Family Planning Services
Federal law requires states to provide family planning services and supplies to Categorically Needy Medicaid beneficiaries of childbearing age, including minors who can be considered sexually active, if such services and supplies are desired and requested; such services are an optional coverage for a state's Medically Needy population but are universally covered. To encourage coverage of family planning services, the Federal Medical Assistance Percentage (matching rate) is 90 percent, i.e., for every dollar that a state pays for a family planning service, it may claim ninety cents in federal Medicaid funds.

Family planning services are not precisely defined in federal law or regulations. However, most states have established coverage policies intended to aid beneficiaries who voluntarily choose not to risk an initial pregnancy and to help families with children who desire to control family size. Accordingly, covered services generally include examination and treatment by medical professionals in accordance with applicable state requirements; medically appropriate laboratory examinations and tests; counseling services and patient education; and medically approved methods, procedures, pharmaceutical supplies and devices to prevent conception. Several states have, however, established frequency limits for some of these services and/or have limited the types of contraceptive supplies and devices covered. And, while infertility services, including sterilization reversals, are eligible for the enhanced matching rate, such services are rarely covered by states. Abortions may not be claimed as a family planning service.
States are precluded, by federal law, from requiring a copayment for any family planning service.

By their nature, family planning services may be provided by a number of different providers, e.g., physicians, physician assistants, or nurse practitioners, in their offices, or in a medical or family planning clinic, or in an outpatient hospital setting. Contraceptive supplies may be provided, through prescription, by pharmacies, or may be dispensed by the medical practitioner. As such, there is no specific coverage policy or reimbursement methodology for family planning services. Instead, the policy and reimbursement methodology applicable to the provider rendering the particular service would be used. The reader is referred to the tables for the aforementioned providers.

Not shown on the tables but worthy of mention is the fact that several states have received approved Section 1115 Waivers from CMS under which family planning services are made available to women, and in some cases men, who have income above the threshold for coverage through either a mandatory or optional Medicaid eligibility category. Beneficiaries covered under these waivers are eligible for family planning services alone; they do not receive other Medicaid services although a condition of the waiver is that referrals for primary care services be assured. As of October 2004, 19 states had received waiver approval (Alabama, Arizona, Arkansas, California, Delaware, Florida, Illinois, Maryland, Minnesota, Mississippi, Missouri, New Mexico, New York, Oregon, Rhode Island, South Carolina, Virginia, Washington and Wisconsin).