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As of October 1, 2018 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

  • 25 states have federal approval to extend Medicaid eligibility for family planning services to individuals who would otherwise not be eligible. (Vermont operates a similar, but entirely state-funded program for the provision of family planning services. Iowa, Missouri and Texas also operate similar programs, but exclude abortion providers from their programs.)
    • 22 states provide family planning benefits to individuals based on income; most states set the income ceiling at or near 200% of poverty. 
  • 3 states provide family planning benefits for women losing full-benefit Medicaid coverage, either when their postpartum period ends (2 states) or for any reason (1 state).
  • 19 states provide family planning benefits to men and women.
  • 21 states include individuals who are younger than 19 years of age; 1 additional state includes 18 year olds but not younger individuals.
  • 15 states operate their programs through a State Plan Amendment; 10 states operate their programs under a waiver from the federal government.
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For more information

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 Full-Benefit Coverage

Men

Individuals  <19

State Plan Amendment

Waiver

Alabama

146%†*

 

X

 

 

X

9/30/22

California

200%

 

X

X

X

 

N/A

Connecticut

263%†

 

X

X

X

 

N/A

Florida

 

For any reason

 

X

 

X

Ω

Georgia

200%*

 

 

‡

 

X

Ω

Indiana

146%†

 

X

X

X

 

N/A

IowaΨ

 

 

 

 

 

 

 

Louisiana

138%†

 

X

X

X

 

N/A

Maine

214%†

 

X

X

X

 

N/A

Maryland

200%*

 

 

X

 

X

12/31/2021

Minnesota

200%

 

X

X

X

 

 

Mississippi

199%†*

 

X

X

 

X

12/31/27

MissouriΨ

 

 

 

 

 

 

 

Montana

216%†*

 

 

 

 

X

Ω

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

X

 

N/A

Oklahoma

138%†*

 

X

X

X

 

N/A

Oregon

250%

 

X

X

 

X

12/31/2021

Pennsylvania

220%†

 

X

X

X

 

N/A

Rhode Island

 

Postpartum

 

X

 

X

12/31/18

South Carolina

199%†

 

X

X

X

 

N/A

TexasΨ

 

 

 

 

 

 

 

VermontΨ

 

 

 

 

 

 

 

Virginia

205%†*

 

X

X

X

 

N/A

Washington

260%*

 

X

X

 

X

12/31/2023

Wisconsin

306%†

 

X

X

X

 

N/A

Wyoming

 

Postpartum

 

 

 

X

Ω

TOTAL

22

3

19

21

15

10

 

*     State also extends Medicaid eligibility for family planning services to people losing full-benefit coverage after the end of the postpartum period.
†     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 Iowa, individuals with incomes up to 300% of the federal poverty line (FPL) are eligible. In Missouri and Texas, women at least 18 years of age with incomes up to 185% of the FPL are eligible. In Missouri, women losing Medicaid postpartum are also eligible. In Vermont, anyone with an income up to 200% of the FPL is eligible.

 

 

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