DATE: OCTOBER 18, 2008
Manual: Family and Children’s Medicaid
Change No: 12-08
To: County Directors of Social Services
Effective: November 1, 2008
The Medicaid Family Planning Waiver (FPW) Program provides coverage of family planning services for women ages 19-55 or men ages 19-60 if they have not had a medical procedure to prevent them from having a baby or fathering a baby. Services include, but are not limited to: an annual physical examination, birth control methods, pregnancy tests, pap tests, screening for sexually transmitted infections (STIs) and voluntary sterilizations for women and men.
In order to evaluate for FPW the DMA-5063A, Medicaid Family Planning Waiver (FPW) Addendum, must be completed. The DMA-5063A has been revised effective November 1, 2008.
This policy is effective November 1, 2008. Use the DMA-5063A with a revision date of 11/01/08 for all applications/redeterminations taken on or after November 1, 2008. Use the new form with applications/redeterminations in process on November 1, 2008, unless the previous version of the DMA-5063A has already been completed.
If you have any questions regarding this information, please contact your Medicaid Program
Representative. For any other issues that are not able to be handled through that venue, Mrs.
Angela Floyd, Assistant Director for Recipient and Provider Services, will be your point of
contact and can be reached at (919) 855-4000.
Tara R. Larson, Acting Director
(This material was researched and written by Sandi Morrow, Medicaid Policy Consultant, Medicaid Eligibility Unit.)
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.