What Does Medicaid Cover In Terms Of Family Planning Benefits
Typically, if you already have Medicaid coverage, you can access family planning services from any provider that participates in Medicaid. This is true whether or not this provider is in-network for Medicaid.
Family planning is classified as a mandatory benefit under Medicaid. This means that all state Medicaid programs must cover family planning. However, states can determine how Medicaid covers specific family planning services and supplies at their discretion. However, there is no formal definition of family planning in the Medicaid program. Federal law guarantees payment for family planning services and supplies for anyone who qualifies for Medicaid in their state and also wishes to access family planning services and supplies. This is true of minors who are sexually active, too.
Want to see if youre eligible for Medicaid? Or if you qualify for subsidies on a Marketplace health insurance plan ? Then enter your zip code below.
North Carolina Medicaid Expansion Update
North Carolina is one of 12 states that has not yet expanded Medicaid under the Affordable Care Act .
If Medicaid is expanded in North Carolina, it is estimated that 624,000 residents would become newly eligible for coverage.
Governor Cooper has long pushed for Medicaid expansion, but GOP lawmakers oppose expansion.
North Carolinas Medicaid program is transitioning to a managed care model in 2021 after several delays.
Be Smart Family Planning Clarification On Sterilization And Eligibility
Clinical Policy and Programs, DMA, 919-855-4260
Background on Family Planning Medicaid
The provision of family planning services and family planning-related services has been the sole purpose of the Be Smart Family Planning Medicaid program since it started in October 2005, and continued with the CMS approval of the State Plan Amendment in 2014.
Be Smart Family Planning Medicaid, listed as MAFDN eligibility category in NCTracks, provides limited coverage to eligible beneficiaries. Family Planning Medicaid serves eligible beneficiaries, regardless of age or gender, but covers family planning and family planning related services only, as described in Clinical Policy 1E-7, Family Planning Services. Therefore, beneficiaries with MAFDN eligibility are not eligible for any other Medicaid program or categories of service.
Be Smart and Sterilization
Providers have been seeking clarification from N.C. Medicaid about sterilization and eligibility under the Be Smart program. The Centers for Medicare and Medicaid Services notified N.C. Medicaid that it is not acceptable to ask questions related to a beneficiarys sterilization status during the Medicaid application process. Therefore, some beneficiaries will be approved for Family Planning Medicaid who have no need for family planning services.
Additional information about the Be Smart program and eligibility for services is found in the next section.
Guidance for Providers of Be Smart Services
Recommended Reading: How To Enroll My Newborn In Medicaid
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
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.
Read Also: How To Get Help With Medicaid
Recommended Reading: What Is Medicaid Buy In Program
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.
Family Planning Medicaid Waiver Evaluation Materials
Collection of materials used by Medicaid FP Waiver Evaluators Workgroup. Evaluators of FP waivers in DHHS Region IV first met in September 2005 at the RNDMU Workshop in Asheville, NC. They continue to meet monthly in conference calls to discuss issues in evaluating waiver demonstration and share issues and solutions. Over time, state staff assigned to the Medicaid family planning waiver joined the evaluators to discuss issues of common interest. In addition, evaluators and staff from states beyond Region IV have become an integral part of the Workgroup, as have other partners from Guttmacher Institute and CMS.
You May Like: Wellcare Of North Carolina Medicaid
If I Give Away Just $14000 To All My Kids And Grandkids Will Medicaid Penalize The Gift
In a word..YES. There is a difference between the annual gift tax exclusion for IRS purposes and what is permitted under Medicaid rules. Unless some other exception applies, every gift counts in computing Medicaid eligibility, no matter the value of the gift. Non-cash gifts of items like automobiles or tangible property count as well. Example: If you gave away $100,000.00 divided by $6,300.00 the period of ineligibility for Medicaid would be nearly 16 months.
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.
Recommended Reading: Kentucky Medicaid Phone Number For Providers
Medicaid Family Planning Policy
The manner in which family planning services are financed and organized is unique within the Medicaid program. All state Medicaid programs must offer some level of family planning benefits, and health care providers and pharmacies are not permitted to charge cost-sharing for family planning services. In most cases, beneficiaries enrolled in Medicaid managed care networks may obtain family planning services from the provider of their choice even if they are not considered in-network providers. The federal government matches state family planning contributions to all participating providers at 90%, which is generally a higher rate than that offered for other services. This payment policy has been an incentive in state efforts to expand coverage for family planning services to individuals who have not been otherwise eligible for full scope Medicaid coverage.
Medicaid and sterilization
Figure 2: Provider Counseling on Sexual Health Topics Among Women, by Insurance Coverage, 2013
Family Planning Providers
Figure 3: Site of Reproductive Care Among Women, by Insurance Coverage, 2013
Figure 4: Share of Women Ages 15-49 with Medicaid who are Enrolled in Managed Care, 2011
Medicaid Family Planning Programs
State Profile: Family PACT in California
Nc Medicaid Family Planning Waiver
Free reproductive health services for men and women in North Carolina.
