Florida SB 368: Tampa Bay Area Regional Transit Authority

Bill Text

368 
Presumptive Medicaid Eligibility for Pregnant Women 
2025-11-04T07:10:26Z 
Authorizing certain entities meeting specified criteria to serve as qualified Medicaid providers for purposes of making presumptive Medicaid eligibility determinations for pregnant women; requiring the Department of Children and Families to ensure that such providers are adequately trained and monitored for compliance when serving in such roles; requiring the Agency for Health Care Administration to provide Medicaid coverage to pregnant women deemed presumptively eligible for the duration of a specified time period, etc. 
Original Filed Version 
2026 
S 
2026-07-01T00:00:00Z 
GB 
General Bill 
__ 

 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 need