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Medicaid Coverage for Family Planning Services

Medicaid Coverage for Family Planning Services

Medicaid Coverage for Family Planning Services

Federal law mandates that all state Medicaid programs cover family planning services and supplies to individuals of childbearing age. While the law does not define “family planning services,” the congressional intent was to provide services to aid those who voluntarily choose not to risk an initial pregnancy as well as those families with children who desire to control family size. According to the United States Department of Health and Human Services, states are free to choose what family planning supplies and services to provide as long as they are “sufficient in amount, duration and scope to reasonably achieve their purpose.” However, states are required to provide coverage for contraceptives as family planning supplies.

To encourage Medicaid beneficiaries to take advantage of the family planning services benefit, federal law prohibits states from imposing any cost sharing mechanisms on family planning supplies or services. This means that beneficiaries do not have to make a co-payment or incur any other out-of-pocket expense in obtaining these services. In addition, Medicaid beneficiaries who are enrolled in managed care plans can obtain family planning services from any Medicaid-participating healthcare provider, whether or not the provider is part of a beneficiary’s plan.


To encourage states to make family planning services widely available, the federal government reimburses states at a rate of 90 percent for family planning services and supplies. Reimbursement rates for other Medicaid services range from 50 to 77 percent of the cost of services, depending on the per capita income of the state. Medicaid provides 90 percent reimbursement for the following family planning services and supplies: costs of counseling services and patient education; examination and treatment by medical professionals in accordance with applicable state requirements; laboratory examinations and tests; medically approved methods, procedures, pharmaceutical supplies and devices to prevent conception; and infertility services, including sterilization reversals. However, Medicaid does not provide the 90 percent matching rate to services not directly related to family planning such as a hysterectomy or treatment of an infection due to an intrauterine device.

Based on a determination that family planning services cost states much less than the costs associated with unplanned pregnancies, many states have obtained Medicaid waivers that allow the states to expand eligibility requirements for family planning services. Some state waivers provide for Medicaid-funded family planning services for a period of time after a woman gives birth. Other states have been granted waivers that raised the income-eligibility for family planning services up to the maximum level of eligibility for pregnancy-related services. In four states, waivers for Medicaid-funded family planning services allow coverage for services and supplies to men as well as women.

Copyright 2011 LexisNexis, a division of Reed Elsevier Inc.

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