What are the Medicaid family planning benefits?
Family planning is a key component of health care for all people of reproductive age. And fortunately, all state Medicaid programs must offer some form of family planning benefits. Benefits vary by state, but health care providers and pharmacies may not charge for family planning care. More good news? The federal government matches family planning contributions at a much higher rate than other forms of health care covered under Medicaid. This means that states are more incentivized to expand their coverage for family planning services. And this is true even for those who may not have been covered under Medicaid otherwise. This means more people can ensure they’re getting the care they need to grow their families on their own timelines.
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.
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Contraception and sterilization
Contraception is one of the primary services in all family planning programs. Most states offer very broad coverage for FDA-approved prescription contraceptives (birth control) in their Medicaid programs. This includes oral contraceptives (aka birth control pills), long-acting reversible contraception (LARCs) like implants and intrauterine devices (IUDs). Some states may even cover the placement of a postpartum IUD, inserted after childbirth. Likewise, some states may also cover over-the-counter emergency contraception. Typically, Medicaid covers at least one form of prescription emergency contraception. This is usually true of all state Medicaid programs.
In some states, Medicaid family planning benefits might even cover vasectomies. Most Medicaid programs also pay for sterilization for women. According to federal law, a women must wait for thirty days between when she signs a consent form for a sterilization procedure and when the procedure may actually be performed.
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 (STIs) 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.
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 state’s program. In most states, if you are You can see if you’re eligible and apply for Medicaid here.
Some states also have what’s 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 (ACA), 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.
Right now, 26 states have federal approval to extend Medicaid eligibility for family planning benefits for those who would not otherwise qualify for Medicaid. Four states also run their own, fully state-funded programs for the expansion of Medicaid for family planning services. 23 states provide family planning benefits based on income, with most states setting their eligibility ceiling at 200% of the federal poverty line. Two states provide family planning eligibility for those losing Medicaid eligibility in the postpartum period. And one state provides family planning benefits for those losing Medicaid eligibility for any reason.
How can I apply for Medicaid family planning benefits?
You can apply for Medicaid family planning benefits even if you don’t otherwise qualify for Medicaid by contacting your state’s Medicaid agency. You can then request an application for family planning benefits and see if you might qualify for coverage.