September 24, 2014
Conversion of Family Planning Waiver to a State Optional Medicaid Program.
Section 2303 of the Affordable Care Act (ACA) allowed North Carolina to amend the Medicaid State Plan and convert the Section 1115 Family Planning Waiver to a State Optional Medicaid Program. The Medicaid Family Planning Program continues to extend eligibility for family planning services to individuals with incomes at or below 195% of the federal poverty level. It establishes a system by which individuals can more easily access family planning services to reduce the number of unplanned pregnancies.
The purpose of this letter is to provide instructions on determining eligibility for the Medicaid Family Planning Program.
MA-2170 and MA-3265 have been removed from the manuals and replaced with a link to this letter.
Use ex parte process when re-determining eligibility at the end of the 12 month certification period. Evaluate for full Medicaid coverage prior to authorizing continued Family Planning Program (FPP).
Redeterminations are keyed in NCFAST P7.
Changes include but are not limited to changes in income, household, disability status or ability to meet a deductible. Beneficiaries should report changes within 10 days. When a change in circumstance is reported determine eligibility within 30 days.
Key an administrative application in P2/6 and complete as open/shut.
The Family Planning Program (FPP) in P7 remains open as ongoing.
Terminate Family Planning Program (FPP) in P7.
Key an administrative application into P2/6 and authorize in appropriate aid category.
At redetermination evaluate for all Medicaid programs, including medically needy.
Individuals previously determined FPW eligible as a budget unit of 1, without regard to parental income must be evaluated under MAGI budgeting methodology.
This policy is effective October 1, 2014.
If you have questions regarding this material, please contact the Operational Support Team (OST) at email@example.com.
Robin Gary Cummings, M.D.
Deputy Secretary for Health Services
Director, Division of Medical Assistance
(This information was researched and written by Pam Cooper, Policy Consultant, Medicaid Eligibility Unit).
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.