Cms Provides New Clarity For Family Planning Under Medicaid
Family planning services and supplies have been a part of the Medicaid program since it was first established half a century ago. And over the past several decades, Medicaid has become the dominant public funding source for family planning in the United States, accounting for three-quarters of that funding at last count. That should not come as a surprise, given the demographics of the population that Medicaid insures: According to unpublished tabulations of U.S. Census Bureau data, 20 percent of U.S. women of reproductive age are enrolled in Medicaid, including 47 percent of those living below the federal poverty level.
This spring, the Centers for Medicare and Medicaid Services turned an unprecedented amount of attention to these issues, recognizing Medicaids importance in enabling low-income women to access the family planning care they need. Sweeping new regulations governing the involvement of private-sector managed care plans in the Medicaid program and threeadditionalpieces of guidance to state officials focusing exclusively on family planning together form the most comprehensive set of rules, principles, and recommendations for states that CMS has offered on the subject.
Free Choice of Services
Free Choice of Providers
Focus on Long-Acting Reversible Contraceptives
What Are The Negatives Of Medicaid
Disadvantages of Medicaid Lower reimbursements and reduced revenue. Every medical practice needs to make a profit to stay in business, but medical practices that have a large Medicaid patient base tend to be less profitable. Administrative overhead. Extensive patient base. Medicaid can help get new practices established.
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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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.
FAMILY PLANNING PROGRAM MONTHLY INCOME LIMITS: 300% OF POVERTY
What Does Planned Parenthood Do For Free
We do offer many of the same services Planned Parenthood does, but ours are completely free. Some of our services include pregnancy testing, ultrasounds, options consultations, and more! You have nothing to lose by receiving our free support and care. We help you move forward in your pregnancy journey without the cost.
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Potential Federal Actions To Restore Medicaid Enrollees Access To Family Planning Services
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.
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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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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.
How Do I Prevent Sexually Transmitted Diseases
Sexually transmitted diseases are diseases passed between people when they have sexual contact. Some STDs can be passed without sex by kissing, touching, or rubbing the parts of the body parts where disease is present.
STDs are very common. But in many cases STDs do not cause symptoms, so people dont know they have one. The most common STDs can be treated easily and cured. Other STDs cannot be cured, but symptoms can be managed.
Condoms and female condoms, if used correctly, provide very good protection against STDs. But they must be used correctlyevery time you have sex. In some rare cases, you can still get STDs, even when you use a condom. The only way to prevent STDs is to abstain from oral, anal, and vaginal contact with a person who has one.
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What Services Are Available Through This Program
- 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
Get Important News & Updates
Sign up for email and/or text notices of Medicaid and other FSSA news, reminders, and other important information. When registering your email, check the category on the drop-down list to receive notices of Medicaid updates check other areas of interest on the drop-down list to receive notices for other types of FSSA updates.
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What Is Not Covered By Medicaid
Although it seems that Medicaid covers practically everything someone needs, it doesnt necessarily provide full coverage. Medicaid does not cover private nursing, for example, nor does it cover services provided by a household member. Also, things like bandages, adult diapers, and other disposables arent covered.
Public Notice Of Annual Public Forum For 1115 Family Planning Waiver
Pursuant to 42 C.F.R. Section 431.420, a Public Forum is required annually after the implementation of the Division of Medicaids Family Planning Waiver. This Public Forum provides stakeholders the opportunity to provide meaningful comments on the progress of the Family Planning Waiver. The Family Planning Waiver operates under the authority of an 1115 waiver approved by the Centers for Medicare and Medicaid Services effective January 1, 2018 through December 31, 2027. This Public Forum will be held at 10 a.m. on Wednesday, September 30, 2020. Due to the public health emergency, the Public Forum will be held via teleconference at 888-822-7517, access code: 4282244. There will be an opportunity for public comment during the forum.
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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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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.
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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.
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.
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What Is Family Planning Only
Family Planning Only is a program that provides individuals coverage for family planning services to help them take charge of their lives and prevent unintended pregnancies. For more information on the program view the Family Planning Only coverage brochure.
received approval for renewal of the Section 1115 Family Planning Only Demonstration Waiver for five years . The approval letter, Special Terms and Conditions, and Expenditure Authority can be found on CMSs website under Washington Family Planning Only Program and then clicking on Demonstration Approval. For questions please contact .)
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
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What Services Are Covered By Family Pact
Family PACT is a program that provides family planning and related services to people who qualify. If you are eligible for Family PACT, you can receive family planning services for free. Family PACT covers the following services:
- Various birth control methods, including long-acting reversible contraceptives, emergency contraception, and sterilization
- Family planning counseling and education
- Sexually transmitted disease testing & treatment
- HIV testing
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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What Is The Family Planning Benefit Program
The FPBP is a public health insurance program for New Yorkers who need family planning services, but may not be able to afford them. It is intended to increase access to confidential family planning services and to enable teens, women and men of childbearing age to prevent and/or reduce the incidence of unintentional pregnancies.
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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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.
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