An emotionally and physically exhausted mid adult female nurse rubs her head as she leaves the hospital.

In-home healthcare and personal care services provider Help at Home is pulling out of Alabama, as the state’s failure to expand Medicaid eligibility has made it too difficult to continue operations, according to a company spokesperson.

“The current reimbursement and regulatory environment for Medicaid-funded in-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,” said Kristen Trenaman, vice president of public relations and marketing at Help at Home, in a statement sent to McKnight’s Home Care Daily Pulse.

A total of 785 Help at Home employees across the state will also soon lose their jobs, according to an Associated Press report. In addition to severance and retention packages for these workers, the company is working to transition its caregivers to other providers in the state or Personal Choices, Alabama’s home- and community-based services Medicaid program, said Trenaman.

Since passage of the Affordable Care Act, states have been able to extend Medicaid eligibility to people making 133% of the federal poverty level. Alabama is one of just 10 states that declined to expand Medicaid as it was estimated by the Public Affairs Research Council of Alabama to cost more than $225 million per year.

Still, Help at Home made it clear that its operations in other states will not be affected.

“We have no plans to exit other states as this is an isolated situation specific to the state’s approach to Medicaid-funded home care supports and services,” Trenaman noted. “Help at Home is committed to meeting the growing demand for in-home care for Medicaid populations in our core states, enabling more seniors and disabled populations to age-in-place in their own homes.”

Help at Home currently has locations in Florida, Georgia and Mississippi, which have also not passed Medicaid expansion.