The Family Planning Waiver program is for women and men who receive Medicaid benefits limited to family planning services and family planning related services. This includes one annual visit and subsequent visits related to their birth control methods and family planning services. Beneficiaries cannot exceed a total of four visits per federal fiscal year (Oct. 1-Sept. 30). These beneficiaries are not eligible to receive any other Medicaid benefits.
Beneficiaries certified as eligible for family planning services and family planning related services must re-certify every year to remain eligible for the family planning waiver demonstration. Loss of eligibility will occur when beneficiary:
- Moves from the state of Mississippi
- Becomes eligible for another Medicaid aid category
- Becomes pregnant
- Reaches 45 years of age
- Has a procedure performed that prevents them from reproducing
- Obtains Medicare, CHIP, or any other health insurance or third party medical coverage
- Requests that their case be closed.
The automated voice response system (AVRS) eligibility transaction response will identify these beneficiaries as eligible for family planning services only, in Medicaid Aid Category 029 (Family Planning).
Women and men who qualify will be issued a yellow Medicaid identification card to denote that they are in the Family Planning Waiver demonstration program.
The Family Planning Waiver demonstration program originally began on Oct. 1, 2003 and the program was renewed on January 1, 2015.
Who is Eligible for Family Planning?
Beneficiaries must meet the following eligibility criteria:
- Family income is at or below 194% of the federal poverty level (FPL)
- Must be capable of reproducing ages 13-44 years of age.
- Must not have had a procedure that prevents them from reproducing.
- Must not have Medicare, CHIP, or any other health insurance or third party medical coverage.
Family income must be at or below 194% of the federal poverty level (FPL).
Family Planning Waiver Resources
- Family Planning Waiver diagnosis and procedure codes
- Family Planning Waiver services application form
- Family Planning Waiver Special Terms and Conditions (STCs) approved by the Centers for Medicare and Medicaid Services
- Family Planning Waiver webinar presentation – Jan. 30, 2015
- Family Planning Waiver Demonstration 2015 Annual Report
Effective January 1, 2015, beneficiaries enrolled in the Family Planning waiver demonstration program may have a prescription for contraceptives and/or medications to treat a sexually transmitted infection (STI)/sexually transmitted disease (STD) written by any Medicaid participating provider filled at their local Medicaid participating pharmacy.