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Bill Summary · SB 368

Summary of SB 368: Presumptive Medicaid Eligibility for Pregnant Women

Bill Information:
- Bill Number: SB 368
- Title: Presumptive Medicaid Eligibility for Pregnant Women
- Status: Filed
- Introduced: November 04, 2025
- Sponsor: Senator Davis

Purpose and Intent

SB 368 aims to enhance access to Medicaid for pregnant women by establishing presumptive eligibility criteria. This legislation seeks to ensure that pregnant women can receive timely medical care during their pregnancy and postpartum period, thereby improving maternal and infant health outcomes.

Key Provisions

  1. Presumptive Eligibility Determinations:

    • The bill allows certain qualified entities (e.g., hospitals, federally qualified health centers, and nonprofit maternal health organizations) to determine presumptive Medicaid eligibility for pregnant women.
    • These entities must meet specific training and certification standards set by the Department of Children and Families (DCF).

  2. Coverage Duration:

    • Pregnant women deemed presumptively eligible will receive Medicaid coverage for the maximum period allowed under federal law or until a full eligibility determination is made, whichever comes first.

  3. Medically Necessary Services:

    • Coverage includes all medically necessary services, particularly for high-risk pregnancies, ensuring that women have access to specialists and subspecialists as needed.
    • All prior authorizations granted before or during the presumptive eligibility period will remain valid, promoting continuity of care.

  4. Federal Approval and Rulemaking:

    • The Agency for Health Care Administration (AHCA) is required to seek federal approval to extend the presumptive eligibility period to 180 days.
    • The AHCA and DCF must initiate necessary rulemaking within 60 days of the bill becoming law.

Affected Parties

  • Pregnant Women: The primary beneficiaries of this bill are pregnant women with incomes at or below 185% of the federal poverty level, who will gain easier access to Medicaid services.
  • Healthcare Providers: Qualified Medicaid providers will be responsible for making eligibility determinations and will require training and monitoring to ensure compliance with the new provisions.

Procedural Aspects

  • Effective Date: The bill is set to take effect on July 1, 2026.
  • Timeline for Implementation: The AHCA must seek federal approval and initiate rulemaking within 60 days after the bill becomes law.

Conclusion

SB 368 represents a significant step towards improving healthcare access for pregnant women in Florida. By establishing presumptive Medicaid eligibility, the bill aims to reduce barriers to necessary medical services, ultimately supporting better health outcomes for mothers and infants.

Compiled from official sources — confirm details with the bill’s official record.

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