Adult Medicaid Change Notices

A. Allow affected women and men the opportunity to choose if and when to have children;

B. Provide comprehensive reproductive health care for low-income women and men who otherwise do not have access to such services; and

C. Improve the well being of children and families in North Carolina.

A. APPLICATION

B. PRINCIPLES

C. MEDICAID TERMINATIONS AND DENIALS

D. ELIGIBILITY AND PROCESSING

CHANGE NOTICE FOR MANUAL NO. 22-05, MEDICAID FAMILY PLANNING WAIVER

DATE: AUGUST 8, 2005

Manual: Aged, Blind, and Disabled

Change No: 22-05

To: County Directors of Social Services

Effective: October 1, 2005

I. BACKGROUND

North Carolina has received approval to implement a Medicaid waiver program targeting family planning services only. The Family Planning Waiver is a 5 year demonstration waiver that intends to reduce unintended pregnancies and improve the well being of children and families in North Carolina by offering family planning services. The name of this waiver program is the “Be Smart” program.

The 1998 Pregnancy Risk Assessment Monitoring System (PRAMS) data indicate that 44% of women report their pregnancy was unintended. In addition, North Carolina has one of the highest infant mortality rates in the nation. By helping women to time and space their pregnancies, appropriate contraceptive use may help avoid adverse health, social and economic consequences associated with unintended pregnancies.

The target population for the Family Planning waiver is

• women age 19 through 55 and men age 19 through 60 and

• with income at or below 185% of the federal poverty level.

Medicaid eligibility for family planning services to men and women will:

A. Allow affected women and men the opportunity to choose if and when to have children;

B. Provide comprehensive reproductive health care for low-income women and men who otherwise do not have access to such services; and

C. Improve the well being of children and families in North Carolina.

II. HIGHLIGHTS OF POLICY

A. APPLICATION

The DMA-5063, Health Check/NC Health Choice for Children Application, is the primary application used to apply for this program. Any adult application or redetermination form may also be used to apply for family planning services.

B. PRINCIPLES

The Income Maintenance Caseworker (IMC) must evaluate for Medicaid Family Planning Waiver (FPW) if the applicant/recipient is ineligible for other Medicaid programs. Both women and men can apply. Individuals age 19 and over will be covered under this program.

C. MEDICAID TERMINATIONS AND DENIALS

Before denying an application, evaluate for FPW. At every Medicaid (Adult and F & C) termination, evaluate for FPW.

D. ELIGIBILITY AND PROCESSING

See the Family & Children’s Medicaid Manual Section MA-3265, Medicaid Family Planning Waiver, for eligibility and processing requirements.

III. EFFECTIVE DATE AND IMPLEMENTATION

This policy is effective October 1, 2005. Apply this policy to redeterminations started and applications taken on or after October 1, 2005. Do not apply this policy to any pending applications or redeterminations.

Applications for FPW will be accepted beginning 10-01-05. Retroactive eligibility can begin no earlier than 10-01-05.

IV. MAINTENANCE OF MANUAL

Insert MA-2170, Family Planning Waiver, page 1, effective October 1, 2005. Refer to Family and Children’s Manual Change Notice Number 18-05 and MA-3265, Medicaid Family Planning Waiver for requirements.

If you have any questions regarding this information, please contact your Medicaid Program Representative.

L. Allen Dobson, Jr.,M.D., Assistant Secretary

for Health Policy and Medical Assistance

(This material was researched and written by Susan Ryan, Policy Consultant, Medicaid Eligibility Unit.)