Alabama Medicaid to request $1.184 billion for 2026

by Anna Barrett, Alabama Reflector
February 7, 2025

The Alabama Medicaid Agency will request $1.184 billion from the state for FY 2026, about $229 million more than its budget this year. 

“Most of it is related to health care inflation cost,” Alabama Medicaid Commissioner Stephanie Azar told legislators Thursday afternoon. “We have to build that in to make sure that we can pay our providers for what comes along.” 

The request was not a surprise but represents something of a landmark for Alabama Medicaid, a cornerstone of the state’s health care sector. 

Despite strict eligibility requirements that mostly limit the program to children, the elderly and those with disabilities, Medicaid provides health care coverage for about 20% of the state; pays for more than half the births in Alabama and is critical to keeping hospitals, nursing homes and medical practices open. 

Azar said that the increase in her request is technically $53 million, but it appears to be $229 million because of the federal aid the state received during the COVID-19 pandemic, aid that is no longer coming to the state. 

“It looks like the growth of the program is a lot more than it was, because we’ve had federal COVID dollars that has made the Legislature be able to appropriate us less,” she said. “And this year, that’s really moving away.”

Since last June, Alabama Medicaid enrollment has dropped by nearly 300,000 to 1.081 million, according to Azar’s presentation. This is nearly back to its pre-COVID enrollment at 1.054 million.

“I’ve always been an advocate for the people in this state that have needs. But there are some that have taken advantage of the system,” Rep. Chris Blacksher, R-Smiths Station, said. “That’s not fair to the people who truly need it.”

Medicaid makes up the largest single allocation in the Alabama General Fund budget, which pays for most noneducation state programs. But the state share is only a fraction of the total cost of the program. The federal government is expected to pay about 73% of the program’s costs next year. Azar estimates that Medicaid will receive over $7 billion from the federal government.

“I’m optimistic that I will be appropriated for my 2026 budget,” she said. “As long as we follow federal requirements, which is our full intention, we should draw our matching dollars for that state share.”

House General Fund Ways and Means Committee Chair Rep. Rex Reynolds, R-Hazel Green, said the committee will try its best to grant Medicaid its requested budget.

“We certainly hope we can. We know that if we don’t, it impacts our hospitals, impacts our nursing homes and impacts our providers,” he said. “We really got to find a way to make that happen.”

Alabama Reflector is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Alabama Reflector maintains editorial independence. Contact Editor Brian Lyman for questions: info@alabamareflector.com.

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Alabama executes Demetrius Terrence Frazier for 1991 rape and murder of Pauline Brown

by Ralph Chapoco, Alabama Reflector
February 6, 2025

The state of Alabama executed Demetrius Terrence Frazier by nitrogen gas Thursday evening  for the rape and murder of Pauline Brown in Birmingham in 1991.

Frazier, 52, the fourth person the state has executed by nitrogen gas, was pronounced dead at 6:36 p.m., according to Gov. Kay Ivey’s office.

“First of all, I want to apologize to the friends and family of Pauline Brown, what happened to her should never have happened,” Frazier said when he made his final statement. “I want to apologize to the Black community.”

Frazier also criticized Michigan Gov. Gretchen Whitmer for not intervening in his case. Frazier was transferred to Alabama in 2011 while serving a life sentence in Michigan for the 1992 murder of Crystal Kendrick, 14. His legal team had urged Whitmer to take custody of his case and have him transferred back to the state for the crimes he committed in Michigan. Whitmer did not intervene.

A member of the Corrections staff adjusted Frazier’s mask at about 6:10 p.m. and the nitrogen gas began to flow a few minutes afterward. Media witnesses reported that Frazier struggled to breathe for several minutes during the execution.

At one point in the execution, Frazier lifted his legs and his body twitched, according to media witnesses. That is similar to what other witnesses observed from the three other executions that the state carried out using nitrogen gas.

Witnesses said that they observed Frazier take his final breath at about 6:20 p.m.

“It went according to plan like our protocol says,” ADOC Commissioner John Hamm said at a news conference following the execution.

The state executed Kenneth Eugene Smith by nitrogen gas in January 2024. Alan Eugene Miller was put to death under the method in September. Carey Dale Grayson followed in November.

“In Alabama, we enforce the law,” Ivey said in a statement Thursday evening. “You don’t come to our state and mess with our citizens and get away with it.”

The governor said that justice was carried out on behalf of Brown and her loved ones.

“I pray for her family that all these years later, they can continue healing and have assurance that Demetrius Frazier cannot harm anyone else,” Ivey said.

Frazier was convicted of Kendrick’s death in 1993 and sentenced to life in prison. An Alabama  jury convicted Frazier of capital murder in 1996 and recommended he be put to death by a vote of 10-2. While arguing that Frazier should be returned to Michigan, Frazier’s legal team also argued the nitrogen gas protocol violated Frazier’s Eighth Amendment protections against cruel and unusual punishment, citing the distress that media witnesses reported among the men who had previously been subjected to it.

The federal courts rejected both arguments. Michigan Attorney General Dana Nessel said they would not ask for Frazier to be returned to their state.

