of all legislation being debated, the legislature will not reconvene until 2025.

Background

Alabama has a concerningly low number of counties that employ a full-time dentist. Approximately 80 percent of all dentists practicing in Alabama practice in the 13 most urban counties. The other 20 percent practice in the 54 non-urban counties of Alabama; many of these smaller counties only have one or two dentists, with one county (Greene) offering no permanent dental care at all for residents.

The federal government lists 65 of Alabama’s 67 counties as “dental professional shortage” areas. As such, many residents in rural communities are forced to travel far distances for dental care, putting an economic and logistical burden on patients. To combat this, several non-profits frequently bring in dentists and dental hygienists from other states to do low-cost or pro bono work in the state as volunteers. Currently, those dentists are required to obtain a full license in the state of Alabama, even if they only plan to practice for a short time as a volunteer. This often makes the volunteer service cost-prohibitive for those who would otherwise choose to come to Alabama.

Proposed Legislation

Representative McCampbell proposed HB70 as a solution, offering a volunteer license for individuals doing this form of work. Individuals who have an active, full, unrestricted license in another state may submit an application to the Board of Dental Examiners of Alabama for a temporary license valid up to 15 calendar days within 30 days, which may be renewed at the discretion of the Board. Volunteer licenses will be available for $150 each for dentists and dental hygienists, which prior could have cost individuals thousands of dollars.

The bill goes into effect on October 1, 2024.

Potential Impact

Oral health is intricately linked to systemic health, and untreated dental issues can exacerbate or contribute to various chronic conditions. For instance, untreated gum disease has been associated with an increased risk of heart disease, stroke, and diabetes. According to a study published in the American Heart Association journal Circulation, individuals with severe gum disease have a 53% higher risk of developing heart disease compared to those with healthy gums (Lockhart et al., 2012). Moreover, chronic inflammation in the mouth due to untreated dental problems can trigger inflammatory responses throughout the body, potentially worsening conditions such as arthritis and respiratory diseases.

It is the hope that this license fee will entice more charitable work in the area of dental practice in areas that are facing higher levels of poverty. Routine dental hygiene is often a financial struggle for individuals living at or below the poverty line, particularly since Medicaid and other government assistance programs do not offer dental coverage for those over the age of 21, except for individuals who are pregnant or post-partum.

Learn More

Want to learn more about the impact of rural dentistry in the state of Alabama? Check out this guest publication from Drs. Davis and Lockwood breaking down the current state of dental infrastructure in the state.

Community Partner Spotlight: Alabama Rivers Alliance Releases Water and Sanitation Infrastructure Resource Guide

May 15, 2024 | Victoria Miller (Alabama Rivers Alliance), Kimberly Randall (Lister Hill Center for Health Policy)

Alabama has made headlines in recent years for the difficulties in maintaining and modernizing water infrastructure in the state, particularly through the rural Black Belt areas where poverty and distance between homes exasperate the issue. Researchers at The University of Alabama and UAB have collaborated on trying to understand the public health and engineering impacts and potential solutions, teaming up with a plethora of community partners to help address the issues. The Alabama Rivers Alliance, a Lister Hill Center community partner, is a statewide network of groups working to protect and restore all of Alabama’s water resources through building partnerships, empowering communities, and advocating for sound water policy and enforcement.

One difficult aspect of addressing the water and sanitation crisis in Alabama is the lack of understanding about community and government resources available for residents who lack proper infrastructure. Most government resources have pooled in Lowndes County, Ala., bordering Montgomery, with other organizations reaching into other areas of the Black Belt like Wilox County. However, the complexity of finding and understanding those resources presents a barrier to the residents who most need them.

The Alabama Rivers Alliance’s Wastewater Equity Fellowship has launched a new Alabama water infrastructure resource website, which will help communities address their wastewater needs. As concerns around water and wastewater infrastructure challenges grow in Alabama, and as funding deadlines approach, this new online resource hub is designed to empower citizens, advocates, and policymakers with knowledge and tools to address their community’s needs. This website serves as a vital starting point for communities looking to learn more about solving water-related issues with funding. The team unveiled their new website, and reported on their wastewater equity research, at Alabama Water Rally in March, the annual gathering of clean water advocates.

