Alabama Medicaid Agency
The Alabama Medicaid Agency is a state government entity that administers the federal-state Medicaid program in Alabama, providing health coverage to roughly one million eligible low-income residents — including children, pregnant women, elderly, and disabled individuals — through an enrolled provider network and a portfolio of managed care, HCBS waiver, pharmacy, and maternal health programs.
- Company typePrivate
- Founded1970
- HeadquartersMontgomery, United States
- Headcount501–1,000
- GTM typeB2C
- OfferingServices
What Alabama Medicaid Agency does
The Alabama Medicaid Agency is the single state agency designated by Alabama to administer the federal Medicaid program under the Social Security Act, jointly funded by the federal government (approximately 70–80% FMAP) and the State of Alabama. It provides health coverage to eligible low-income Alabamians across categorical segments including children, pregnant women, parents/caretaker relatives, elderly, disabled individuals, and specialty populations eligible through the Plan First family planning waiver and Breast and Cervical Cancer program. Care is delivered through an enrolled provider network of approximately 88 hospitals, 219 skilled nursing facilities, and thousands of pharmacies and individual practitioners across the state.
The agency's operational portfolio is organized into four pillars: (1) managed care delivery via the Alabama Coordinated Health Network (ACHN) and Integrated Care Networks (ICNs); (2) seven Home and Community-Based Services waivers (Elderly & Disabled, Intellectual Disabilities, Living at Home, SAIL, Technology Assisted, ACT, and Community Waiver Program) plus the PACE program; (3) pharmacy services with a Preferred Drug List, 340B program administration, and prior authorization through Acentra Health; and (4) dedicated programs for maternal health (TMaH Model, Nurse-Family Partnership, Presumptive Eligibility for Pregnancy), dental, transportation, and Durable Medical Equipment.
The underlying technology is a standard government MMIS architecture: the Alabama Medicaid Interactive Web Portal for providers, the My Medicaid recipient portal, the Insure Alabama online application system, Provider Electronic Solutions software, CMS-mandated Electronic Visit Verification, and the statewide One Health Record Health Information Exchange. Core vendor partnerships include Gainwell Technologies (provider portal and enrollment), Acentra Health (pharmacy administration), Myers and Stauffer (SNF cost reporting), and Alivia Analytics (Recovery Audit Contractor). Distribution occurs through district offices, web self-service, public forums, and the enrolled provider network. The agency operates as a state government entitlement program — it does not sell products or services, with most coverage provided at little to no cost to eligible beneficiaries, and is not an investable private entity.
Alabama Medicaid Agency firmographics
Firmographics- Name
- Alabama Medicaid Agency
- Legal name
- Alabama Medicaid Agency
- Website
- https://medicaid.alabama.gov
- Company type
- Private
- Founded year
- 1970
- Operating status
- Operating
- Headcount range
- 501–1,000 employees
- Short description
- The Alabama Medicaid Agency is a state government entity that administers the federal-state Medicaid program in Alabama, providing health coverage to roughly one million eligible low-income residents — including children, pregnant women, elderly, and disabled individuals — through an enrolled provider network and a portfolio of managed care, HCBS waiver, pharmacy, and maternal health programs.
- Ownership category
- akta.pro rank
Alabama Medicaid Agency industry classification
Industry- Product category
- Government Healthcare Programs
- NAICS
- Administration of Public Health Programs (923120), Individual and Family Services (6241)
- SIC
- Hospital & Medical Service Plans (6324), Services-Social Services (8300)
- akta.pro primary industry
- Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH)
- akta.pro secondary industries
- Government Program Administrative Services (Medicare/Medicaid ASO/TPA) (HLAEALAO), Maternal, Child & Adolescent Health Administration (BPAIAJAJ)
Keywords
Where Alabama Medicaid Agency is headquartered
LocationHeadquarters
- HQ city
- Montgomery
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
Alabama Medicaid Agency business model
Business model- GTM type
- B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Infrastructure, Others
Revenue model
- Federal-State Medicaid Funding: Alabama Medicaid is jointly funded by the federal government (approximately 70-80% federal match rate) and the Alabama state government. The agency administers the Medicaid program to provide health coverage to eligible low-income individuals including children, pregnant women, parents, elderly, and disabled persons.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Other | Other | Medicaid coverage for eligible individuals |
Go-to-market motion1 record
Distribution channels5 records
Marketing channels5 records
Alabama Medicaid Agency product offering
Product offeringCore offering
The Alabama Medicaid Agency is the state government entity that administers Alabama's Medicaid program, providing health coverage to eligible low-income Alabamians including children, pregnant women, parents, elderly, and disabled persons. The agency operates managed care programs (ACHN with Integrated Care Networks), seven Home and Community-Based Services waivers, pharmacy benefits, and dedicated initiatives for maternal health, dental, transportation, and DME, delivering these services through an enrolled network of hospitals, skilled nursing facilities, pharmacies, and other providers reimbursed for covered care.
