FL H1351

Pregnant women applying for Medicaid through a qualified provider must be offered the opportunity to be deemed presumptively eligible, with coverage lasting the maximum period allowed under federal law or until a full eligibility determination is made, whichever comes first.

Qualified providers authorized to make presumptive eligibility determinations include Medicaid-participating hospitals, federally qualified health centers, birth centers, nonprofit maternal and child health organizations (e.g., healthy start coalitions), WIC clinics, and local housing authorities, provided they meet training and certification standards.

The Department of Children and Families must ensure qualified providers are adequately trained and monitored for compliance with federal and state presumptive eligibility requirements.

Presumptively eligible pregnant women are entitled to all medically necessary Medicaid services, including specialist and subspecialist care for high-risk pregnancies, and all prior authorizations granted before or during the eligibility period remain valid throughout.

Within 60 days of enactment, the Agency for Health Care Administration must seek federal approval to extend the presumptive eligibility period for pregnant women to 180 days; the act takes effect July 1, 2026.