Family Planning Services
Plan First! is Michigan’s Section 1115 Demonstration Waiver for family planning services. Plan First! covers women of child bearing years (ages 19 through 44) who are not eligible for Medicaid and whose other insurance does not cover family planning services, and whose income level is at or below 185 percent of the Federal Poverty Level (FPL).
Plan First! Waiver coverage has been extended until further notice for beneficiaries who:
- Were enrolled in Plan First! on April 1, 2014, or may have been enrolled in Plan First! after April 1, 2014, and
- Have not been determined eligible for comprehensive health care coverage
New enrollments into Plan First! are no longer accepted. Under the Affordable Care Act (ACA), women currently enrolled in Plan First! must apply for comprehensive health care coverage under the Healthy Michigan Plan or through other options on the Federally Facilitated Marketplace.
MDCH and the Department of Human Services are working to restore the Plan First! eligibility information for a limited time period within the MI Bridges eligibility system and the Community Health Automated Medicaid Processing System (CHAMPS) eligibility inquiry. Until this information is restored, beneficiary letter B-14-35 will show proof of Plan First! coverage.
Through this waiver, MDCH offers family planning services to women:
19 through 44 years of age
Who are not currently Medicaid eligible
- Who have family income at or below 185% of the federal proverty level (FPL). DHS will determine eligibilty for this program
Who reside in Michigan
Meet Medicaid citizenship requirements
A woman's coverage will continue for the duration of the waiver as long as the eligibility criteria are met. Program determinations will be completed annually. Family planning services are defined as any medically approved means, including diagnostic evaluation, pharmaceuticals, and supplies, for voluntarily preventing or delaying pregnancy.
There are no patient co-pays for family planning services, supplies or pharmaceuticals. Services covered under this waiver include:
Initial physical exam and health history, including patient education and counseling relating to reproductive health and family planning options;
Annual physical examination for reproductive health/family planning purposes, including a pap smear and testing for sexually transmitted infections when indicated;
Brief and intermediate follow-up office visit related to family planning;
Necessary family planning/reproductive health-related laboratory procedures and diagnostic tests;
Contraceptive management, including drugs and supplies;
Insertion, implant or injection of contraceptive drugs or devices;
Removal of contraceptive devices;
Sterilization services and related laboratory services (as long as a properly completed sterilization consent form has been submitted); and
Medications required incidental to or as part of a procedure done for family planning purposes.
The Family Planning service benefit will not include coverage of abortions or treatment of infertility.
Click here for a list of covered Plan First! Family Planning codes.
Service Delivery System
Professional services related to family planning are available from and billed to MDCH by family planning clinics, primary care physicians (MDs and DOs) in public and private practice, and other Medicaid approved providers, i.e., Certified Nurse Midwives and Nurse Practitioners. In addition, Medicaid enrolled pharmacies, laboratories and outpatient hospitals are eligible to provide and bill for services, as appropriate. Federally Qualified Health Centers (FQHC), School-Based/Linked Health Centers, Rural Health Clinics (RHC), Tribal Health Centers and the sub-grantees of the Title X publicly funded family planning agencies (including local health departments, Planned Parenthood clinics and private non-profit family planning agencies) provide and bill for services as well. Family planning services are available statewide.
Access to Primary Care Services
Should a beneficiary need primary care services beyond what is covered under Plan First!, the provider may either provide the services and work with a beneficiary to arrange payment options or they may refer or inform them how to access primary care services at the nearest FQHC. Click Here for a list of FQHC's in Michigan.