5 Strategies for Designing a Medicaid Family Planning Program

June 09, 2023 - States can improve their Medicaid family planning programs by addressing five key areas: eligibility and enrollment, consumer outreach and education support, covered services, confidentiality, and provider access, a Manatt Health brief found.

Eligibility and enrollment design for a Medicaid family planning program may be subject to federal application and renewal requirements, depending on how a state structures its program. States must facilitate a streamlined application process and undergo ex parte renewals.

Beyond these requirements, however, states can implement a few other strategies to improve their processes and beneficiaries’ experience of the family planning program. Many states already use a family planning program application that is distinct from the Medicaid application to facilitate greater uptake among populations who are not covered through Medicaid.

To ensure quick access to Medicaid family planning services, states may build presumptive eligibility into their program designs. Individuals that apply using presumptive eligibility attest to their Medicaid eligibility and have access to family planning program services on the same day that they apply. This gives enrollees a month to complete the full application while still receiving coverage for services.

States can also change certain limitations, like increasing the income limit or extending the eligibility timeframe to a year of continuous eligibility regardless of changing circumstances. They could establish flexible household composition eligibility, permitting various combinations of household size and income sources to enable more widespread eligibility.

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These options can enlarge the pool of potential enrollees to increase uptake, and they also can better facilitate confidential applications.

For consumer outreach and education support, the federal government has established some requirements. Medicaid programs must provide notice of eligibility determinations to Medicaid applicants with certain information. They also have to offer information in multiple languages and share coverage and application information.

States can supplement these requirements with a few key strategies. They can design effective consumer-facing outreach materials in physical form and on their websites to explain details about the Medicaid family planning program and how to apply. Local partners are also key to outreach, such as social services, health departments, providers, and community based organizations.

States could also implement a Medicaid family planning program identification card that details what services the program covers. This approach could both support enrollees’ understanding of their benefits and prevent providers from delivering services that are not covered.

Unlike eligibility and enrollment or outreach and education, there are no requirements regarding specific services that a Medicaid family planning program must cover. Federal guidance states that Medicaid programs must adequately cover services to prevent or delay pregnancy or treat infertility and protect enrollees’ rights to choose their own prevention methods.

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Still, states have some leeway to get creative with their family planning programs. Some of the most effective coverage strategies include covering all FDA-identified contraceptives and services classified as family planning-related. States may also institute yearlong contraceptive dispensing limits instead of three-month or one-month limits.

Confidentiality protocols are crucial for a family planning program. Beneficiaries may experience partner violence, familial opposition, or other complex and dangerous scenarios that demand discretion.

Federal regulations have established certain standards for maintaining individuals’ privacy. However, states can go beyond these standards to protect their enrollees.

Since brochures and member-facing materials may be one of the first entry points to a family planning program, states can declare very clearly on these materials that enrollees’ right to privacy will be respected.

To prevent unwanted parties from seeing records of family planning service utilization, states can leave out family planning services utilization in the explanation of benefits. Additionally, throughout the member’s experience, states should continue to emphasize that the family planning program will not reach out to parents or guardians and will only send communications to enrollees’ requested addresses.

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Lastly, the federal government has issued certain requirements around provider access in family planning programs, but states can take additional steps to ensure enrollee access to care. The federal requirements include allowing enrollees to choose any Medicaid provider for family planning services.

One factor hampering access to family planning services is provider participation. States can simplify their provider enrollment process to increase the number of providers in their family planning programs. They can also offer provider training so that providers know how to receive reimbursement for Medicaid family planning services.

States should also update their provider locators or directories regularly. The problem of inaccurate provider directories extends outside of Medicaid, but it can present a significant barrier to accessing family planning services.

States can leverage telehealth to expand access to family planning services. Those that enacted telehealth policies during the coronavirus pandemic should transition these services into permanent status.