MONTGOMERY, Ala. (AP) — A home health provider will end its services in Alabama at the end of September and lay off nearly 800 employees soon after, blaming the state’s refusal to expand Medicaid.

Chicago-based Help at Home informed the Alabama Department of Commerce of its upcoming closure and layoffs in a WARN notice, which employers are required to file ahead of such moves.

Help at Home spokesperson Kristen Trenaman told AL.com that its Alabama operations will cease Sept. 30, when the company’s annual contracts with the state expires. The layoffs of 785 employees, which are scattered throughout all 67 counties in the state, will be effective Nov. 4, she said.

“The current reimbursement and regulatory environment for Medicaid-funded home care has made it difficult to recruit, hire and retain workforce and we have not been able to overcome these challenges in the state of Alabama,” Trenaman said in an email.

Alabama is one of 10 states that hasn’t accepted federal funding to expand its Medicaid coverage under the Affordable Care Act, and has some of the strictest income-based eligibility requirements in the country.

Advocates and legislators say an estimated 300,000 people could gain Medicaid coverage through an expansion. So far, the state has blamed cost – an estimated $225.4 million per year – for its lack of expansion. Yet, in 2023 alone, Alabama passed on more than $2 billion in federal money for Medicaid.

Help at Home, which provides services for elderly and disabled patients, has operated in Alabama since 1975 and has five offices across the state. Trenaman said the company is working with the state and the Administration on Aging, a nationwide network on aging overseen by the federal government, to connect its clients and their caregivers with other providers.

The company will offer severance and retention packages to its full-time employees in Alabama, Trenaman said.