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.
   26          
   27  Be It Enacted by the Legislature of the State of Florida:
   28  
   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.