Frazier’s family and supporters petitioned Whitmer to intervene. Frazier’s mother Carol penned a letter that requested Whitmer get involved, and a petition collected more than 4,000 signatures.

“We are disappointed that Michigan chose to ignore requests to intercede, to ignore its own history, and failed to have Mr. Frazier returned to Michigan to complete his life sentences,” Frazier’s legal team said in a statement after Frazier’s execution Thursday. “We are disappointed that Gov. Ivey has not granted clemency, especially under these uniquely unfair and painful circumstances.  Martin Luther King, Jr. said ‘Injustice anywhere is a threat to justice everywhere.’ Tonight, we grieve for everyone.”

Alabama Reflector is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Alabama Reflector maintains editorial independence. Contact Editor Brian Lyman for questions: info@alabamareflector.com.

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Alabama Senate approves bill defining gender based on biological sex

by Alander Rocha, Alabama Reflector
February 6, 2025

The Alabama Senate Thursday approved a bill defining “sex-based terms” strictly based on biological sex. 

SB 79, sponsored by Sen. April Weaver, R-Alabaster, passed the chamber on a 26-5 vote. The legislation would define “sex” as the “the state of being male or female as observed or clinically verified at birth,” and provides further definitions for male, female, man, woman, boy, girl, mother and father.

“This bill is based on a fundamental truth that is as old as the book of Genesis and as reliable as the sun in the sky. Men are born men and women are born women, and this legislation simply reinforces that inescapable fact,” Weaver said to the Senate.

Critics said the bill opened the door to further legal discrimination against transgender Alabamians. Rep. Susan DuBose, R-Hoover, has filed a similar bill for the past two years, and Gov. Kay Ivey endorsed the legislation in her State of the State address on Tuesday.

The bill defines genders as “male” and “female” based on the human reproductive system. Female would be defined as a person “who has, had, will have, or would have, but for a developmental anomaly, genetic anomaly, or accident, the reproductive system that at some point produces ova.”

Likewise, male would be defined as someone “who has, had, will have, or would have, but for a developmental anomaly, genetic anomaly, or accident, the reproductive system that at some point produces sperm.”

Allison Montgomery, a member of Alabama Trans Rights Action Coalition (ALTRAC), said in a phone interview after the bill’s passage Thursday the legislation creates legal justification for discrimination. Montgomery said the bill is “one step away from a bathroom bill or a ban on trans people in bathrooms,” pointing to the bill initially being a bathroom ban before being amended. Alabama passed a bill in 2022 banning K-12 students from using the bathroom corresponding with the sex assigned at birth.

“The sponsors of this bill are starting with a predetermined conclusion and cherry-picking examples to support their viewpoint, instead of just following the facts where they lead,” Montgomery said. 

Sen. Rodger Smitherman, D-Birmingham, spoke at length about the “discriminatory manner” the bill “is going to be able to implement,” citing his experiences with Alabama’s Jim Crow laws when he was younger. Smitherman said he was concerned about how the definitions in the bill would be applied.

“Implementation of the intent, if it’s not clear in here, is subject to the person who has authority, thanks to what you’ve implemented, and that may be totally contrary to the problems and the things that we’re- that I’m trying to address to make sure that does not happen in this situation,” he said.

Sen. Linda Coleman-Madison, D-Birmingham, said that using Christianity to justify the bill “rubs me the wrong way.”

“None of this is based on the Bible and what the Bible says of how we treat each other,” Coleman-Madison said.

But Weaver doubled down on the definitions being “biological facts” and said that this is the “simplest and easiest to understand bill” that lawmakers will see during this session.

“I would be happy to go testify wherever I needed to, to talk about the intent of this bill, and I would challenge anybody to make the case that any of these definitions listed here are in any way inaccurate,” she said.

Weaver said the bill wouldn’t stop people from “doing whatever they want to do,” saying that the bill only puts “common sense” definitions into law.

Madison-Coleman said common sense is not something everybody has, and legislation would be creating a problem.

“When you put something into law and everybody has to abide by the law, now you change the treatment, or mistreatment, of a person based on a perception of a law that we pass, by definition that this person doesn’t fit in this square,” Madison-Coleman said.

Montgomery rejected the “common sense” framing, pointing to public testimony from transgender individuals who said the bill could force them into unsafe spaces.

“It is not common sense to take a man with a full beard and a deep voice, receding hairline, one who is transgender, who this bill would define as female, and say you have to use the women’s room. That’s not common sense to anybody,” Montgomery said.

Coleman-Madison also pointed to the Alabama Supreme Court’s decision last year that defined frozen embryos outside the womb as “children” and allowed parents to file civil lawsuits over the destruction of embryos under an 1872 law.

“We are going down a slippery slope that we don’t need to go down once again, shining a negative light on the state of Alabama like we’re from some backwoods- this doesn’t make any sense at all, and I’m sorry, I just cannot agree with your rationale,” Coleman-Madison said.

The bill moves to the full House.

Alabama Reflector is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Alabama Reflector maintains editorial independence. Contact Editor Brian Lyman for questions: info@alabamareflector.com.

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