THE BILL ITSELF
HB 1351
Presumptive Medicaid Eligibility for Pregnant Women
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A bill to be entitled
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An act relating to presumptive Medicaid eligibility
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for pregnant women; amending s. 409.903, F.S.;
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authorizing certain entities meeting specified
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criteria to serve as qualified Medicaid providers for
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purposes of making presumptive Medicaid eligibility
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determinations for pregnant women; requiring the
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Department of Children and Families to ensure that
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such providers are adequately trained and monitored
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for compliance when serving in such roles; requiring
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the Agency for Health Care Administration to provide
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Medicaid coverage to pregnant women deemed
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presumptively eligible for the duration of a specified
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time period; providing that pregnant women deemed
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presumptively eligible are entitled to coverage of all
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medically necessary services under the Medicaid
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program during such eligibility period; requiring that
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all prior authorizations granted before or during such
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period remain in effect for the duration of such
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period; requiring the agency, within a specified
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timeframe, to seek federal approval to extend the
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allowable period of presumptive Medicaid eligibility
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coverage for pregnant women; requiring the agency and
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the department to initiate certain rulemaking within a
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specified timeframe; providing an effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Subsection (5) of section 409.903, Florida Statutes, is amended to read:
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409.903 Mandatory payments for eligible persons.—The
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agency shall make payments for medical assistance and related
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services on behalf of the following persons who the department,
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or the Social Security Administration by contract with the
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Department of Children and Families, determines to be eligible,
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subject to the income, assets, and categorical eligibility tests
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set forth in federal and state law. Payment on behalf of these
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Medicaid eligible persons is subject to the availability of
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moneys and any limitations established by the General
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Appropriations Act or chapter 216.
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(5) A pregnant woman for the duration of her pregnancy and
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for the postpartum period consisting of the 12-month period
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beginning on the last day of her pregnancy, or a child under age
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1, if either is living in a family that has an income that is at
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or below 185 percent of the most current federal poverty level.
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Such a person is not subject to an assets test. Further, a
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pregnant woman who applies for eligibility for the Medicaid
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program through a qualified Medicaid provider must be offered
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the opportunity, subject to federal rules, to be made
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presumptively eligible for the Medicaid program.
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(a) Qualified Medicaid providers that may conduct
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presumptive eligibility determinations for Medicaid for pregnant
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women include, but are not limited to, hospitals participating
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in the Medicaid program; federally qualified health centers;
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birth centers; nonprofit maternal and child health
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organizations, such as healthy start coalitions; clinics
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operating under the Special Supplemental Nutrition Program for
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Women, Infants, and Children; and local housing authorities,
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provided such entities have met the applicable training and
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certification standards established by the department for such
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purpose. The department shall ensure such providers are
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adequately trained and monitored for compliance with federal and
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state requirements relating to presumptive eligibility
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determinations.
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(b) For pregnant women deemed presumptively eligible under
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this subsection, the agency shall provide such coverage under
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the Medicaid program for the maximum period allowable under
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federal law or until a full Medicaid eligibility determination
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is made, whichever occurs earlier.
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(c) Pregnant women deemed presumptively eligible under
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this subsection are entitled to coverage of all medically
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necessary services under the Medicaid program, including, but
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not limited to, services provided by specialists and
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subspecialists needed to comanage high-risk pregnancies,
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including for issues outside the scope of general obstetrics.
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All prior authorization approvals granted before or during the
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presumptive eligibility period remain valid for the duration of
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such period to ensure continuity of care and to reduce the risk
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of adverse maternal or infant health outcomes.
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Within 60 days after this act becomes a law, Section 2.
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the Agency for Health Care Administration shall seek federal
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approval to extend the allowable period of presumptive Medicaid
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eligibility for pregnant women to 180 days under s. 409.903,
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Florida Statutes, and the agency and the Department of Children
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and Families, as applicable, shall initiate any necessary
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rulemaking to implement the amendments made by this act to s.
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409.903, Florida Statutes.
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Section 3. This act shall take effect July 1, 2026.