HB89 Alabama 2025 Session

Summary

Primary Sponsor

Marilyn LandsRepresentative

Democrat

Session

2025 Regular Session

Title

Medicaid; providing presumptive eligibility to pregnant women

Summary

HB89 creates a presumptive eligibility pathway so pregnant women can get up to 60 days of Medicaid-covered prenatal care before formal approval, if they meet income and documentation requirements.

What This Bill Does

The bill lets a qualified ambulatory prenatal care provider determine presumptive eligibility for a pregnant woman based on preliminary information (proof of pregnancy and income). If determined eligible, the woman can receive prenatal care coverage for up to 60 days, ending at the earliest of the agency’s final determination, the last day of the month after the determination if she didn’t file for Medicaid, or 60 days after the determination. Only one presumptive period per pregnancy is allowed, and coverage during this period cannot be retroactively denied if the woman doesn’t file or if the final decision is negative. The woman must apply for Medicaid by the last day of the month following the determination, and the agency will set rules for documentation and forms. The act also repeals on Oct 1, 2028 and becomes effective Oct 1, 2025.

Who It Affects

• Pregnant women who submit proof of pregnancy and income to a qualified prenatal care provider and may receive up to 60 days of Medicaid prenatal coverage during presumptive eligibility
• Ambulatory prenatal care providers qualified by the Medicaid Agency and the Alabama Medicaid Agency, who determine presumptive eligibility and implement the accompanying rules and timelines

Key Provisions

• Establishes presumptive eligibility for prenatal care under Medicaid for up to 60 days before formal approval, based on preliminary information including proof of pregnancy and income
• Eligibility is determined by a qualified ambulatory prenatal care provider using income not exceeding the state MAGI limit for pregnant women, with one presumptive period per pregnancy
• The presumptive eligibility period ends at the earliest of: the agency’s determination of eligibility, the last day of the month after determination if the woman did not file, or 60 days after determination
• Coverage during the presumptive period cannot be retroactively denied due to not filing an application or a negative final decision
• The provider must notify the Medicaid Agency within five working days and inform the woman to apply for Medicaid by the last day of the following month
• The woman must apply to the agency for Medicaid no later than the last day of the month following the determination
• The agency will adopt rules defining acceptable preliminary documentation (proof of pregnancy and current household income) and may provide forms for providers
• The act repeals on October 1, 2028 and becomes effective October 1, 2025

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