Medicaid Coverage of Family Planning Benefits: Results from a State Survey

Family Planning Support Services

Key Finding: Family Planning Support Services
There is broad coverage for some family planning-related services such as counseling and well woman visits, but considerably fewer states reported they cover screenings for intimate partner violence.

Family planning services are an integral component of comprehensive primary, preventive, and sexual health care. The survey asked states about their coverage policies for family planning support services including contraceptive counseling, contraceptive follow-up and side effects management, well woman visits and check-ups, and intimate partner violence (IPV) screening. Nearly all states indicated that they cover support services, but this varied across eligibility pathways (coverage is required for ACA expansion programs), and some states indicated the service is not separately reimbursable, but is a component of some other type of office visit.

Coverage across Eligibility Pathways

Six states noted that contraceptive counseling is provided as a component of an office visit and is not separately reimbursable: Alaska, Alabama, Connecticut, Washington and West Virginia indicated the service is a component of a clinic or office visit and Georgia noted the service is a component of a family planning visit. In 2012, Illinois implemented a special initiative to pay an enhanced rate for family planning counseling services to select providers that have a family planning focus.

Coverage varied considerably across eligibility pathways for IPV screening (Table 15). Of the responding states with a family planning waiver or SPA, 16 out of 23 cover IPV screening. Nine states noted that intimate partner violence screening would be included in the context of other types of office visits or services. Maryland, Missouri, New Mexico, Virginia and Wyoming do not cover IPV screening in either their family planning waiver/SPA or in their traditional Medicaid program.

Limitations and Utilization Controls

A few states reported utilization controls for family planning support services. North Carolina allows one annual visit and six follow up exams for contraceptive counseling and follow up in its family planning waiver. Well woman visits are limited to one annual exam per year and IPV screening is left to the discretion of the provider. Alabama allows one initial visit, one annual visit and four periodic visits for contraceptive side effects management and for well woman visits. Contraceptive counseling is considered a component of these visits. The state also covers IPV screening for family planning waiver recipients receiving care coordination (not available under traditional Medicaid). Ohio provides one well woman or checkup visit per year.

Table 15: Coverage for Family Planning Services
  Traditional Medicaid
Family Planning Waiver/SPA
Covered as a component
of an office visit or other service
Not Covered in Either Program
Contraceptive Counseling 40 22 6 MD
Follow-up Visit/Side Effects Management 41 22 1
Well Woman Visits/Check-ups 41 22 4
Intimate Partner Violence Screening 35 16 9* MD, MO, NM, VA, WY
NOTES: *West Virginia’s Right from the Start program assesses each prenatal and infant client for partner or household violence. The state requires that the screening happen once, but the Designated Care Coordinator (DCC) is free to complete the assessment for partner violence at any time it is felt necessary. Service is billed under care coordination. The state also noted that screening is a component of a mental health assessment.
Alabama provides screening under its care coordination benefit for family planning recipients.
Oregon provides the service in its family planning waiver in the context of a contraceptive management visit. Connecticut, Illinois, Michigan, Montana, and Washington report that the service is provided with a clinic or routine office visit. Georgia noted the service is a component of a family planning visit.
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