What Does Medicaid Family Planning Services Cover


Understanding Types Of Medicaid Insurance In New Mexico

NY Medicaid Guidelines – An In Depth Discussion with Neil Stern, Senior Planning Services

There are various types of NM Medicaid insurance, and enrollees can review their options when completing the Medicaid application process. The medical insurance plans are offered by four managed care plans that have been contracted by the state of New Mexico to provide Medicaid services. The Medicaid coverage plans are through: Blue Cross Blue Shield, Molina Health Care, Presbyterian Health Plan and UnitedHealthcare Community Plan.

The types of Medicaid insurance in New Mexico in which members enroll determine the amount of coverage for which they qualify. The health plans offer the full array of Medicaid services, including community-based long-term services, institutional behavioral health, acute services and support services.

After signing up for NM Medicaid coverage, you will have to choose a health plan. If you do not, one will be automatically assigned to you. The Medicaid health policy you choose will determine the network of providers from which you can obtain services. NM Medicaid services are only covered if they are provided by health centers, facilities, clinics, providers or doctors that are in a plans network.

Who Is Eligible For The Fpp

  • Men and women, ages 12 through 54, who are:
  • Iowa residents or
  • U.S. citizens or qualified immigrants
  • Who meet income limits

Women whose pregnancies and deliveries were covered by Medicaid will have family planning services covered for an additional 12 months without having their eligibility re-determined.

In determining FPP eligibility, the households countable monthly income shall not exceed the amounts shown in the chart below for a household of the same size.



Health Education Cancer Screenings Sti Testing And Treatment Pregnancy And Preconception Screening

Oftentimes, states also include sexual and reproductive health education programs and testing and treatment for sexually transmitted infections in their family planning coverage, too. In addition to contraception to prevent pregnancy and space out births, many family planning programs include pregnancy testing and counseling, basic infertility services, STI and HIV services, and preconception services such as screening for obesity, smoking, and mental health. Screening for intimate partner violence is also often covered by Medicaid family planning benefits. However, there is no requirement that all states must provide all these benefits in their own Medicaid programs for family planning care.

Breast cancer and cervical cancer screenings are also typically covered by state Medicaid programs. The HPV vaccine for young adults is also covered in all but one state Medicaid program. This vaccine is the only vaccine proven to prevent cancer, in this case cervical cancer.

Recommended Reading: Blue Choice Healthy Connections Medicaid

Family Planning Medicaid Or Be Smart Medicaid

The Family Planning Medicaid Program or Be Smart program is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina. Family planning, reproductive health and contraceptive services are provided to eligible men and women, whose income is at or below 195% of the federal poverty level, with no age restrictions.

Billing For Codes And Services

Medicaid Moving Forward

SoonerPlan will pay for the following services:

  • Birth control information and supplies
  • Office visits and physical exams related to family planning
  • Laboratory tests related to family planning services, including pregnancy tests, Pap smears and screening for some sexually transmitted infections
  • Tubal ligations for women age 21 and older
  • Vasectomies for men age 21 and older
  • Gardasil 9 for males and females through age 45.

Tubal ligations and vasectomies are paid in accordance with current SoonerCare policy and require the Sterilization Consent form.

Medically necessary office visits related to family planning are unlimited for SoonerPlan members younger than 21.

For SoonerPlan members 21 and older, medically necessary office visits and physical exams related to family planning are limited to four per month except for the initial visit code. For 99202, the limit is two per month.

Copayments do not apply for any family planning service, device, prescription or over-the-counter product.

Also Check: I Am Pregnant And Need To Apply For Medicaid

What Is The Family Planning Program

This program allows men and women to get family planning services only. This program is a form of limited insurance coverage. If you are able to enroll in the FPP, most of your basic family planning services will be paid for. However, it does not meet the Affordable Care Act requirements for a minimum essential benefits plan.

Medicaid Covers Family Planning Services

Since 1972, states have been required to provide family planning services in their Medicaid programs. Now, under the Affordable Care Act, states have the option to offer such services , under state plan authority, to individuals who would not otherwise be eligible for Medicaid. This has greatly expanded the number of people who can benefit from these fundamental services.

