SESSION WATCH
THE BILL ITSELF

SB 368

Presumptive Medicaid Eligibility for Pregnant Women

VERSION S 368 Filed · BACK TO THE SUMMARY · OFFICIAL RECORD

underlined language is being added; struck language is being deleted. Line numbers are the Legislature's own — the same ones amendments cite.

Florida Senate - 2026 SB 368 By Senator Davis 5-00611A-26 2026368__
1 A bill to be entitled
2 An act relating to presumptive Medicaid eligibility
3 for pregnant women; amending s. 409.903, F.S.;
4 authorizing certain entities meeting specified
5 criteria to serve as qualified Medicaid providers for
6 purposes of making presumptive Medicaid eligibility
7 determinations for pregnant women; requiring the
8 Department of Children and Families to ensure that
9 such providers are adequately trained and monitored
10 for compliance when serving in such roles; requiring
11 the Agency for Health Care Administration to provide
12 Medicaid coverage to pregnant women deemed
13 presumptively eligible for the duration of a specified
14 time period; providing that pregnant women deemed
15 presumptively eligible are entitled to coverage of all
16 medically necessary services under the Medicaid
17 program during such eligibility period; requiring that
18 all prior authorizations granted before or during such
19 period remain in effect for the duration of such
20 period; requiring the agency, within a specified
21 timeframe, to seek federal approval to extend the
22 allowable period of presumptive Medicaid eligibility
23 coverage for pregnant women; requiring the agency and
24 the department to initiate certain rulemaking within a
25 specified timeframe; providing an effective date.
27 Be It Enacted by the Legislature of the State of Florida:
29 Section 1. Subsection (5) of section 409.903, Florida
30 Statutes, is amended to read:
31 409.903 Mandatory payments for eligible persons.—The agency
32 shall make payments for medical assistance and related services
33 on behalf of the following persons who the department, or the
34 Social Security Administration by contract with the Department
35 of Children and Families, determines to be eligible, subject to
36 the income, assets, and categorical eligibility tests set forth
37 in federal and state law. Payment on behalf of these Medicaid
38 eligible persons is subject to the availability of moneys and
39 any limitations established by the General Appropriations Act or
40 chapter 216.
41 (5) A pregnant woman for the duration of her pregnancy and
42 for the postpartum period consisting of the 12-month period
43 beginning on the last day of her pregnancy, or a child under age
44 1, if either is living in a family that has an income that is at
45 or below 185 percent of the most current federal poverty level.
46 Such a person is not subject to an assets test. Further, a
47 pregnant woman who applies for eligibility for the Medicaid
48 program through a qualified Medicaid provider must be offered
49 the opportunity, subject to federal rules, to be made
50 presumptively eligible for the Medicaid program.
51 (a) Qualified Medicaid providers that may conduct
52 presumptive eligibility determinations for Medicaid for pregnant
53 women include, but are not limited to, hospitals participating
54 in the Medicaid program; federally qualified health centers;
55 birth centers; nonprofit maternal and child health
56 organizations, such as healthy start coalitions; clinics
57 operating under the Special Supplemental Nutrition Program for
58 Women, Infants, and Children; and local housing authorities,
59 provided such entities have met the applicable training and
60 certification standards established by the department for such
61 purpose. The department shall ensure such providers are
62 adequately trained and monitored for compliance with federal and
63 state requirements relating to presumptive eligibility
64 determinations.
65 (b) For pregnant women deemed presumptively eligible under
66 this subsection, the agency shall provide such coverage under
67 the Medicaid program for the maximum period allowable under
68 federal law or until a full Medicaid eligibility determination
69 is made, whichever occurs earlier.
70 (c) Pregnant women deemed presumptively eligible under this
71 subsection are entitled to coverage of all medically necessary
72 services under the Medicaid program, including, but not limited
73 to, services provided by specialists and subspecialists needed
74 to comanage high-risk pregnancies, including for issues outside
75 the scope of general obstetrics. All prior authorization
76 approvals granted before or during the presumptive eligibility
77 period remain valid for the duration of such period to ensure
78 continuity of care and to reduce the risk of adverse maternal or
79 infant health outcomes.
80 Section 2. Within 60 days after this act becomes a law, the
81 Agency for Health Care Administration shall seek federal
82 approval to extend the allowable period of presumptive Medicaid
83 eligibility for pregnant women to 180 days under s. 409.903,
84 Florida Statutes, and the agency and the Department of Children
85 and Families, as applicable, shall initiate any necessary
86 rulemaking to implement the amendments made by this act to s.
87 409.903, Florida Statutes.
88 Section 3. This act shall take effect July 1, 2026.