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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 October 2024 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.600 24

M0330.600 PLAN FIRST - FAMILY PLANNING SERVICES

A. Policy Plan First, Virginia’s family planning services health program covers individuals who are not eligible for another full or limited-benefit Medicaid covered group or FAMIS. This optional covered group is available to individuals regardless of their age, gender, disability status, insured status or if they previously had a sterilization procedure. Plan First covers only family planning services, including transportation to receive family planning services. The income limit for Plan First is 200% FPL. Plan first is an “opt in” program effective 12/1/2024. If the applicant does not indicate whether they are opting in or out (leaves box blank) they are assumed to be opting out of Plan First. There are no specific age requirements for Plan First, so eligibility for Plan First is determined for any individual including children if the child’s parent or the individual requests an evaluation for Plan First. Individuals who are eligible for Plan First must be referred to the Federal Health Insurance Marketplace for an evaluation for the APTC, because they are not eligible for full Medicaid coverage.

If the information contained in the application indicates potential eligibility in a full-benefit Medicaid covered group (e.g., the applicant has a child under 18 in the home or alleges disability), in another limited benefit covered group (e.g., the individual has Medicare) or in FAMIS, the worker must determine whether eligibility exists in another covered group before the individual(s) can be determined eligible for Plan First. If additional information is needed to complete the eligibility determination in another Medicaid covered group, the applicant must be given the opportunity to provide the additional information needed. If the additional information is not provided by the deadline and Plan First was requested, determine the applicant’s eligibility for Plan First only. When an individual is not eligible for Medicaid in any other covered group, evaluate eligibility for Plan First if the individual has indicated on the application the desire to opt in to be evaluated for Plan First. When a Medicaid enrollee no longer meets the requirements for the current covered group, prior to cancelling coverage the individual must be evaluated in all other covered groups. If the individual is not eligible for full-benefit Medicaid coverage or as a Medicare beneficiary, eligibility for Plan First must be evaluated if the individual has indicated on the application the desire to opt in to be evaluated for Plan First.