All state Medicaid programs must offer some family planning benefits, and most provide coverage for prescription contraceptives, as well as health education and promotion, testing and treatment for sexually transmitted infections , and preconception services such as screening for obesity, smoking, and mental illness. In 2013, women with Medicaid coverage were more likely than women with private insurance to report they had spoken with a provider about contraception or birth control, sexual history or relationships, HIV and domestic violence.

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What Services Are Covered

Family planning and related services cover:

  • Family planning education and risk reduction counseling.
  • All FDA approved birth control methods including: pills, patches, rings, shots, IUDs, implants, diaphragms, cervical caps, condoms, and spermicides , and emergency contraception.
  • Education and supplies for natural family planning and abstinence.
  • Permanent methods: tubal ligations , hysteroscopic sterilization, and vasectomy.
  • Limited screening and treatment for sexually transmitted infections .
  • Screening for cervical cancer and a well woman physical exam.
  • Office visits directly related to a family planning problem when medically necessary.

Family Planning Only does not cover:

  • Vaccinations.
  • Mammograms.
  • Services unrelated to family planning, such as: follow-up of abnormal Pap smears, pregnancy care, evaluation and treatment of health problems like diabetes, asthma, or high blood pressure.

Potential Federal Actions To Restore Medicaid Enrollees Access To Family Planning Services

Allow Senior Planning Services to Take on the Medicaid Application Process from Start to Finish

The Biden administration has tools at its disposal to address these constraints on access, such as disapproving pending Section 1115 waiver requests, revoking the approved Texas waiver, reissuing guidance outlining federal free-choice requirements, and initiating compliance actions in states that restrict access to family planning providers in ways not permitted by federal law.

The recently proposed rescission of the Title X gag rule represents a substantial step to undo family planning restrictions imposed by the prior administration. Advocates for sexual and reproductive health care are closely watching for signs of how the Biden administration will restore womens rights and strengthen their access to health care.


1 Section 1902 of the Social Security Act generally allows Medicaid enrollees to obtain medical services from any provider that is qualified to perform the service or services required and that undertakes to provide such services. States that opt for a managed care delivery system are permitted to restrict enrollees to providers that participate in the managed care plans network. But even then, federal law preserves enrollees right to free choice of family planning providers, including those that do not participate in the plans network.

Publication Details

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Who Can Qualify For Medicaid Family Planning Benefits

If you already qualify for Medicaid in your state, this means you are already eligible for the family planning benefits of your states program. In most states, if you are You can see if youre eligible and apply for Medicaid here.

Some states also have whats known as Medicaid family planning expansion. This means that states have utilized the option of accessing a waiver from the federal government that allows them to provide access for family planning care on the basis of income to those previously not covered by or eligible for Medicaid. And a few states even have waivers to cover family planning for those who are leaving the Medicaid program.

Thanks to the Affordable Care Act , all states now have the option of expanding their Medicaid programs in terms of family planning benefits without the use of a time-limited waiver. Now, any state that wishes to extend Medicaid coverage for family planning for anyone who meets the income requirements may do so permanently.

What Does Medicaid Not Cover In New Mexico

Although there are many Medicaid services included in your government-sponsored health care policy in New Mexico, there are several that are not covered. When it comes to services deemed what is not covered by Medicaid, be prepared to pay partial or full medical expenses. New Mexico Medicaid coverage does not include the following health services and items:

  • Non-emergency medical services offered by out-of-network providers or outside of New Mexico without prior authorization
  • Amounts that would have been paid by Medicare as the primary carrier if you were entitled to Medicare or paid out by other valid coverage
  • Services for which you have no legal obligation to pay for
  • Services that are not considered medically necessary
  • Treatment procedures, supplies, devices, drugs, equipment or facilities that are unproven, considered investigational or experimental
  • Personal comfort items you may want in the hospital, e.g. TV or telephone
  • Weight loss programs and equipment that have not been authorized by your PCP

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Medicaid Family Planning Services

