HB494 Alabama 2024 Session

Summary

Primary Sponsor

Marilyn LandsRepresentative

Democrat

Session

Regular Session 2024

Title

Medicaid; permit presumptive eligibility for pregnancy care benefit before approval

Summary

HB494 would allow pregnant women in Alabama to receive Medicaid-funded prenatal care for up to 60 days before Medicaid approval by using presumptive eligibility based on preliminary information.

What This Bill Does

The bill creates a presumptive eligibility period for ambulatory prenatal care of up to 60 days before final Medicaid approval. A qualified prenatal care provider can determine eligibility using preliminary information (proof of pregnancy and monthly household income) and provide coverage during that period, with a limit of one presumptive period per pregnancy; coverage cannot be retroactively denied if the final decision is unfavorable. Providers must notify the Medicaid Agency within five days of the determination and tell the woman to apply by the last day of the following month, and the woman must submit a Medicaid application by the last day of the month after the determination. The Medicaid Agency will define acceptable preliminary documentation and may develop forms to support determinations, and the act becomes effective October 1, 2024.

Who It Affects

• Pregnant women who have not yet been formally approved for Medicaid but provide proof of pregnancy and monthly household income to a qualified prenatal care provider, enabling up to 60 days of Medicaid-funded prenatal care.
• Qualified providers of ambulatory prenatal care and the Alabama Medicaid Agency, who determine presumptive eligibility, notify the agency, inform patients about applying, and implement the program through rules and forms.

Key Provisions

• Establishes a presumptive eligibility period of up to 60 days for pregnant women to receive Medicaid-funded ambulatory prenatal care before a final eligibility determination is made.
• Eligibility is based on preliminary information provided by a qualified prenatal care provider showing pregnancy and household income within the state's pregnant-women income limit.
• Allows only one presumptive eligibility period per pregnancy.
• Presumptively eligible coverage cannot be retroactively denied due to failure to file an application or a negative final decision.
• Qualified providers must notify the Medicaid Agency within five working days of the determination and inform the woman to apply by the last day of the following month.
• A woman must apply to the Medicaid Agency no later than the last day of the month after the presumptive eligibility determination.
• The Medicaid Agency will adopt rules to define acceptable preliminary documentation and may develop forms or worksheets to support determinations.
• The act becomes effective October 1, 2024.

AI-generated summary using openai/gpt-5-nano on Feb 22, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Health