Birthing Options Program
Family Planning Waiver FAQs
- What services are covered?
- Why was the doctor or lab not reimbursed and why is the client being billed?
What is the Family Planning Waiver?
The Family Planning Waiver extends Medicaid eligibility for family planning services for a twelve month period to all women aged 18 through 50 living in a household with income at or below 185% of the federal poverty level.Please see Federal Poverty Levels for current federal poverty levels. Women who have other insurance,or who have had a sterilization procedure performed prior to application for the Family Planning Waiver,are not eligible for services under the waiver.
How do I apply?
Application for the Family Planning Waiver is made through the Income Support Division county office.
What services are covered?
Family planning services are those services provided to prevent or delay pregnancy or to otherwise control family size. Counseling services, laboratory tests, medical procedures and pharmaceutical supplies and devices are covered if provided for family planning purposes. Birth control supplies and devices, sterilizations (such as tubal ligations) and regular reproductive health exams/screenings (pap smears and sexually transmitted disease screens) are covered if performed in a family planning context. If a routinely performed screening test indicates that the client has a medical condition/problem, which requires treatment, then such treatment would not be covered. Hysterectomies or medically induced/performed abortions are not family planning services. Treatment of infertility and mammograms are not family planning services.
Why was the doctor or lab not reimbursed and why is the client being billed?
The claims submitted by the doctor or lab may have had an incorrect procedure code or an incorrect diagnosis code. The client is not responsible for the bill unless the client was told prior to the service being rendered that the procedure/service would not be covered under the Family Planning Waiver.