On March 1, 2006, the Centers for Medicare and Medicaid Services (CMS) approved Michigan's submission of a Section 1115 demonstration waiver to provide family planning services to Michigan citizens meeting certain eligibility requirements.

The demonstration waiver is approved for five (5) years with an implementation date of July 1, 2006. This program enables the Michigan Department of Community Health (MDCH) to provide family planning services to women who otherwise would not have medical coverage for these services. 

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

It is estimated that at least 200,000 women may meet this criteria. Beneficiary applications are available at local health departments, local Department of Human Services (DHS) offices and Title X clinics.  For more information providers may call 1-800-292-2550.

Covered Services

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.

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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. 
 

Paper Application and Brochure

Application   and  Brochure    (Printer Friendly)

The paper MSA-1582 form, when completed, can be either mailed or faxed to the DHS central office for processing.  The central office address and fax number are found on the last page of the application and are found on the brochure.

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