Improve Access - Add or Expand Medicaid Family Planning Coverage

ICAN! guides states to implement and enhance Medicaid Family Planning Programs.

Equitable access to high quality preventive and primary care–including basic birth control–remains out of reach for millions of people.

At the same time, Community Health Centers (CHCs) that provide essential prenatal, postpartum, and family planning care for the most underserved communities are struggling in part due to birthing hospital closures and revenue loss due to Medicaid unwinding.

Medicaid Family Planning Programs are established through permanent State Plan Amendments (SPAs) or temporary 1115 Waivers also known as “demonstration projects”. These limited eligibility programs allow people who are not eligible for full Medicaid coverage to access benefits for specified family planning and related services, which under the federal medical assistance percentages (FMAP), are covered at 90%, leaving the state responsible for just 10% of the cost.

These programs can help improve access to essential sexual and reproductive healthcare services for the most vulnerable communities and provide more robust and predictable funding for health centers.

Robust and inclusive Family Planning SPAs and Waivers can:

Significantly reduce or eliminate the contraceptive coverage gap in your state.
Build on the momentum to care for mothers postpartum (at “12 months and 1 day”) and across the reproductive health lifespan.
Provide primary care providers a path for reimbursement of family planning services and accountability for delivery of high-quality, person-centered care.

Has your state expanded Medicaid coverage for family planning?

Interested in learning how your state can strengthen its Family Planning SPA or waiver? Interested in developing a new SPA or waiver? ICAN! can help!

Family Planning Eligibility Expansions

Yes, Medicaid State Plan Amendment (SPA)
Yes, Medicaid 1115 Waiver
Pending Medicaid 1115 Waiver
State-funded program
Not yet

What does a model Medicaid Family Planning Program look like?

Comprehensive

Covers all FDA-approved birth control methods, STD/STI testing and treatment, HIV prevention (PEP and PrEP), and many preventive services (e.g. pap and mammogram).

Flexible

Auto-enrollment for Medicaid applicants ineligible for full benefits.

Equitable

Income eligibility supports parity with Medicaid programs for pregnant people. Coverage is open to all genders and ages and based on individual, rather than household income.

Confidential

Open to individuals with existing insurance who have confidentiality concerns.

Timely

Includes Family Planning Presumptive Eligibility (FPPE) for immediate, temporary coverage that allows providers to deliver same-day services.

Case Study

Learn how ICAN! advanced and implemented a model, reproductive justice-aligned SPA in Illinois.

Download the Illinois Case Study

"The ICAN! team have been tremendous partners as we work to implement [Illinois' new Medicaid] Family Planning Program."

“The ICAN! team have been tremendous partners as we work to implement [Illinois’ new Medicaid] Family Planning Program. ICAN!’s outreach to providers across the state has ensured that hundreds of sites have registered as Family Planning Presumptive Eligibility providers within the first year of our roll out. Their ongoing outreach, training, and technical assistance have been critical to raising the awareness of this expansive new program among health and social service providers throughout Illinois. We have joined and co-facilitated numerous ICAN! trainings and their presentations are thoughtfully crafted with actionable information.

In addition, ICAN! is leading the efforts statewide to reach people newly eligible for coverage under the Family Planning Program through a robust public education campaign informed by community voices. ICAN! has surfaced sound recommendations for how we can optimize enrollment procedures and make them less complicated so that everyone who is eligible is able to access this coverage.”

– Director at Illinois Medicaid

Commons Challenges to Effective Medicaid Family Planning Programs

Your program’s scope of coverage is limited.

There may only be a few covered services and eligibility may be limited by gender, age, and income level.

ICAN! can help by:

Improve coverage for vulnerable populations (e.g., immigrants, youth, LGBTQ+, etc.).
Analyze fee schedules to maximize scope of coverage.
Support navigation of CMS guidelines.

Few people are enrolled in coverage.

30 states have Family Planning SPAs and waivers on the books; just 4 have enrolled > 50% of the eligible population.

ICAN! can help by:

Determine pathway for immediate coverage.
Propose solutions for auto-enrollment and redetermination.

Safety-net providers have not been supported to operationalize the program.

Few resources beyond a "provider notice" have been deployed to alert providers to cover services, elegibility requirements, and billing and enrollment procedures.

ICAN! can help by:

Raise provider awareness of Family Planning Programs in partnership with Primary Care Associations, public health departments, and Perinatal Quality Collaboratives.
Facilitate training for community health providers on enrollment and service utilization.
Facilitate training for social service providers (e.g., case managers, home visitors, community health workers, etc.) focused on screening, enrollment, and/or referrals to enrollment sites.

People who are eligible for coverage don't know the program exists.

Few patient-centered resources and tools exist to raise awareness of benefits and to connect patients to enrollment support.

ICAN! can help by:

Support omnichannel evidence-informed and culturally affirming marketing campaigns responsive to the needs of people who fall into the contraceptive coverage gap.
Develop a direct-to-consumer platform that simplifies the complexities of healthcare coverage.