AL HB494

Establishes presumptive Medicaid eligibility for pregnant women based on proof of pregnancy and household income documentation submitted to a qualified ambulatory prenatal care provider, without waiting for formal Medicaid agency approval.

Limits presumptive eligibility coverage period to no more than 60 days or until the earliest of: agency determination on a filed application, last day of month following the determination month, or 60 days after provider determination.

Permits pregnant women to receive no more than one presumptive eligibility period per pregnancy, with coverage that cannot be retroactively denied if the woman fails to submit an application or receives a negative agency decision.

Requires qualified providers to notify the Medicaid Agency within five working days of determining presumptive eligibility and to inform women they must apply for Medicaid no later than the last day of the following month.

Authorizes the Medicaid Agency to adopt rules defining acceptable documentation of preliminary information, limited to proof of pregnancy and current household income, and to develop worksheets and forms for qualified providers to use in determining preliminary eligibility.

Effective date: October 1, 2024.