Product overview
Alabama Medicaid Agency operates a comprehensive government health insurance program serving eligible Alabama residents including children, pregnant women, parents, elderly, and disabled individuals. The agency administers a multi-component portfolio consisting of: (1) core managed care programs through the Alabama Coordinated Health Network (ACHN) with Integrated Care Networks (ICNs); (2) seven Home and Community-Based Services (HCBS) waivers covering Elderly & Disabled, Intellectual Disabilities, Living at Home, SAIL, Technology Assisted, ACT (transition), and Community Waiver programs; (3) pharmacy services with Preferred Drug List management and 340B program; (4) dedicated programs for maternal health (Plan First, TMaH, Nurse-Family Partnership, PEP), dental, transportation, and DME; and (5) technology platforms including My Medicaid recipient portal, Provider Electronic Solutions software, Electronic Visit Verification, and the One Health Record health information exchange. The program coordinates care across multiple delivery systems including fee-for-service and managed care, serving approximately 1 million beneficiaries through enrolled providers statewide.
Differentiator
Problem solved
Functional benefit
Products and services
- Alabama Coordinated Health Network (ACHN)
Companies that use Alabama Medicaid Agency
Customer profileNamed customers3 records
Segments5 records
Ideal customer profiles2 records
Alabama Medicaid Agency technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature5 records
Alabama Medicaid Agency partnerships and signals
Strategic signalPartnerships
Eight partnerships are on record, tiered core and minor.
- Gainwell TechnologiescoreGainwell Technologies is the Medicaid vendor responsible for the Provider Secure Web Portal, provider enrollment services, and the Provider Assistance Center. They handle provider contact information and support provider enrollment and revalidation processes.
- Myers and StauffercoreMyers and Stauffer serves as the cost reporting software contractor and hosts the electronic submission portal for skilled nursing facility cost reports. They process facility registration forms and manage the cost report submission process.
- Acentra HealthcoreAcentra Health serves as the Pharmacy Administrative Services contractor for Medicaid, handling prior authorization requests for non-preferred drugs and other pharmacy-related services.
- Alivia AnalyticscoreAlivia Analytics serves as the Alabama Medicaid Recovery Audit Contractor (RAC), conducting audits to identify improper payments and educate providers on compliance requirements.
- Alabama Department of Mental HealthcoreADMH-DDD is the Operating Agency for the Intellectual Disabilities (ID), Living at Home (LAH), and Community Waiver Programs (CWP) that operate concurrently with the 1915(c) waivers administered by Alabama Medicaid.
- Alabama Department of Rehabilitation Services (ADRS)coreADRS serves as the Operating Agency for the State of Alabama Independent Living (SAIL) Waiver, providing home and community-based services to individuals with physical disabilities.
- Alabama Department of Public HealthminorADPH partners with Medicaid on the Insure Alabama online application system and the Plan First family planning program.
- Centers for Medicare & Medicaid Services (CMS)coreCMS provides federal funding oversight and regulatory guidance for the Alabama Medicaid program. All state plan amendments, waiver renewals, and demonstration waivers require CMS approval.
Scale indicators3 records
Recent moves6 records
Expansion highlights5 records
Alabama Medicaid Agency competitors and assessment
Company assessmentBroad incumbents
- Centene Corporation: Largest Medicaid managed care organization in the U.S., holding contracts in many states. Comparable as the private-sector counterparty that delivers Medicaid benefits on behalf of state agencies; directly relevant for understanding Alabama's vendor and MCO landscape.
- Texas Health and Human Services Commission: Comparable as a much larger state Medicaid and human services agency operating STAR and STAR+PLUS managed care programs. Broader portfolio (multiple HHS programs) but directly comparable Medicaid administration scope and federal-state funding structure.
Others
- Gainwell Technologies: Core technology vendor for Alabama Medicaid and the broader state Medicaid market, operating MMIS, provider portals, and BPO services. Highly relevant as a strategic vendor partner, not a competitor, but central to the agency's operating model.
