Subcommittee approves substitute to let non-hospital entities determine presumptive eligibility for ambulatory prenatal care pending federal approval

Senator Locke presented a substitute for Senate Bill 831, which concerns hospital presumptive eligibility (HPE) and extends presumptive eligibility for ambulatory prenatal care to pregnant individuals. The substitute directs the Department of Medical Assistance Services (DMAS) to seek necessary federal authority from the Centers for Medicare & Medicaid Services (CMS) to implement presumptive eligibility for pregnant individuals and, if approved, to authorize listed qualified entities (beyond hospitals) to make those determinations.

Nut graf: The substitute converts a permissive expansion into a state plan option that requires DMAS to prepare and submit the federal paperwork; implementation depends on CMS approval and state-level systems, contracting, and training for new entities.

DMAS staff member Sarah Cariano told the panel that a state plan amendment is required and that CMS typically has 90 days to approve or return edits; realistically, the federal approval process and system changes mean implementation could take months, with additional time needed to set up systems, contracts and training.

A motion to accept the substitute was adopted and a subsequent motion to recommend the bill for reporting carried by roll call; the transcript recorded the committee vote as “4 ayes, 0 noes.”

Ending: The record shows the subcommittee recommended the substitute bill for reporting to the parent committee; implementation will require DMAS to submit paperwork to CMS and build operational capacity.