Alabama runs no MCO contracts; every managed-care-equivalent structure in the state is a non-risk-bearing PCCM Entity. ACHN, the statewide network launched October 1, 2019, covered 811,224 members in 2024 across seven regional networks statewide. ACHN itself does not deliver medical services or bear financial risk; it coordinates care through an attribution-based model, with claims still paid fee-for-service by the Agency's fiscal intermediary, and operates under a 1915(b) waiver rather than a state-plan managed care amendment. A second, narrower PCCM Entity, Integrated Care Network, is operated by Alabama Select Network and coordinates care specifically for long-term-care and HCBS beneficiaries, covering 26,388 members in 2024 (20,750 of them dual-eligible) under its own 1915(b) waiver.

• Alabama Care Network Mid-State: ACHN region
• Alabama Care Network Southeast: ACHN region
• Gulf Coast Total Care: ACHN region
• My Care Alabama Central: ACHN region
• My Care Alabama East: ACHN region
• My Care Alabama Northwest: ACHN region
• North Alabama Community Care: ACHN region
• Alabama Select Network: Integrated Care Network (LTC/HCBS PCCM Entity)

Long-term services and supports are fee-for-service, administered directly by the Agency rather than through any risk-bearing plan; there is no MCO to integrate LTSS into. Care coordination for LTC and HCBS beneficiaries runs through the Integrated Care Network PCCM Entity described above, a non-risk-bearing coordination layer, not a managed LTSS product. Seven 1915(c) HCBS waivers currently serve distinct populations, including the AL Community Transition (ACT) Waiver, two separate waivers for people with intellectual disabilities (a standalone waiver and the HCBS Living at Home Waiver, LAH), a waiver for the elderly and disabled, the AL SAIL Waiver (physical disabilities, ages 18-63), and the AL Technology Assisted (TA) Waiver (technology-dependent individuals ages 21 and older). A separate Section 1115 demonstration, the Alabama Community Waiver Program, provides HCBS to individuals age 3 and older who would otherwise require an ICF/IID level of care, running through September 30, 2026.

Not integrated into managed care

Behavioral health is not carved out to a separate vendor; like every other Medicaid service in Alabama, it is paid fee-for-service directly to providers rather than administered through a plan. A narrower federal authority adds coverage on top of the base State Plan benefit: the Alabama Section 1115 Institutions for Mental Disease Waiver for Serious Mental Illness covers acute psychiatric hospital stays for members ages 21-64 diagnosed with serious mental illness, but only in Baldwin and Mobile counties, a narrow geographic scope, not a statewide program.

Carved in

Dental is a direct fee-for-service benefit billed against the Agency's own published Dental Fee Schedule. No separate dental benefit administrator was found.

No separate pharmacy benefit manager contract was found for Alabama Medicaid; pharmacy claims appear to run through Gainwell Technologies' own point-of-sale system alongside its broader fiscal-intermediary role, rather than being carved out to a dedicated PBM. Separately, Alabama's Community Pharmacy Relief Act requires every commercial pharmacy benefit manager operating in the state (not just Medicaid's own claims processor) to reimburse independent pharmacies using the Alabama Medicaid rate formula. Medicaid's own reimbursement formula is now the statewide regulatory floor for commercial PBM reimbursement, even though the Act itself regulates commercial PBMs rather than creating a Medicaid PBM contract.

Non-emergency transportation is billed fee-for-service against the Agency's own published NET (Non-Emergency Transportation) Fee Schedule.

Gainwell Technologies serves as Alabama Medicaid's fiscal intermediary, receiving, processing, and paying claims.

29 agency updates tracked for Alabama. Available with Pro.