Emerging players
- Molina Healthcare: Medicaid-focused managed care company serving managed care plans across multiple states. Comparable in business model for delivering Medicaid benefits to similar low-income populations, and a potential partner for Alabama's ACHN program.
Direct peers
- Florida Agency for Health Care Administration: Direct peer as a large Southeastern state Medicaid agency administering the Statewide Medicaid Managed Care program, HCBS waivers, and LTC services. Comparable scope and operational scale in a neighboring state with a similar population profile.
- Mississippi Division of Medicaid: Direct peer as a neighboring non-expansion state Medicaid agency administering a similar federal-state Medicaid program for low-income children, pregnant women, elderly, and disabled populations. Operates a comparable waiver and managed care structure in a similar Southern demographic and economic context.
- South Carolina Department of Health and Human Services: Direct peer as a non-expansion Southeastern state Medicaid agency with managed care delivery (Healthy Connections), HCBS waivers, and pharmacy benefits administration serving a similar population profile.
- Georgia Department of Community Health: Direct peer as a Southeastern state agency administering Medicaid and PeachCare for Kids with comparable managed care (Georgia Families), HCBS waivers, and pharmacy programs. Operates in a similar regulatory and demographic environment to Alabama Medicaid.
- Louisiana Department of Health (Medicaid): Direct peer as a non-expansion-then-expansion Southern state Medicaid agency operating Healthy Louisiana managed care, HCBS waivers, and pharmacy programs. Highly comparable in beneficiary mix, provider structure, and federal regulatory exposure.
- Tennessee Bureau of TennCare: Direct peer as a state Medicaid agency operating a mature managed care model (TennCare) with fully capitation contracts, serving similar low-income populations. Comparable in administering HCBS waivers, pharmacy benefits, and long-term care services.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat4 records
Key risks6 records
Key highlights7 records
Customer concentration
Alabama Medicaid Agency social profiles
Digital presenceAlabama Medicaid Agency financial estimates
Financial estimateRevenue estimate
Valuation estimate
Alabama Medicaid Agency leadership team
Management profileNumber of profiles
Profiles2 records
Alabama Medicaid Agency funding detail
Funding detailFunding overview
Funding rounds
Investors
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Alabama Medicaid Agency M&A and investment
M&A and investmentM&A
Investments
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Frequently asked questions about Alabama Medicaid Agency
What does Alabama Medicaid Agency do?
The Alabama Medicaid Agency is the state government entity that administers Alabama's Medicaid program, providing health coverage to eligible low-income Alabamians including children, pregnant women, parents, elderly, and disabled persons. The agency operates managed care programs (ACHN with Integrated Care Networks), seven Home and Community-Based Services waivers, pharmacy benefits, and dedicated initiatives for maternal health, dental, transportation, and DME, delivering these services through an enrolled network of hospitals, skilled nursing facilities, pharmacies, and other providers reimbursed for covered care.
Is Alabama Medicaid Agency a public or private company?
Alabama Medicaid Agency is a private company. It is classified as state government owned and is currently operating.
When was Alabama Medicaid Agency founded?
Alabama Medicaid Agency was founded in 1970. It employs 501 to 1,000 people.
Where is Alabama Medicaid Agency based?
Alabama Medicaid Agency is headquartered in Montgomery, United States, in the North America region.
How does Alabama Medicaid Agency make money?
One revenue line is on record: federal-State Medicaid Funding.
Who are Alabama Medicaid Agency's main competitors?
Broad incumbents on record are Centene Corporation and Texas Health and Human Services Commission. Gainwell Technologies is listed as an others. Molina Healthcare is listed as an emerging player. Direct peers are Florida Agency for Health Care Administration, Mississippi Division of Medicaid, South Carolina Department of Health and Human Services, Georgia Department of Community Health, Louisiana Department of Health (Medicaid) and Tennessee Bureau of TennCare.
Does Alabama Medicaid Agency have an API?
No public API is recorded for Alabama Medicaid Agency.
What industry is Alabama Medicaid Agency in?
Alabama Medicaid Agency's product category is Government Healthcare Programs. Its primary akta.pro industry code is BPAIAKAH, Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage), with a secondary code of HLAEALAO, Government Program Administrative Services (Medicare/Medicaid ASO/TPA). Its NAICS code is 923120 and its SIC code is 6324.