  • How do I get Medicaid Family Planning Services? If you have Medicaid managed care in New York State, you can go to any provider inside or outside your health plan for family planning and reproductive health services, as long as that provider accepts Medicaid and offers the services you need.
  • Do I need prior approval from my health plan or regular doctor? No. You do not need a referral from your primary care provider or anyone else in your health plan to see any family planning provider inside or outside your plan that offers these services and accepts Medicaid.
  • What kind of services can I get? You have free and confidential access to:
    • all types of birth control: pills, condoms, diaphragms, IUDs, Depo Provera, Norplant, and contraceptive foams
    • emergency contraception
    • sterilization
    • testing and treatment for sexually transmitted diseases including colposcopy, cryotherapy and LEEP *
    • HIV testing and pre test and post test counseling *
    • Pap smears testing for cervical cancer, pelvic problems, breast disease, anemia, and high blood pressure *
    • abortion.
    • *As part of a family planning visit

  • If I am under 18 years of age, can I still get these services? Yes. When making the appointment, ask if the doctor or clinic will see someone your age.
  • Can I get tested for HIV outside my plan? Yes. You can go to any Medicaid provider for HIV testing and counseling, as part of a family planning visit.
  • Will my services be confidential? Yes. All services are confidential.
  • The Family Planning Program

    Does Medicare Cover Therapy Services?

    The Family Planning Program is for men and women who are 12-54 years of age. The FPP helps with the cost of family planning related services. The FPP is a state-funded DHS program which replaced the Iowa Family Planning Network program. Eligibility and covered benefits did not change. The location where you receive services may have changed. As of July 1, 2017, eligible IFPN members transitioned to the FPP.

    Find an FPP Provider

    The provider search tool will take you to the Iowa Medicaid Enterprise Provider Search Portal. Select ‘FPP Provider’ in the ‘Type’ dropdown.

    You can change the ‘Specialty,’ ‘County’ or ‘Metro’ to expand or narrow your search. Provider lists are subject to change and are updated daily.

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    Family Planning Benefit Program

    To apply for the Family Planning Benefit Program please bring the items found on the checklist and the completed application form with you to your appointment.

    This free program provides family planning services to women and men of childbearing age who meet certain income and residency requirements. The program is funded through Medicaid, but you do not need to be a current Medicaid patient to participate. Many more people can get free services with this program than other Medicaid programs.

    In order to be eligible you must meet these requirements:

    • Male or female of childbearing age, including teens and college students
    • New York State resident that meets satisfactory citizenship or immigration requirements
    • Eligible income level

    This program provides coverage for family planning-related health care including:

    • Most FDA approved birth control methods, devices, and supplies including birth control pills, condoms, the patch, Nuvaring, IUDs and Nexplanon
    • Emergency contraception and follow-up care
    • Male and female sterilization
    • Preconception counseling, preventive screening and family planning options before pregnancy

    The following services are also free when they are part of a family planning visit. You MUST have these services as part of or follow up to a family planning visit or they will not be covered by the Family Planning Benefit Program.

    Who Is Eligible For Family Planning

    Beneficiaries must meet the following eligibility criteria:

    • Family income no more than 194 percent of the federal poverty level conversion)
    • Must be capable of reproducing ages 13-44 years of age.
    • Must not have had a procedure that prevents them from reproducing.
    • Must not have Medicare, CHIP, or any other health insurance or third party medical coverage.

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    How Do I Apply For The Fpbp

    You can go to a Family Planning Services Provider for a presumptive eligibility screening and/or to get an FPBP application and enrollment assistance. You may access a list of these locations by visiting our website at Family Planning Program Sites.

    If you need your application to remain completely confidential with regard to your residence address, you must clearly tell us this on your application and give us a safe and confidential mailing address and contact phone number so we may reach you if needed to further determine your eligibility for the FPBP

    Cervical And Breast Cancer Services

    Personal Services Contracts – Florida Medicaid Planning

    The survey asked states about their policies with respect to coverage of services for cervical and breast cancers under their traditional programs and family planning expansion programs. These include the HPV vaccine, pap smear and follow up testing after abnormal laboratory results, mammograms, genetic screening for high-risk women, and breast cancer preventive medication for high-risk women. These services are required coverage for the ACA expansion group as they are recommended by the US Preventive Services Task Force.

