Personal tools

Issue Alert - Family Planning Program

Document Actions
Date:

Jul 11, 2006

Program Area:

Medical Assistance

Issue Summary:

More low income women will be able to receive no-cost family planning services under Michigan’s newly-approved Medicaid Family Planning waiver.

Persons Affected:

Women aged 19 through 44 who have too much income or too many assets to qualify for Medicaid, or who are not in one of the groups covered by Medicaid (i.e.. are not pregnant, a parent, or a person under age 21).

For More Information:

Center for Civil Justice 320 S. Washington, 2nd Floor Saginaw, MI 48607 (989) 755-3120, (800)724-7441 Fax: (989) 755-3558 E-mail: info@ccj-mi.org

Michigan Poverty Law Program 611 Church Street, Suite 4A Ann Arbor, MI 48104-3000 (734) 998-6100 (734) 998-9125 Fax


What's Happening?

Beginning July 1, 2006, the new Plan First! Program provides Medicaid-funded family planning services to women who cannot qualify for Medicaid because their income or assets are too high, or because they are not in one of the groups covered by Medicaid (e.g. pregnant women, parents, individuals under age 21, etc.).
To qualify for Plan First!, a woman must be:
• age 19 through 44,
• not receiving Medicaid or Adult Medical Program (AMP)/Adult Benefits Waiver (ABW) coverage,
• in a family with budgeted income below 185% of the federal poverty level,
• are residents of Michigan, meet residency requirements, and
•meet Medicaid citizenship requirements.

Men are not eligible for the Plan First! Program, nor are incarcerated women.

The Department of Community Health (DCH) Medical Services Administration (MSA) has issued policy (Bulletin MSA-06-37,available at http://www.michigan.gov/documents/MSA-06-37-Family_Planning_Waiver-FINAL_161007_7.pdf) regarding the new Plan First! family planning benefit. The Department of Human Services (DHS) policy is available at http://www.mfia.state.mi.us/olmweb/ex/pem/124.pdf ( PEM 124).

Beneficiaries receive a mihealth card and have a scope/coverage code of 1Y

Application and Eligibility Process:
The program will be administered through the Department of Community Health (DCH), by the centrally located Plan First! Unit. Final eligibility determination and redeterminations are the responsibility of the Plan First! Unit. A simplified application form,MSA-1582, Plan First! Family Planning Program, has been developed to apply for this program.

Women may apply by mail or fax, or submit the application in-person at their local DHS office.

Benefit/Coverage:
Plan First covers
• office visits for family planning
• contraceptives
• contraceptive supplies and devices for voluntarily delaying or preventing pregnancy
• laboratory testing and pharmaceuticals related to contraception or initial treatment of sexually transmitted infections
• sterilizations, for the purpose of rendering a female beneficiary permanently sterile, completed in accordance with Medicaid policy

There are no co-pays. Some contraceptives and supplies can be dispensed or provided for multiple months.

Coverage begins the first day of the month in which the application is received by DHS, if the applicant is eligible.

Among other things, Plan First does not cover abortions, fertility treatment, and inpatient hospital services.

Income eligibility:
Once eligible, eligibility continues until redetermination unless the person:
•Reaches age 45 or
•Moves out of state, or
•Is ineligible due to Institutional Status (PEM 265), or
•Dies.

Immigration status:
The client must be a U.S. citizen or have acceptable alien status. Persons whose alien status limits them to emergency services under Medicaid do NOT have acceptable status. See PEM 225

What Should Advocates Do?

Share information about Plan First! with clients and agencies.

What Should Clients Do?

Women who need help paying for family planning but have been denied Medicaid and/or AMP/ABW should apply for the Plan First! program. Seek legal advice if you are denied.

Finding Help

Most legal aid and legal services offices handle these types of cases, and they do not charge a fee.

You can locate various sources of legal and related services, including the free legal aid office that serves your county, at MichiganLegalAid.org.

You can also look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.