Florida 2025 Regular Session

Florida House Bill H1003 Compare Versions

Only one version of the bill is available at this time.

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10	10	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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14	14	A bill to be entitled 1
15	15	An act relating to Medicaid presumptive eligibility 2
16	16	for pregnant women; creating s. 409.9026, F.S.; 3
17	17	creating a pilot program to provide temporary Medicaid 4
18	18	coverage to pregnant women who are presumptively 5
19	19	eligible for Medicaid; defining terms; authorizing t he 6
20	20	Agency for Health Care Administration to approve 7
21	21	certain entities to serve as qualified presumptive 8
22	22	eligibility locations under the pilot program; 9
23	23	providing application requirements; requiring the 10
24	24	agency to prioritize the approval of qualified 11
25	25	entities located in underserved areas of this state; 12
26	26	specifying duties of qualified entities; requiring 13
27	27	qualified entities to provide written notice of their 14
28	28	determinations to applicants within a specified 15
29	29	timeframe; providing requirements for the notice; 16
30	30	specifying performance standards qualified entities 17
31	31	are required to meet each year to continue 18
32	32	participating in the pilot program; specifying the 19
33	33	timeframe of the presumptive eligibility period for 20
34	34	temporary Medicaid coverage under the pilot program; 21
35	35	requiring the agency to implement certain procedures 22
36	36	that allow for the seamless transition from temporary 23
37	37	Medicaid coverage under the pilot program to 24
38	38	enrollment for full Medicaid benefits; requiring the 25
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47	47	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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51	51	agency, in collaboration with the Department of 26
52	52	Health, to implement an outreach program for specified 27
53	53	purposes; requiring the agency, by a specified date, 28
54	54	to seek federal approval to implement the pilot 29
55	55	program; requiring the agency to implement the pilot 30
56	56	program within a specified timeframe after receiving 31
57	57	such federal approval; providing an effective date. 32
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59	59	Be It Enacted by the Legislature of the State of Florida: 34
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61	61	Section 1. Section 409.9026, Florida Statutes, is created 36
62	62	to read: 37
63	63	409.9026 Presumptive eligibility for pregnant women. —To 38
64	64	increase access to n ecessary prenatal care for pregnant women in 39
65	65	underserved areas of this state, there is established a 10 -year 40
66	66	pilot program to expand the availability of Medicaid presumptive 41
67	67	eligibility locations and coverage for pregnant women. 42
68	68	(1) DEFINITIONS.—As used in this section, the term: 43
69	69	(a) "Eligible individual" means a pregnant woman who has 44
70	70	not yet been deemed eligible for Medicaid but, based on the 45
71	71	preliminary personal information disclosed by the woman, is 46
72	72	likely to meet the eligibility requirements of the state 47
73	73	Medicaid program, including the requirements related to 48
74	74	citizenship and residency status and income. 49
75	75	(b) "Presumptive eligibility" means temporary Medicaid 50
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84	84	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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88	88	coverage provided to individuals who are likely to be eligible 51
89	89	for the state Medicaid progr am, to ensure timely access to care 52
90	90	while a final eligibility determination is made. 53
91	91	(c) "Qualified entity" means a Medicaid provider or other 54
92	92	entity that has been approved by the agency to make presumptive 55
93	93	eligibility determinations in accordance with t he state Medicaid 56
94	94	program requirements. 57
95	95	(2) QUALIFIED ENTITIES; DUTIES; NOTICE; PERFORMANCE 58
96	96	STANDARDS.—In addition to existing qualified hospitals, the 59
97	97	agency may approve community health centers, county health 60
98	98	departments, birth centers, nonprofit organ izations, and other 61
99	99	health care facilities that are Medicaid providers to serve as 62
100	100	qualified presumptive eligibility locations under the pilot 63
101	101	program. To qualify, the entity must apply to the agency in a 64
102	102	manner specified by agency rule. The agency shall p rioritize the 65
103	103	approval of entities located in underserved areas of this state. 66
104	104	(a) Qualified entities shall ensure that: 67
105	105	1. Employees making the presumptive eligibility 68
106	106	determinations have met the training certification requirements 69
107	107	set by the agency; 70
108	108	2. Presumptive eligibility determinations are made only by 71
109	109	employees, not independent contractors or any other third -party 72
110	110	vendor, who have received the required training certification; 73
111	111	3. Presumptive eligibility determinations are made in 74
