What Is Family Planning Medicaid


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How Do I Know If I Qualify For The Fpbp

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.

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.

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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.

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.

Who Is Eligible For Family Planning

Medicaid Drives Upward Trend in Public Funding for Family ...

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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Where Do I Get Family Planning Services Covered By The Fpbp

There are many health care providers that can provide confidential family planning services under this program, including hospital based and freestanding clinics, family planning clinics, county health department clinics, federally qualified health centers, rural health centers, obstetricians and gynecologists, physicians, licensed midwives, nurse practitioners, pharmacies, and laboratories. If you need help in locating a Medicaid enrolled family planning provider in your area, please call toll free at 18005412831 for assistance.

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

Managed Care

Figure 4: Share of Women Ages 15-49 with Medicaid who are Enrolled in Managed Care, 2011

Medicaid Family Planning Programs

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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.

Medicaid Family Planning Services

ACHN: Family Planning Recipients
  • 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.
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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.

    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.

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    Medicaid Family Planning Waiver Program

    The family planning waiver program covers family planning services to eligible women, ages 14 through 55. Services are provided up to 24 months. Eligibility is limited to women with family incomes at or below 191 percent of the Federal Poverty Level who have lost or are losing Florida Medicaid State Plan eligibility and are not otherwise eligible for Medicaid, Childrens Health Insurance Program, or health insurance coverage that provides family planning services.

    Recipients losing SOBRA eligibility will have passive enrollment during the first 12 months of losing Medicaid. Non-SOBRA women will have to actively apply for the first year of benefits at their local county health department. All women enrolled in the family planning waiver will have active re-determination of eligibility through their local county health department after 12 months of family planning waiver eligibility. In order to receive the second year of benefits, recipients must reapply at their local county health department.

    Legal Authority: Section 381.0051, Florida Statutes, Contraceptive information and services may be rendered to minors by practitioners licensed to practice medicine under the provisions of Section 458 or 459, Florida Statutes, as well as by the Department of Health through its family planning waiver program, provided the minor:

    The family planning waiver program covers the following services:

    What Services Are Available Through This Program

    Medicaid and Family Planning  Medicaid Family Planning ...
    • Physical exams which may include a pap smear, breast exam, and STD testing
    • Family planning counseling and pregnancy test
    • Birth control supplies including condoms
    • Colposcopies and treatment for STDs which are limited to a six week period after a family planning exam, counseling visit, or supply visit
    • Related pharmaceuticals and laboratory test

    Please noteAll Services are CONFIDENTIAL

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    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.



    Does Planned Parenthood Still Exist

    Planned Parenthood Federation of America , or Planned Parenthood, is a nonprofit organization that provides reproductive health care in the United States and abroad. A member of the International Planned Parenthood Federation , it is a tax-exempt organization under Internal Revenue Code section 501.

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    Family Planning Waiver Resources

    MedicationsEffective January 1, 2015, beneficiaries enrolled in the Family Planning waiver demonstration program may have a prescription for contraceptives and/or medications to treat a sexually transmitted infection /sexually transmitted disease written by any Medicaid participating provider filled at their local Medicaid participating pharmacy.

    How Do I Apply

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    First, go to Washington Healthplanfinder to see if you are eligible for Apple Health coverage or a subsidized Qualified Health Plan. If you’re eligible, sign up for one of those plans. They provide full health care coverage, which includes family planning.

    If you’re a teen you may be eligible for Apple Health coverage on your own. Call Washington Healthplanfinder at 1-855-923-4633 to find out if you’re eligible. Read more information about health coverage for teens and young adults.

    If you’re not eligible for Apple Health, make an informed choice to waive your right to apply for Apple Health, or you need confidential services, contact your Apple Health provider and apply for benefits over the phone or in-person with an eligible Apple Health provider.

    You can also apply by fax , email , telephone with HCA or mail without provider assistance. In that case, you should securely transmit or mail the Application for Family Planning Only services. Family Planning Only programs services are available through any Apple Health provider.

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    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.

    What Do I Need To Provide With My Application When Applying For The Fpbp

    You will need to bring or send in documentation for each of the items listed below:

    • Full legal name as it appears on your birth certificate
    • Social Security Number
    • Proof of your citizenship or immigration status. If you are a U.S.citizen and provide a valid Social Security Number , a match with Social Security Administration will verify your SSN, date of birth/age and U.S. citizenship. If SSA verifies this information, no further proof is needed. The SSA match cannot verify birth information for a naturalized citizen. You will need proof of naturalization or a U.S. passport)
    • Proof of your age , like a birth certificate, or a passport
    • Proof of earned income, like recent paycheck stubs , a letter from your employer or a profit and loss statement if you are selfemployed
    • Proof of your unearned income, from sources like Social Security Benefits, NYS Disability Benefits, or Unemployment Benefits
    • Proof of where you live, like a rent receipt, letter from your landlord, mortgage statement, or postmarked nonwindow envelope from mail you received recently
    • Health Insurance benefit card or policy statements
    • You do not need to bring or send in proof of your resources, such as bank statements, vehicles you own or insurance policies. Resources are not counted in determining eligibility for the FPBP.

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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

    What Services Does Family Planning Offer

    Medicaid and Family Planning  Medicaid Family Planning ...

    Services such as reproductive and sexual health are available at each Family Planning NSW clinic. Services provided by these organizations include contraception information, contraceptive procedures , pregnancy options, including early abortion, STI testing and management, and advice on how to manage menopause symptoms.

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    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.


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