GIS 12 MA/030: Changes to the Family Planning Benefit Program and the Family Planning Extension Program
To: Local District Commissioners, Medicaid Directors
From: Judith Arnold, Director - Division of Health Care Reform and Health Insurance Exchange Integration
Subject: Changes to the Family Planning Benefit Program and the Family Planning Extension Program
Effective Date: November 1, 2012
The purpose of this General Information System (GIS) message is to advise local departments of social services (LDSS) of changes to the Family Planning Benefit Program (FPBP) and the Family Planning Extension Program (FPEP). The changes include moving the authority for the FPBP from the 1115 Partnership Plan Waiver to the Medicaid State Plan, implementation of Presumptive Eligibility for the FPBP, and the inclusion of the FPEP into WMS and eMedNY.
The Affordable Care Act (ACA) of 2010 allows states to amend their Medicaid State Plans to include authorization for the Family Planning Benefit Program and to allow Medicaid enrolled family planning providers to screen individuals for presumptive eligibility (PE) for FPBP covered services.
FPBP as a Medicaid State Plan Service
There are three changes associated with the FPBP becoming a Medicaid State Plan service. Currently, the FPBP is limited to individuals who are age 10 through 64. Effective November 1, 2012, the age limits in WMS will be eliminated. The second change is the addition of transportation services to the benefit package for FPBP. Transportation is covered to the same extent that it is covered for fully eligible individuals. This includes utilizing the same request and prior approval process. Lastly, retroactive FPBP coverage for up to 3 months prior to the FPBP application date will be available as of November 1, 2012, if the individual is eligible for that retroactive period.
Note: The FPBP funding remains unchanged. Shares continue to be 90 percent Federal, 10 percent State and 0 percent Local.
Presumptive Eligibility for FPBP
Effective November 1, 2012, Presumptive Eligibility (PE) for the FPBP will be included in the Medicaid State Plan. Under PE for the FPBP, individuals will have the opportunity to be screened presumptively eligible for FPBP at a Medicaid enrolled and trained Family Planning Provider who has signed a Memorandum of Understanding (MOU) with the New York State Department of Health (the Department). Presumptive Eligibility provides an individual immediate access to FPBP covered services and assures that the provider will be reimbursed by Medicaid for services, supplies and treatment provided.
