Alabama has not expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 does not apply to a state expansion population. This model counts no Alabama adults as subject.
The requirement matters for Alabama in a different way: if the state expanded Medicaid later, its expansion adults would report from day one. The American Community Survey counts about 536,237 uninsured Alabama adults with household income at or below 138% of the poverty line, the population an expansion would cover and the requirement would then reach.
Key figures
| Measure | Alabama |
|---|---|
| Expansion state | No |
| Subject to the requirement via waiver | No |
| Expansion pool (adults 19 to 64) | 0 |
| Adults subject, strict definition | 0 |
| Adults subject, permissive definition | 0 |
| Share of expansion pool subject | 0.0% |
| Projected coverage loss by 2034 | 0 |
| Hardship exception status | Non expansion |
| Early implementer | No |
| Ex parte capability score (0 to 100) | n/a |
Counties in Alabama: uninsured adults below 138% of poverty
Jefferson County (70,803), Madison County (44,708), and Mobile County (43,220) hold the most uninsured low-income adults in Alabama.
| County | Uninsured adults at or below 138% FPL | Poverty rate | Working-age population |
|---|---|---|---|
| Jefferson County | 70,803 | 16.0% | 393,352 |
| Madison County | 44,708 | 11.0% | 248,380 |
| Mobile County | 43,220 | 18.0% | 240,112 |
| Tuscaloosa County | 26,566 | 17.0% | 147,586 |
| Baldwin County | 24,979 | 10.0% | 138,773 |
| Shelby County | 24,534 | 7.0% | 136,298 |
| Montgomery County | 23,810 | 20.0% | 132,278 |
| Lee County | 20,616 | 18.0% | 114,532 |
| Morgan County | 12,903 | 14.0% | 71,686 |
| Limestone County | 12,262 | 11.0% | 68,122 |
| Calhoun County | 12,219 | 18.0% | 67,882 |
| Houston County | 11,168 | 18.0% | 62,044 |
| Etowah County | 10,660 | 16.0% | 59,220 |
| Lauderdale County | 10,069 | 13.0% | 55,940 |
| Marshall County | 9,989 | 17.0% | 55,494 |
| St. Clair County | 9,966 | 11.0% | 55,368 |
| Elmore County | 9,795 | 10.0% | 54,418 |
| Cullman County | 9,355 | 13.0% | 51,971 |
| Talladega County | 8,609 | 19.0% | 47,828 |
| DeKalb County | 7,440 | 20.0% | 41,332 |
| Walker County | 6,574 | 16.0% | 36,524 |
| Autauga County | 6,381 | 11.0% | 35,450 |
| Russell County | 6,281 | 22.0% | 34,894 |
| Blount County | 6,137 | 14.0% | 34,097 |
| Colbert County | 5,981 | 16.0% | 33,226 |
| Coffee County | 5,693 | 16.0% | 31,627 |
| Jackson County | 5,478 | 19.0% | 30,436 |
| Dale County | 5,131 | 18.0% | 28,504 |
| Chilton County | 4,786 | 14.0% | 26,588 |
| Tallapoosa County | 4,093 | 17.0% | 22,742 |
| Escambia County | 3,748 | 22.0% | 20,824 |
| Covington County | 3,687 | 19.0% | 20,483 |
| Pike County | 3,662 | 24.0% | 20,346 |
| Dallas County | 3,643 | 27.0% | 20,240 |
| Chambers County | 3,555 | 18.0% | 19,748 |
| Lawrence County | 3,485 | 16.0% | 19,361 |
| Franklin County | 3,262 | 17.0% | 18,125 |
| Marion County | 2,964 | 16.0% | 16,466 |
| Geneva County | 2,749 | 21.0% | 15,272 |
| Cherokee County | 2,570 | 14.0% | 14,275 |
| Barbour County | 2,569 | 24.0% | 14,272 |
| Bibb County | 2,448 | 21.0% | 13,601 |
| Winston County | 2,406 | 18.0% | 13,366 |
| Clarke County | 2,282 | 22.0% | 12,676 |
| Randolph County | 2,271 | 20.0% | 12,616 |
| Pickens County | 2,005 | 22.0% | 11,138 |
| Monroe County | 1,942 | 23.0% | 10,788 |
| Macon County | 1,925 | 25.0% | 10,692 |
| Marengo County | 1,888 | 21.0% | 10,490 |
| Butler County | 1,844 | 21.0% | 10,242 |
| Henry County | 1,737 | 16.0% | 9,650 |
| Fayette County | 1,602 | 22.0% | 8,899 |
| Cleburne County | 1,585 | 13.0% | 8,808 |
| Washington County | 1,583 | 16.0% | 8,794 |
| Clay County | 1,467 | 18.0% | 8,148 |
| Hale County | 1,447 | 25.0% | 8,040 |
| Lamar County | 1,346 | 15.0% | 7,476 |
| Crenshaw County | 1,321 | 15.0% | 7,340 |
| Choctaw County | 1,215 | 19.0% | 6,752 |
| Sumter County | 1,171 | 30.0% | 6,507 |
| Conecuh County | 1,099 | 18.0% | 6,107 |
| Bullock County | 1,055 | 28.0% | 5,862 |
| Coosa County | 1,049 | 11.0% | 5,829 |
| Wilcox County | 1,002 | 27.0% | 5,566 |
| Lowndes County | 996 | 26.0% | 5,533 |
| Perry County | 750 | 33.0% | 4,167 |
| Greene County | 701 | 33.0% | 3,896 |
State brief and methodology
Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.