“This work is one of many in a larger, ongoing effort to strengthen collaborations between institutes of higher education and community-based partners to develop more effective water-related solutions for local communities.” Dr. Jillian Maxcy-Brown, post-doctoral researcher at the University of Alabama who participated in the Alabama Rivers Alliance fellowship, said. “We are also working on installing pilot-systems to test innovative low-cost water treatment technologies, conducting regional wastewater needs studies, and developing resource guides to holistically address historic infrastructure challenges in the Alabama Black Belt. We are planning to expand upon the work begun in this fellowship with more in-depth analyses of infrastructure funding mechanisms across the U.S.”

The Alabama Water Hub website provides opportunities to learn about how water infrastructure is funded in Alabama. From the website, users can learn more about water infrastructure in general, see a list of funding options for water infrastructure projects, learn more about commonly used water funding terms, and find contacts for further assistance with water infrastructure funding.

Also featured on the website are the first maps of the applicants to the Alabama Department of Environmental Management’s (ADEM’s) State Revolving Fund (SRF). Mapping the SRF applicant information provided by ADEM highlights the primary mechanism being used to issue water funding to communities that need it.

With the recent influx of federal water funding, communities are at a critical time to get informed about how drinking water and wastewater funding is allocated and how to access water funding when your town needs it. For communities that have long suffered with infrastructure issues such as crumbling/aging water pipes, overflowing sewers, contaminated drinking water, and/or degraded water quality, the funding availability is an opportunity to seek relief and get funding to address those issues.

“Water infrastructure is a complex topic, but this website is a space where any Alabamian can learn more about the landscape in our state and find funding resources for water projects,” Madelyn Cantu, Alabama Rivers Alliance wastewater fellow, said. “Water is life, and we want this resource hub to help make water infrastructure more accessible.”

Learn More

Visit the website today to access valuable resources and learn about water infrastructure funding in Alabama.

Want to get involved with environmental justice and policy work? The Lister Hill Center is hosting a Summer Advocacy Training Workshop with ARA on June 5th to give opportunities for individuals to learn more, increase their civics education, and learn how to get started.

Boldly Opening Doors to Better Chances and Improved Healthcare

A BOLD grant was awarded to a program by MedsPLUS in collaboration with the Lister Hill Center for Health Policy and Jenkins Public Health Consulting.

By Miriam Calleja

The Building Opportunities for Lasting Development (BOLD) grant awarded by The City of Birmingham’s Department of Innovation and Economic Opportunity (IEO) accepts proposals from organizations, businesses, and public or private entities to provide programs or services to promote economic development to Birmingham residents. IEO aims to foster an ecosystem that thrives on innovation and opportunity. They provide resources to nurture talent, establish infrastructure to support the growth of women, minorities, and disadvantaged businesses, and focus on developing small businesses. Now in its sixth year, the BOLD funding program aims to create partnerships with community organizations that share IEO’s vision of making Birmingham a model of an inclusive and resilient economy.

BOLD’s objectives include overcoming barriers in development and prioritizing certain geographic areas that are deemed disadvantaged and that may often be overlooked. Working with data-driven and innovative approaches, they aim to provide funds for sustainable development.

One of the grants this year was awarded to MedsPLUS Consulting, an independent pharmacy and healthcare consulting firm that has a history of serving minority communities in Birmingham, particularly those who feel they have been mistreated and marginalized by mainstream healthcare and government systems.

The BOLD grant will provide finances for a two-pronged approach.

Three individuals will be trained to become community health workers, and a diabetes education service will be set up for sixty Birmingham residents. The project aims to overcome various barriers to employment opportunities by training workers to become pharmacy technicians who specialize in diabetes management while also setting them up for employment, which includes instruction such as resume writing and LinkedIn profile setup. It also targets the education of diabetes patients themselves.

The collaborators in this project are Dr. Dashauna Ballard, a Postdoctoral Fellow at the Lister Hill Center for Health Policy at the University of Alabama at Birmingham (UAB) who did her Ph.D. in Health Education and Health Promotion, MedsPLUS Consulting, and Jenkins Public Health Consulting (JPHC).

Dr. Dashauna met Dr. Pauline Long and Dr. Jennifer Campbell from MedsPLUS Consulting by chance over a year and a half ago at a Birmingham city meeting. Since then, they’ve collaborated and applied for a few grants together. They were able to prepare two scientific presentations when Dr. Pauline and Dr. Jennifer had the idea of a pilot program to offer a culturally-tailored diabetes self-management, education, and support services to the public. According to the American Diabetes Association, diabetes is a significant problem in Alabama, including Birmingham. Around 15% of Alabamians have diabetes, and less than 7% of people with diabetes have any formal diabetes education.

