GIS 15 MA/010: Family Planning Benefit Program Changes

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) which are effective immediately.

Recent changes approved by the Centers for Medicare and Medicaid Services (CMS) require FPBP eligibility to be determined using only the applicant's income. The applicant's income is then compared to 223% of the federal poverty level for the appropriate family size. Family size continues to be determined along the lines of legal responsibility.

Districts and NY Health Options are instructed to use only the recipient's income but include all appropriate household members in the case count.

This includes renewals for:

• FPBP-only cases with only one active household member.
• Multi-member Medicaid renewals where individuals are determined income ineligible for Medicaid, are within FPBP income guidelines (223% FPL) and have indicated on the renewal they want FPBP coverage: FPBP coverage can be authorized without doing individual budgets for each household member.
• Multi-member Medicaid renewals where individuals are determined income ineligible for Medicaid and FPBP, and have indicated on the renewal they want FPBP coverage: FPBP eligibility should be determined on an individual basis. Therefore, individual budgets should be calculated for each household member,
based on the individual's own income while comparing it to the appropriate family size. As WMS can accommodate one stored budget per case, a copy of each individual's budget should be printed and filed in the case record to support and document each member's FPBP eligibility.

This GIS is a clarification of previous instructions provided during the monthly M-TAG conference calls.