H 1351

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
    HB 1351  2026
1A bill to be entitled
2An act relating to presumptive Medicaid eligibility
3for pregnant women; amending s. 409.903, F.S.;
4authorizing certain entities meeting specified
5criteria to serve as qualified Medicaid providers for
6purposes of making presumptive Medicaid eligibility
7determinations for pregnant women; requiring the
8Department of Children and Families to ensure that
9such providers are adequately trained and monitored
10for compliance when serving in such roles; requiring
11the Agency for Health Care Administration to provide
12Medicaid coverage to pregnant women deemed
13presumptively eligible for the duration of a specified
14time period; providing that pregnant women deemed
15presumptively eligible are entitled to coverage of all
16medically necessary services under the Medicaid
17program during such eligibility period; requiring that
18all prior authorizations granted before or during such
19period remain in effect for the duration of such
20period; requiring the agency, within a specified
21timeframe, to seek federal approval to extend the
22allowable period of presumptive Medicaid eligibility
23coverage for pregnant women; requiring the agency and
24the department to initiate certain rulemaking within a
25specified timeframe; providing an effective date.
                                                  Page 1 of 4
 CODING: Words stricken are deletions; words underlined are additions.
                                                                                                         hb1351-00
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
 HB 1351  2026
26
27    Be It Enacted by the Legislature of the State of Florida:
28
29Section 1.       Subsection (5) of section 409.903, Florida
30    Statutes, is amended to read:
31409.903     Mandatory payments for eligible persons.—The
32    agency shall make payments for medical assistance and related
33    services on behalf of the following persons who the department,
34    or the Social Security Administration by contract with the
35    Department of Children and Families, determines to be eligible,
36    subject to the income, assets, and categorical eligibility tests
37    set forth in federal and state law. Payment on behalf of these
38    Medicaid eligible persons is subject to the availability of
39    moneys and any limitations established by the General
40    Appropriations Act or 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.
                                               Page 2 of 4
     CODING: Words stricken are deletions; words underlined are additions.
                                                                                                      hb1351-00
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
 HB 1351  2026
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
71    this subsection are entitled to coverage of all medically
72    necessary services under the Medicaid program, including, but
73    not limited to, services provided by specialists and
74    subspecialists needed to comanage high-risk pregnancies,
75    including for issues outside the scope of general obstetrics.
                                               Page 3 of 4
     CODING: Words stricken are deletions; words underlined are additions.
                                                                                                      hb1351-00
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
 HB 1351  2026
76    All prior authorization approvals granted before or during the
77    presumptive eligibility period remain valid for the duration of
78    such period to ensure continuity of care and to reduce the risk
79    of adverse maternal or infant health outcomes.
80Section 2.       Within 60 days after this act becomes a law,
81    the Agency for Health Care Administration shall seek federal
82    approval to extend the allowable period of presumptive Medicaid
83    eligibility for pregnant women to 180 days under s. 409.903,
84    Florida Statutes, and the agency and the Department of Children
85    and Families, as applicable, shall initiate any necessary
86    rulemaking to implement the amendments made by this act to s.
87    409.903, Florida Statutes.
88Section 3.       This act shall take effect July 1, 2026.
                                               Page 4 of 4
     CODING: Words stricken are deletions; words underlined are additions.
                                                                                                      hb1351-00