Overcoming Barriers

Dr. Dashauna set out to investigate the barriers that patients with diabetes face when taking care of their disease. She was able to boil it down to three main barriers. Even though diabetes education is available at health centers, hospitals, and doctors’ offices, many patients are not taking advantage of what is available. For many patients, the biggest hurdle was physically getting to the appointments, especially if they lived in the suburbs or couldn’t get into the city to be present for their appointments. Parking and transportation were the second type of issue they faced. Thirdly, there was a lack of knowledge on the accessibility of diabetes education. It became clear that diabetes education needed to be available closer to home. And so, for example, the service could be accessed from libraries within the community if these were found to be active sites in the chosen neighborhoods.

This is when their third collaborator, Jenkins Public Health Consulting, will come in. Brittaney Jenkins, CEO at JPHC, is a Certified Health Education Specialist and Public Health Practitioner who will engage and communicate with the specific community. This is a crucial step in detecting where help is needed most. They will assist in recruiting individuals for the health worker program and engage the community to recruit participants for the diabetes education sessions.

To conduct this pilot study, MedsPLUS culturally tailored a standardized program by the Association of Diabetes Care Education Specialists (ADCES). As part of the norms for the project, Drs. Jennifer, Pauline, and Dashauna agreed to have participants address them by their first name as a means of building rapport and trust in the communities for which they will be working. Dr. Dashauna and the Lister Hill Center for Health Policy then translated their pilot program work into research presented at scientific conferences. Dr. Dashauna completed the background research and processed the literature review so that the information obtained through the program could be published.

The project aims to get several research publications that will establish evidence-based benefits from their pilot program and then scale it up to help more people across the state of Alabama. The background research found evidence to justify the project’s structure and methodology. When the program launches this January 2024, Dr. Dashauna will oversee the data management, the quality of data collected, and how that data is reported. Her role is to ensure success, i.e., that the project achieves what it sets out to do so that more patients with diabetes can be educated and empowered, and more health workers can be set up to work in the field.

Better Opportunities

The three community health workers will be chosen from the Birmingham area. They will benefit from a twelve-month apprenticeship to get health worker training and become licensed pharmacy technicians by the end of the program. MedsPLUS will then either employ the workers or set them up for meaningful employment elsewhere in the same field. While no healthcare background will be required since MedsPLUS will be conducting the training, the individuals will be chosen on criteria that assess their soft skills, an essential and sometimes overlooked aspect of healthcare.

“This type of apprenticeship will allow them to see the community health worker side and the pharmacy technician side and to get professional development so that they can go on to do what they would like to do,” said Dr. Pauline, referring to the case study they made for their grant, of a young recently-graduated high schooler from one of these geographical areas, who is not sure what to do next in career terms.

The training will be conducted by Connection Health, a non-profit organization that recruits, trains, and deploys community health workers. When the individuals have completed 120 hours of training and become entry-level health workers, they will start their diabetes training through the Association of Diabetes Care and Education Specialists (ADCES). These two phases will prepare them to go into communities and assist pharmacists or diabetes educators with facilitating their courses. In the fourth quarter of 2024, they will undergo professional development training to get their pharmacy technician license.

A Promising Future

This project is an excellent example of how community engagement can help change different populations’ health prospects. By coming together, the Lister Hill Center for Health Policy at UAB, MedsPLUS Consulting, and Jenkins Public Health Consulting have employed their specific skills to improve countless people’s lives through skilled outreach. This robust program is a promising start that will elevate the quality of life of many. And this is just the beginning. Once the research shows improvement, the three players can scale their program to help more individuals across Birmingham obtain health worker training and control their diabetes for improved health.

Cool Green: Together, we gather strength

Together, we gather strength.

A partnership of teams brings fantastic news for the livability and health of Birmingham!

By Miriam Calleja

When we think about our health, we often focus on factors such as diet, exercise, sleep, stress reduction, and medication. While these things are undoubtedly important, we often overlook our natural environment’s impact on our well-being. Trees provide critical benefits to human health, including cleaner air, reduced stress, and protection from the sun’s heat. Often, areas that are less dense in trees coincide with areas of race or ethnicity-based discrimination.

In a recent development, three organizations in Birmingham, Alabama, have joined forces in a project that positively impacts public health and the environment. The Jefferson County Department of Health, the University of Alabama at Birmingham’s Lister Hill Center for Health Policy, and the program Cool Green Trees, which functions under CAWACO RC&D Council, a non-governmental organization (NGO) and local non-profit, have come together to improve the well-being of Birmingham residents and mitigate the potential damage caused by storms in one fell swoop. This is how it happened.