112	112	accordance with the state Medicaid program requirements; and 75
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121	121	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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125	125	4. Staff are available to assist eligible individuals with 76
126	126	their submission of applications for full Medicaid benefits. 77
127	127	(b) Qualified entities shall provide written notice of 78
128	128	their presumptive eligibility determinations to applicants 79
129	129	within 10 days after making the determination. 80
130	130	1. If an applicant is determined to be presumptively 81
131	131	eligible, the notice must include all of the following: 82
132	132	a. The date the presumptive eligibility period begins. 83
133	133	b. An explanation that an application for full Medicaid 84
134	134	benefits must be filed before the presumptive eligibility period 85
135	135	ends or there may be a gap in coverage for the individual. 86
136	136	c. Notification that the presumptive eligibility period 87
137	137	ends 180 days after it begins or when an application for full 88
138	138	Medicaid benefits is acted upon by the agency, whichever occurs 89
139	139	earlier. 90
140	140	2. If the applicant is determined not to be presumptively 91
141	141	eligible, the notice must include all of the following: 92
142	142	a. The reason the i ndividual was not deemed eligible. 93
143	143	b. Notification that the individual still has the option 94
144	144	to submit an application for full Medicaid benefits. 95
145	145	(c) Qualified entities shall assist eligible individuals 96
146	146	with completing and submitting an application for full Medicaid 97
147	147	benefits, whether by paper application or through online or 98
148	148	phone applications. For paper applications, the qualified entity 99
149	149	shall provide the eligible individual with the proper mailing 100
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158	158	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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162	162	address or fax number to submit the application. 101
163	163	(d) Qualified entities are required to meet the following 102
164	164	performance standards each year in order to continue 103
165	165	participating as a qualified entity under the pilot program: 104
166	166	1. An average of 90 percent of individuals the qualified 105
167	167	entity determines to be presu mptively eligible submitted an 106
168	168	application for full Medicaid benefits before the end of the 107
169	169	presumptive eligibility period. 108
170	170	2. On average, individuals submitted applications for full 109
171	171	Medicaid benefits within 10 days of being determined to be 110
172	172	presumptively eligible. 111
173	173	3. An average of 90 percent of individuals who submitted 112
174	174	an application for full Medicaid benefits before the end of the 113
175	175	presumptive eligibility period were ultimately deemed eligible 114
176	176	for full Medicaid benefits. 115
177	177	(3) PRESUMPTIVE ELIGIBILITY PERIOD.—The presumptive 116
178	178	eligibility period for temporary Medicaid coverage under the 117
179	179	pilot program begins on the date a qualified entity determines 118
180	180	an eligible individual to be presumptively eligible and ends 180 119
181	181	days later or on the date the eligible indi vidual is deemed 120
182	182	eligible for full Medicaid benefits, whichever occurs earlier. 121
183	183	(4) STREAMLINING BENEFIT ENROLLMENT. —The agency shall 122
184	184	implement procedures that allow pregnant women to transition 123
185	185	seamlessly from presumptive eligibility coverage under the pilot 124
186	186	program to full Medicaid enrollment without any loss of 125
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195	195	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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199	199	coverage. The agency shall update all existing technology 126
200	200	platforms and applications used for Medicaid enrollment to 127
201	201	incorporate pregnant women receiving temporary Medicaid coverage 128
202	202	under the pilot program and to allow for their transition to 129
203	203	full Medicaid benefits automatically once the agency deems them 130
204	204	eligible. 131
205	205	(5) COMMUNITY OUTREACH. —The agency, in collaboration with 132
206	206	the Department of Health, may implement an outreach program to 133
207	207	encourage entities to serve as qualified presumptive eligibility 134
208	208	locations under the pilot program; facilitate the required 135
209	209	training certification for employees of qualified entities; and 136
210	210	partner with community organizations to create public awareness 137
211	211	about the pilot program. 138
212	212	(6) FEDERAL APPROVAL; IMPLEMENTATION. —By October 1, 2025, 139
213	213	the agency shall seek federal approval through a Medicaid waiver 140
214	214	or state plan amendment to implement the pilot program. The 141
215	215	agency shall implement the program 30 days after receiving 142
216	216	federal approval. 143
217	217	Section 2. This act shall take effect July 1, 2025. 144
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