400.20 FAMILY PLANNING WAIVER – COE-029

Family planning services are provided under an 1115 waiver operated by the Division of Medicaid for women and men, ages 13 – 44, whose household income is below the MAGI-equivalent limit of 194% FPL. Exclusions to waiver coverage include the following: • Waiver participants may not be otherwise eligible for Medicaid, CHIP, Medicare or other health insurance that includes coverage of family planning services. • Waiver participants may not have had surgery to prevent reproduction. Under the Family Planning Waiver (FPW), DOM is allowed to use non-filer household rules to construct a MAGI household if the Family Planning applicant’s filing status is unknown. In addition, applicants under the age of 19 are budgeted as a household of one with parental and other income disregarded. Applicants for waiver participation use the MS Application for Family Planning Services to enroll in the FPW. If a FPW participant becomes pregnant during her 12-month FPW enrollment period, she will be advised in writing to apply for Medicaid coverage. In addition, if claims are filed that indicate pregnancy, Family Planning will be closed and notice issued to the waiver participant that an application for Medicaid is needed. Enrollment in the FPW is for a 12-month continuous period, unless a terminating event occurs such as sterilization, coverage by other insurance, exceeding the age limit or pregnancy is indicated. In addition, terminating events for the FPW include all that apply to continuous eligibility in a child category. Family planning renewals are handled the same as MAGI renewals for both the former pregnant woman and the non-pregnant FPW participant, i.e., an Administrative Ex Parte Renewal is attempted but if one cannot be conducted, a MAGI pre-populated renewal form will be issued for the FPW participant and any other MAGI-eligible household members, if applicable. If the renewal form indicates filer status, the household is budgeted as a filer household for Family Planning.