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UPDATED: JUNE 2010

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OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

FAMILY PLANNING BENEFIT PROGRAM (FPBP) APPLICATION

Interpretation: Persons under the age of 21 who want to apply for family planning services only, are living with their parents, and do not have their parents' financial information complete the “Family Planning Benefit Program” application. This application is available at the LDSS, on the Internet, on the DOH website, and at an FPBP provider who has an MOU. (See INCOME FAMILY PLANNING BENEFIT PROGRAM (FPBP) BUDGETING METHODOLOGY for budgeting guidelines.) Adults who choose not to apply for Medicaid and Family Health Plus also use the Family Planning Benefit Program application.

When the applicant requests confidentiality, the applicant is instructed to write “confidential” in the margin and circle the mailing address, if different from the applicant’s residence address. However, if the application contains a different mailing address, and/or the “Yes” box is checked in answer to the question, “Do you need these services kept confidential?”, the application is treated as confidential, regardless of whether the applicant circled the mailing address or wrote “confidential” in the margin. Regular procedures regarding good cause claims must be followed.

Minors receiving Child Health Plus who have confidentiality concerns about using their Child Health Plus coverage for family planning services are allowed to enroll in FPBP, if otherwise eligible.

Medicaid and Family Health Plus recipients are not eligible for FPBP. These health care programs include family planning services.

Individuals who apply for Medicaid or Family Health Plus and are determined ineligible, have their eligibility determined for FPBP. Individuals who are financially eligible for FPBP, but who choose not to participate in FPBP, must be sent the appropriate notice to the confidential mailing address the A/R has provided if confidentiality has been requested.

(MRG)