What can one woman with conviction and a vital purpose do? She can do a lot. But with some help, she can do much more.

Meet Francesca Gross, a natural scientist who has been working in nonprofits for the past 25 years and the Program Manager at Cool Green Trees. For several years, Francesca has had a specific purpose: to bring together urban conservation and the world of human health. This purpose took a significant turn when she met Ariann Nassel, a scientist and geospatial data specialist from the Lister Hill Center for Health Policy at the University of Alabama, Birmingham.

Ariann and Francesca, using their particular expertise, could take the project to its next goal post by making a visual science-based narrative using data on the EnviroAtlas boundary for the Birmingham area obtained through the Environmental Protection Agency (EPA). The StoryMap helped them (and us) visualize air quality, flooding issues, and summer urban heat island effects on a map of the Birmingham area.

This academic-nonprofit collaboration also caught everyone’s attention. For the first time, residents, the city council, the neighborhood presidents, and, as it turns out, funders were listening and understanding the impact trees had on their city… and their health.

The first financial aid came in thanks to Francesca and her liaison with Mark Wilson, former Jefferson County Department of Health director. This was precisely what the department wanted: an insight into how natural systems directly affect human health. This funding meant that Cool Green Trees was now not only a dream but a viable program.

Three didn’t make a crowd in this collaboration. This trio could move the project even further. Most recently, Cool Green’s StoryMap was used to get a substantial amount of money from the US Forest Service Urban and Community Forestry grant, which was specifically looking at urban forests. The partners for this grant include Ruffner Mountain Nature Coalition, Jefferson County Department of Health, and the City of Birmingham. The data on human health by the US Forest Service tallied with that of EnviroAtlas obtained through the EPA, so there was a solid launchpad to start with.

On top of that, the health department offered a startup sum and an unprecedented five years of funding. This will ensure that the Cool Green – Lister Hill Center for Health Policy UAB – Jefferson County Department of Health partnership can continue improving community livability and health for Birmingham’s residents for years to come.

As Helen Keller said, “Alone we can do so little; together we can do so much.”

Policy Watch: US House of Representatives Proposes Significant Spending Cuts to CDC, Public Health Funding

Kimberly Randall | August 15, 2023

ATLANTA, GA – Exterior of the Center for Disease Control (CDC) headquarters

Background

Each year, the House of Representatives and Senate pass a series of legislation that determine the funding for the federal agencies operating in the US government. Funding is broken down into two categories – mandatory (63%) and discretionary (30%) – determined by whether the funding is tied to specific laws. The remaining budget is dedicated to interest repayment on federal loans.

The budget discussions traditionally begin with the President’s Budget Request (PBR), a formalized plan from the executive branch outlining the President’s suggested funding and taxes for the following fiscal year. Then, respective House and Senate committees produce budget bills that will be discussed, reconciled, and voted on in committee before being sent to the chamber floor. According to the Congressional Budget Act of 1974, the budget is to be voted on by April 15th for the following fiscal year, which begins on October 1st. However, many times this process takes longer.

For the fiscal year 2024 (FY24), President Biden officially requested $144 billion in discretionary spending, an 11.5% ($14.8 billion) increase from FY23, for Health and Human Services, through which the majority of public health funding is funneled. The official budget statement claims that the budget increase is expected to expand healthcare access, lower medical costs, increase funding for cancer research, increase access to behavioral health programs, support rural health programs, and improve nutrition and food safety.

Proposed Legislation

As Congress begins budget discussions for FY24, the House Appropriations Committee released the Fiscal Year 2024 bill for the Labor, Health and Human Services, Education, and Related Agencies Subcommittee. In the draft, several federal agencies are suggested to see a decrease in funding. The bill, named the Fiscal Year 2024 Labor, Health and Human Services, Education and Related Agencies Appropriations Bill, contains significant spending cuts to programs related to public health infrastructure and eliminates federal funding for family planning, HIV prevention, and gun violence research.

According to the Appropriations Chair, Kay Granger (TX), the proposed budget legislation is intended to “restore fiscal responsibility and reduce the scope of social spending by $60.3 billion from the FY23 enacted level, eliminating 61 (support) programs” in addition to funding biomedical research on cancer, Althzeimers, opioid use, and other chronic and rare diseases. The legislation also looks to increase funding in rural health by way of telehealth programs, healthcare workforce recruitment programs, and specialized education funding.

