SB102 Summary

• Pregnant women qualify for presumptive Medicaid coverage for ambulatory prenatal care based on proof of pregnancy and current household income, determined by a qualified prenatal care provider.

• Presumptive eligibility period begins when a qualified provider makes the determination and ends on the earliest of: agency approval of a full application, the last day of the month following the determination, or the 60th day after the determination.

• Qualified providers must notify the Medicaid Agency within 5 working days of a presumptive eligibility determination and inform the woman she must apply for Medicaid by the last day of the following month.

• Coverage during the presumptive eligibility period cannot be retroactively denied due to the woman's failure to submit an application or the agency's negative decision on the application.

• The Medicaid Agency shall adopt rules defining acceptable documentation and may develop worksheets and forms for providers to determine preliminary eligibility; the provision sunsets on October 1, 2028.