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