Medicaid Family Planning Expansions
Published March 2011
Source: "Medicaid Family Planning Eligibility Expansions," Guttmacher Institute, State Policies in Brief. (Data for map updated as of March 2011.)
Expanding Eligibility for Family Planning Services under Medicaid
State Medicaid programs are required to provide coverage of family planning services to Medicaid enrollees, and the federal government pays 90 percent of the cost. Through family planning waivers, states have been able to extend family planning services to certain people who are otherwise ineligible for Medicaid; 25 states currently have such waivers. As of March 23, 2010, the Affordable Care Act permits states additional flexibility to extend family planning services by amending the state’s Medicaid plan, which eliminates the need to apply for or renew a waiver. Three states—New Mexico, South Carolina and Wisconsin—have used this option.
Family Planning Services
Family planning services are available to women (and sometimes men) and may include prescription and over‐the‐counter contraception; preconception care, including gynecological exams, contraceptive counseling, and reproductive health education; screening and treatment for sexually transmitted diseases; cervical and breast cancer screening and prevention, including the Human Papillomavirus (HPV) vaccine; and sterilization services, including tubal ligations and vasectomies. Federal funds may not be used for abortion services, except in cases of rape or incest or if the pregnant woman’s life is in danger.
Eligibility for Services Varies by State
Eligibility criteria for family planning services vary; some states determine eligibility based solely on income, ranging from 133 percent to 300 percent of the federal poverty guidelines. Other states allow an extension of coverage for family planning services to certain enrollees who no longer will qualify for Medicaid, most commonly for women who have given birth and would lose coverage soon thereafter. Generally, coverage is limited to women who are age 19 and older. However, 11 states also provide family planning benefits to men; 19 states provide coverage to those under age 19, and three of these extend coverage only to 18‐year‐olds.
Sources: National Conference of State Legislatures, 2011; Centers for Medicare and Medicaid Services, 2010; Guttmacher Institute, 2011; Kaiser Family Foundation, 2009.
Additional Resources
Health Reform and Women, Children and Adolescents
NCSL webpage
Preventing Pregnancy Among Older Teens
NCSL LegisBrief, April 2011
CMS Guidance on Section 2303 of ACA: State Eligibility Option for Family Planning Services
Centers for Medicare and Medicaid Services (CMS): Letter to State Health Officials, July 2, 2010
State Medicaid Coverage of Family Planning Services: Summary of State Survey Findings
The Kaiser Family Foundation, November 2009
Reproductive Health
Centers for Disease Control and Prevention
This webpage was adapted from an NCSL postcard published in March 2011.
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