What Is Medicaid Family Planning – Eligibility & Enrollment?

Medicaid is the primary provider of family planning services to low-income individuals. It is classified as a mandatory benefit that all states must provide. The program is financed by both the federal and state governments.

The scope of Medicaid coverage and eligibility varies from state to state. However, this health care coverage is set up to provide family planning services to as many people as possible in the US to reduce unintended pregnancies and improve the overall well-being of families and children in the country.

This article will discuss in details Medicaid family planning, including the general scope of coverage, benefits, Medicaid eligibility, costs, and enrollment criteria.

What Is Medicaid Family Planning?

Medicaid family planning is a separate program from traditional Medicaid coverage, providing family planning services to eligible individuals. The program offers affordable access to a range of family planning and reproductive health services to eligible beneficiaries.

The Medicaid Family Planning option was established in 1972 as part of the Social Security Act to offer comprehensive family planning services. All Medicaid plans are mandated to offer these benefits. However, even if you do not qualify for traditional Medicaid, you can still be eligible for Medicaid family planning services as long as you are within the income limit.

The state and federal government highly incentivizes the provision of family planning care to ensure wide access across the US. The services are accessible regardless of whether you are eligible or qualified for the traditional Medicaid plans. Both minors and adults have access to Medicaid family planning services.

Medicaid Family Planning Benefits and Scope of Coverage

The program offers access to the following family planning and reproductive health services:

• Contraceptive methods, including IUDs, implants, injections, birth control pills, and diaphragms. Most states also cover at least one form of prescription emergency contraception. Over-the-counter emergency contraception is also covered in some states
• Vasectomies for men and sterilizations for women. However, there are specific stipulations for vasectomies and sterilizations. For example, women have a 30-day wait period between the date of signing the consent form and when the sterilization procedure is carried out
• Reproductive health education and contraception counseling. For example, advice on choosing the right contraception method, using your preferred birth control method effectively, and reducing the risk of sexually transmitted infections and diseases
• Testing and treatment of STIs, including HIV testing and counseling. A few states cover Expedited Partner Therapy (EPT), which the CDC endorses as an effective method of controlling STI transmission. Also, pre-exposure prophylaxis (PrEP) is covered in some states, although prior authorization may be required
• Pregnancy testing and counseling
• Basic fertility services
• Preconception services such as mental health, smoking, and obesity screening
• Related reproductive health preventative services include pap smears, breast exams, breast cancer screening, cervical cancer screening, HPV vaccine, and pelvic exams

However, Medicaid family planning does not cover the following:

• Infertility treatment
• Prenatal care
• Abortion services, except in cases of incest, rape, or the woman’s life in danger.

There are slight differences in the scope of coverage, benefits, and exemptions from state to state. Therefore, contact your state’s Medicaid agency for full information on the specific family planning services covered in your state.

Medicaid family planning services are provided through outpatient hospitals, free-standing birthing services, Federal qualified health centers (FQHC), certified registered nurse anesthetists, local health departments and centers, nurse practitioners, physicians, pharmacies, etc.

Medicaid Family Planning Cost

In most cases, there are no costs for accessing Medicaid family planning services as long as you qualify. However, a minimal charge or copay could apply for services such as STI testing.

Medicaid Family Planning Eligibility

Medicaid family planning eligibility varies from state to state. That said, if you are enrolled in any Medicaid program, you automatically qualify for Medicaid family planning.

Over 25 states offer federal approval to extend family planning benefits to people who would otherwise not qualify for Medicaid. In 23 states, eligibility is based on your income.

The state bases the eligibility on your income compared to the federal poverty line. For example, the income limit in Mississippi is 194%, while in North Carolina, it is 195% of the federal poverty level.

Four states run an expansion program for Medicaid services to cover family planning services for people leaving the Medicaid program or who would not be eligible for Medicaid.

Generally, the basic requirement to qualify for Medicaid family planning are:

• Must be a US citizen or lawful resident
• Must be a resident of the state you are applying for coverage in
• In reproductive years. Some states have age restrictions, while others do not
• Must not be pregnant
• Income falls within the income limits stipulated in your state’s Medicaid program

In certain states, eligibility can be lost under certain circumstances. For example, in Mississippi, you can lose your Medicaid eligibility under the following circumstances:

• If you move out of the state
• If you become pregnant
• Once you reach the age of 45 years
• If you undergo a procedure to prevent you from reproducing
• If you enroll for Medicare, CHIP, or any other health insurance coverage

Medicaid Family Planning Enrollment

The enrollment process for Medicaid family planning varies slightly from state to state. However, in general, follow the following steps:

1. Confirm your eligibility. Check your state’s Medicaid agency or Medicaid website for eligibility criteria for the family planning program. Use it to determine if you are eligible.
2. Submit your application. If you are eligible, proceed to submit your application. Medicaid has no specific enrollment period; you can apply anytime throughout the year. You can submit your application online on your state’s Medicaid website, by mail, or in person at your Medicaid state agency office. Confirm with your Medicaid state agency about the preferred application submission method.
3. Provide the necessary documentation. You must provide documentation to prove your income, identity, citizenship, or residency in the United States.
4. Wait for determination. Once you have submitted your application, wait for the Medicaid agency to review it and issue a determination. You will be notified and provided information about accessing Medicaid family planning services if you qualify. Note that you are supposed to reapply for coverage each year.

Conclusion

The Medicaid family planning program is funded by the state and federal government to provide comprehensive family planning and reproductive health services to low income individuals across the US. Coverage benefits include contraception, counseling, STI testing, breast and cervical cancer screening, vasectomy and sterilization.

You do not have to be enrolled in traditional Medicaid to access family planning services. However, you must meet your state’s income limit and eligibility criteria. In all states, you must be a citizen or resident of the state in your child-bearing years. You must also not be pregnant or have undergone a procedure to ensure you cannot get pregnant.

The enrollment process is easy as long as you meet the eligibility criteria. Simply provide the relevant documentation and wait for the approval. There are no premiums payable, although low out-of-pocket costs may sometimes apply.