    Cervical Cancer Services PAP Test and Follow Up, HPV Vaccine
    Key Finding: Cervical Cancer Services
    All states cover Pap screening for cervical cancer regardless of eligibility pathway, but follow-up tests for abnormal screening results are less likely to be covered in state family planning waivers or SPAs. Of the states that do provide coverage, many indicate that the procedures or services are covered as part of a family planning visit under a family planning waiver or SPA, rather than as a specific benefit.

    The survey inquired about coverage of pap and lab testing as well as additional screening procedures subsequent to an abnormal result from the pap test. These procedures include:

    Coverage across Eligibility Pathways
    Utilization Controls
    Table 17: Coverage for Breast Cancer Screening and Prevention
    Traditional Medicaid

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    Where Can I Get Services

    Services are available at any eligible Apple Health provider.

    Condoms and spermicides are available at pharmacies without a prescription.

    Emergency Contraception is available at any eligible Apple Health provider or directly from a pharmacist. For more information, visit the Emergency Contraception website.

    Restoring Womens Access To Medicaid Family Planning Services

    • Partner, Manatt Health

    • For many low-income women, particularly those living in states that have not expanded Medicaid, family planning coverage provides access to important preventive health services

    • The Biden administration has tools at its disposal to address family planning restrictions and restore womens access to sexual and reproductive health care

    Family planning services allow women to make their own choices about whether and when to have children. These services, which are critical to ensuring gender and racial equity and reproductive justice, are not limited to contraception, pregnancy testing, and fertility services. For many low-income women, particularly those living in states that have not expanded Medicaid, family planning coverage provides access to important preventive health services, too. Of the 9.3 million women who received publicly funded contraceptive services in 2016, approximately half also received testing for a sexually transmitted infection, nearly 2 million were screened for cervical cancer, and almost 40,000 received an HPV vaccination.

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    State Actions That Restrict Access To Medicaid

    Medicaid, the largest source of public funding for family planning services, has long been barred by the Hyde Amendment from covering abortion, except in very limited circumstances. But longstanding federal law requires states to cover family planning services in their basic Medicaid programs and allows states to provide Medicaid-financed family planningonly coverage for low-income individuals who do not qualify for full Medicaid. Under both types of coverage, the federal free choice provision guarantees Medicaid enrollees the right to receive family planning services from any willing and qualified provider.1

    Notwithstanding this right, some states have excluded providers that offer abortion services from participating in Medicaid, even though these providers are sometimes the largest, or only, local provider of comprehensive family planning services. By seeking to exclude providers that offer abortions outsidethe Medicaid program, these actions jeopardize womens access to essential family planning and preventive health services withinMedicaid. States have pursued three primary strategies to exclude providers, emboldened by supportive actions from the Trump administration.

    How Do I Know If I Qualify For The Fpbp

    Medicare vs. Medicaid [INFOGRAPHIC]

    You may be eligible for the FPBP if:

    • You are a female or male of childbearing age
    • You are a New York State resident
    • You are a U. S. citizen*, national**, Native American, or lawfully present***
    • You meet certain income requirements and
    • You are not already enrolled in Medicaid.

    You may still be eligible for the FPBP if you are already covered by other health insurance but you wish to apply only for Family Planning Services coverage. You may choose to apply only for the Family Planning Benefit Program and not to apply for Medicaid/Child Health Plus comprehensive public health insurance coverage.

    *United States Citizen: For the purposes of qualifying as a United States citizen, the United States includes the 50 states, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands and the Northern Mariana Islands. Nationals from American Samoa or Swain´s Island are also regarded as United States citizens for the purpose of Medicaid eligibility.

    **National: A “national” is a person who is not a U.S. citizen, but who owes permanent allegiance to the United States and may enter and work in the U.S. without restriction. A “national” who is otherwise qualified may, if he becomes a resident of any state, be naturalized upon completing the applicable requirements. Examples of nationals are: persons born in American Samoa and Swain´s Island after December 24, 1952 and residents of the Northern Mariana Islands who did not elect to become U.S. citizens.

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