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Very young adolescents’ sexual and reproductive health needs must be addressed
As of June 1, 2017 State Laws and Policies

Medicaid Family Planning Eligibility Expansions

Background

Since the mid-1990s, many states have expanded eligibility for Medicaid coverage of family planning services. Historically, states have expanded their programs by securing approval of a "waiver" of federal policy from the Centers for Medicare and Medicaid Services. Most of the expansion states grant coverage for family planning solely on the basis of income to individuals not previously covered under Medicaid. A handful of states have received federal approval for more limited expansions that continue coverage for family planning for individuals who are leaving the Medicaid program. The passage of health care reform gave states a new and more expeditious option for expanding eligibility for family planning. Under this law, states may expand their programs by amending their state Medicaid plan. Unlike a waiver, which is time-limited, a State Plan Amendment is a permanent change to the state’s Medicaid program.

Highlights

  • 26 states have federal approval to extend Medicaid eligibility for family planning services to individuals who would otherwise not be eligible. (Texas operates a similar, but entirely state-funded, program that provides family planning services to women at least 18 years of age with incomes up to 185% of the federal poverty line.)
    • 23 states provide family planning benefits to individuals based on income; most states set the income ceiling at or near 200% of poverty. 
    • 1 state provides family planning benefits for women losing Medicaid for any reason.
    • 2 states have extended eligibility for family planning services to women losing Medicaid postpartum.
  • 20 states provide family planning benefits to men and women.
  • 21 states include individuals who are younger than 19 years of age; 2 additional states include 18 year olds but not younger individuals.
  • 11 states operate their programs under a waiver from the federal government; 15 states operate their programs through a State Plan Amendment.
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Topic

United States

Geography

Medicaid Family Planning Eligibility Expansions

STATE

BASIS FOR ELIGIBILITY

ELIGIBLE POPULATION INCLUDES

ORGANIZED AS A:

WAIVER EXPIRATION DATE

Based Solely on Income

Losing Coverage for Any Reason

Losing Coverage Postpartum

Men

Individuals  <19

State Plan Amendment

Waiver

Alabama

146%†​

 

*

X

 

 

X

12/31/17

California

200%

 

 

X

X

X

 

N/A

Connecticut

 263%†

 

 

X

X

X

 

N/A

Florida

 

2 years

 

 

X

 

X

12/31/17

Georgia

200%

 

*

 

‡

 

X

Ω

Indiana

 146%†​

 

 

X

X

X

 

N/A

Iowa

300%

 

*

X

X

 

X

12/31/19

Louisiana

 138%†​

 

 

X

X

X

 

N/A

Maine

214%†​

 

 

X

X

X

 

N/A

Maryland

200%

 

*

 

X

 

X

12/31/21

Minnesota

200%

 

 

X

X

 X

 

 

Mississippi

199%†

 

*

X

X

 

X

12/31/17

MissouriΨ

 

 

 

 

 

 

 

 

Montana

216%†

 

*

 

 

 

X

12/31/17

New Hampshire

 201%†

 

 

X

X

X

 

N/A

New Mexico

 255%†

 

 

X

X

X

 

N/A

New York

 223%†

 

*

X

X

X

 

N/A

North Carolina

 200%†

 

 

X

 

X

 

N/A

Oklahoma

 138%†

 

*

X

X

X

 

N/A

Oregon

250%

 

 

X

X

 

X

12/31/21

Pennsylvania

220%†

 

 

X

X

X

 

N/A

Rhode Island

 

 

Unlimited

 

X

 

X

12/31/18

South Carolina

 199%†

 

 

X

X

X

 

N/A

TexasΨ

 

 

 

 

 

 

 

 

VermontΨ

 

 

 

 

 

 

 

 

Virginia

 205%†

 

*

X

X

X

 

N/A

Washington

250%

 

*

X

X

 

X

12/31/17

Wisconsin

 306%†

 

 

X

X

X

 

N/A

Wyoming

 

 

Unlimited

 

 

 

X

12/31/17

TOTAL

23

1

2

20

21

15

11

 

*     State also extends Medicaid eligibility for family planning services to these individuals.
†    This eligibility ceiling includes a standard "disregard" to an applicant's income equal to five percentage points of the federal poverty level.
‡     Includes 18 year olds but not younger individuals.
Ω    This state is currently seeking an extension for this waiver.
Ψ    The state operates an entirely state-funded program to provide family planning services. In Missouri and Texas, women at least 18 years of age with incomes up to 185% of the federal poverty line are eligible. In Missouri, women losing Medicaid postpartum are also eligible. In Vermont, anyone with an income up to 200% of the federal poverty line is eligible.

 

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