	FY23 Enacted Budget (millions)	FY24 Presidential Request (millions)	FY24 Proposed Budget (millions)
Immunization and Respiratory Diseases	$919	$1,256	$326
HIV/AIDS, Viral Hepatitis, STI, TB	$1,391	$1,545	$1,171
Emerging and Zoonotic Infections Disease	$751	$846	$708
Chronic Disease Prevention and Health Promotion	$1,430	$1,814	$797
Birth Defects, Developmental Disabilities, Disability and Health	$206	$223	$205
Environmental Health	$247	$421	$130
Injury Prevention Control	$761	$1,352	$730
Public Health Scientific Services	$754	$962	$654
Occupational Safety and Health	$363	$363	$247
Global Health	$693	$765	$370
Public Health Preparedness Response	$905	$943	$735
Crosscutting Activities and Program Support	$724	$1,039	$231
Buildings and Facilities	$40	$55	$40

Impact

In the United States, most public health activities are carried out by state and local government agencies, and a large portion of the CDC’s annual budget is distributed via grants and cooperative agreements to these departments. In FY19, over 55% of the CDC’s annual budget was granted to state and local public health agencies and has significant influence on state and local budgets.

In 2022, the Alabama Department of Public Health received $129,863,407 from CDC grants, with millions more going to The University of Alabama, The University of Alabama at Birmingham, Auburn University, and Tuskegee University for research in various areas. Reductions in the federal CDC budget will trickle down to impact local programs, including child vaccinations, staffing, and research. The table below represents a hypothetical look at the budget differences between funded programs in 2022 and a proportional budget in line with the FY24 proposed House budget.

	FY23 Grants Awarded (Alabama)	Proportional Budget Estimate
Immunization and Respiratory Diseases	$4,500,225	$1,597,580 (-64.5%)
HIV/AIDS, Viral Hepatitis, STI, TB	$13,988,137	$11,776,613 (-15.81%)
Emerging and Zoonotic Infections Disease	$2,248,081	$2,096,864 (-5.72%)
Chronic Disease Prevention and Health Promotion	$13,587,018	$7,573,404 (-44.26%)
Birth Defects, Developmental Disabilities, Disability and Health	$6,557,429	$6,524,642 (-0.5%)
Environmental Health	$404,616	$212,990 (-47.36%)
Injury Prevention Control	$7,174,096	$6,882,110 (-4.07%)
Public Health Scientific Services	$727,445	$630,986 (-13.26%)
Occupational Safety and Health	$1,949,377	$1,326,356 (-31.96%)
Public Health Preparedness Response	$9,437,092	$7,664,806 (-18.78)
Crosscutting Activities and Program Support	$5,528,735	$1,764,219 (-68.09%)

The potential budget cuts come on the tails of a significant loss of funding following the Fiscal Responsibility Act of 2023, where an estimated $1.7 billion in secured funding was recessed. The CDC released a statement that multi-year funded projects would not receive the remainder of their grants: “We can confirm that the last two years of funding is no longer available to CDC for jurisdiction awards. Funds previously awarded are not impacted.”

Next Steps

The House of Representatives Appropriations Committee will continue to debate the contents of the bill, amending as necessary. Once the committee agrees on the House bill, party leaders will meet to reconcile it with the Senate bill.

The Senate Appropriations Committee has already passed an appropriations bill for FY24 in a 26-2 vote, providing $117 billion in funding for the Department of Health and Human Services. The Senate released an official statement in late July regarding the sister legislation in the House:

It is unclear how this legislation will proceed through the legislative process, given vastly different topline funding levels under consideration in the Senate and House, which has yet to advance its version of this legislation through the full House Appropriations Committee.

A full list of House Appropriations Committee members can be found here, two of which represent Alabama.

Stay Informed

Want to learn more about public health policy, funding, and advocacy? Check out the Advocacy Portal on the American Public Health Association’s website.

Official updates from Congress can be found on the House of Representatives Appropriations Committee website.

Cool Green

Ariann Nassel, our Director of Geospatial Data Visualization, partnered with Cawaco RC&D Council and The Nature Conservancy in 2020 to develop Cool Green: Healthy Greening and Stormwater Opportunities for Jefferson County, Alabama. This web map application assisted representatives of the broader Cool Green project by providing an interactive narrative that eventually led to the Jefferson County Department of Health funding a public health improvement program in targeted areas that would benefit from planting trees. These areas predominantly have populations that are at risk of being negatively impacted by extremes in day and nighttime temperatures; trees will help to mitigate the effects of urban heat in these areas.

Check out the project by clicking this link!