Overview

Alabama is one of the few states that prohibits most non-compete provisions in employment contracts for professionals, which include physicians. Specifically, the courts held that statutory exemptions allowing non-competes in employment contracts do not apply to professionals and that physicians and other medical providers are professionals under state law.

While the state does not have statutory authority for review or approval of provider mergers, Alabama is the site of a major private antitrust enforcement action against health insurer Blue Shield/Blue Cross. Healthcare providers and individual and small-employer customers separately sued BCBS of Alabama in 2013, alleging horizontal market allocation and conspiracy to divvy up insurance markets all over the country in violation of Section 1 of the Sherman Antitrust Act. The lawsuits were consolidated as MDL in the Northern District of Alabama, which held that the alleged practice of creating exclusive territories is a “per se” violation of the Sherman Antitrust Act and would be subject to the highest legal standard. After the 11th Circuit upheld the decision, BCBS agreed to a settlement agreement with employer subscribers that would pay $2.7 billion to the class plaintiffs, in addition to modification of alleged anticompetitive practices.

In 2024, Alabama considered legislation to abolish the state’s certificate of need program, to exempt health care institutions and services in rural areas from the certificate of need requirement, and to provide more oversight of pharmacy benefit managers.

State Action

Latest Legislative Session: 3/7/2023 - 6/6/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.

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© 2018- The SLIHCQ Database. Initial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.
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© 2018- The SLIHCQ Database. Initial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.
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Additional Resources

STATE BUDGET

The state operates on an annual budget cycle from October 1 to September 30 of the following year.  In November, agencies submit their budget requests to the governor.  By the second legislative day of each regular session of the legislature, the governor must submit his or her proposed budget to the state legislature.  The legislature adopts a budget between February and May. It must pass with a simple majority.  The governor is required to submit a balanced budget to the legislature and the legislature must pass a balanced budget.

STATE LEGISLATURE

Alabama is one of the few states where state representatives and senators all serve four-year terms and all are elected in the same cycle. The House of Representatives has 105 members, and there are 34 seats in the Senate.  The Legislature convenes annually on the first Tuesday in February, except during the first year of the four-year term, when the session begins on the first Tuesday in March. In the last year of a four-year term, the legislative session begins on the second Tuesday in January. The length of the regular session is limited to 30 meeting days within a period of 105 calendar days. There are usually two meeting days per week, with other days devoted to committee meetings.   Bills do not carry over from year-to-year.

KEY RESOURCES

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