The NC Medicaid Family Planning Waiver makes free family planning services available to eligible men and women in North Carolina. The program began in October, 2005 to help reduce unplanned pregnancies and improve the well-being of children and families in North Carolina.
This is a program that is available to North Carolina residents who do not qualify for other Medicaid benefits. The Medicaid Family Planning Program is limited to services related to family planning such as:
- annual family planning exams
Don’t Miss: Does Wv Medicaid Cover Dentures
North Carolina Medicaid Income Limit Charts
The North Carolina Medicaid eligibility income limit charts are divided by groups.
For example, the first chart is focused on income limits for children who qualify for Medicaid.
Similarly, the second chart below focuses on the Medicaid income limits for adults in North Carolina who qualify for Medicaid.
North Carolina Medicaid Income Limit for Children
Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.
|North Carolina Medicaid Income Limit Children|
|Children Medicaid Ages 0-1|
How to Read the North Carolina Medicaid Income Limits Charts Above
You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.
Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.
For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 196% of the Federal Poverty Level which for a family of two is $34,143 as shown in the chart above.
Do I Have To Give Away Everything To Qualify For Medicaid
NOT SO! You dont have to be completely destitute to get Medicaid but rather have assets that are in a non-countable form. If your spouse or dependent relative lives in your primary residence or if you ever intend to return home, then your home is non-countable. You can also keep personal items, a car, some life insurance and certain other assets.
Recommended Reading: How Do I Get A Breast Pump Through Medicaid
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.
Dont Miss: Does Sc Medicaid Cover Weight Loss Surgery
Why Use An Elder Law Attorney
Both the qualifying process and the actual application are complex and a simple clerical error or misunderstanding a point of Medicaid law can cause extensive delays or denial. In addition, your core legal documents should be reviewed. Your will, powers of attorney and advanced directives should match your new situation. The earlier you plan, the more options are available. Call us today!
Additional planning completed for the community spouse and care to preserve your assets for your family. Proper planning needs to be completed to help protect assets from Medicaid Estate Recovery.
Read Also: Is Everyone Eligible For Medicaid
You May Like: Do Unemployed Qualify For Medicaid
Billing For Codes And Services
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.
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
Family Planning Waivers: Free Family Planning Coverage
Family planning and sexual health services are free for men and women with qualifying income who lack medical insurance coverage.
If you’re planning to have a child, or trying to stay in your best health until you are ready to start a family, we can help. If you have no other medical coverage that provides basic family planning and reproductive health services, you may qualify to receive free health care.
You’re eligible for these free services if:
- You are a man or woman between the ages of 13 and 44.
- You are not currently pregnant.
- You have not had a hysterectomy, tubal ligation, or vasectomy.
- You do not have Medicare, CHIP, or any other health insurance or third party medical coverage.
- Your family income is at or below 194% of the Federal Poverty Level.
Also Check: Where Can I Get A Nebulizer With Medicaid
What Is Family Planning Medicaid Nc
- 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.
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.
Recommended Reading: Florida Medicaid In Home Care
The Family Planning Program
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.
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.
Option 1 Apply Online
You can apply online through the North Carolina ePASS Portal as shown in the image below.
If you have an account, you can log in or create your North Carolina ePASS Account. to be taken to the website.
The video below, from the North Carolina Department of Health and Human Services does a great job of walking you through how to apply for Medicaid online.
We highly encourage you to watch it if you are planning to apply for NC Medicaid online.
Read Also: Does Medicaid Cover Breast Augmentation
What Does Family Planning Medicaid Cover In Ga
Participants in the P4HB program are eligible for family planning services covered by the Georgia Medicaid program including: Family planning initial exam and annual exam. planning visits. Pregnancy tests and pap smears. referrals to social services and primary health care providers.
What does Medicaid family planning cover in Alabama?
Eligible women qualify for most family planning services and supplies, including birth control pills, the Depo-Provera shot, vaginal ring, diaphragm and contraceptive patch, doctor/clinic visits and tubal ligations.
Does Nc Medicaid Family Planning Cover Hysterectomy
If it is discovered during screening that the beneficiary has no need for Family Planning Services , Medicaid shall not be billed for the service.
What is family planning services Georgia?
The Georgia Department of Public Healths Family Planning program provides leadership, guidance, and resources to Georgias 18 Health Districts in the development and provision of resources that address the health needs of women.
Also Check: At What Age Can You Qualify For Medicaid
All Information About What Does Medicaid Family Planning Cover In Nc
At dayofdifference.org.au you will find all the information about What Does Medicaid Family Planning Cover In Nc. We have collected a lot of medical information. Check out the links below.