Since 1972, states have been mandated to provide family planning services in their Medicaid programs. The Affordable Care Act has further expanded the number of people who can benefit from these essential services. States have the discretion to decide which services they cover under these limited-scope family planning programs, and pharmacy coverage is restricted to family planning and related services. Eligible individuals will receive a Common Benefit Identification Card (CBIC) to use when accessing covered family planning services.
Medicaid is the primary source of funding for family planning services for low-income people and is jointly funded and managed by the federal and state governments. Screening for cervical and breast cancer during a family planning visit is considered appropriate. States have considerable discretion regarding Medicaid eligibility criteria, managed care enrollment, and payment structures that also affect beneficiary coverage and access to family planning care, as well as the amount, duration, and scope of covered services. If a condition is discovered that requires treatment during an evaluation, the state must provide the services necessary to treat that condition, regardless of whether those services are included in the state Medicaid plan or not. All responding states cover screening mammograms for eligible individuals through the traditional Medicaid pathway, and most cover genetic screening (BRCA) and counseling, as well as medications to prevent or reduce the risk of breast cancer for women at higher risk. The list of preventive services recommended by these committees includes several family planning and related services, such as contraceptives approved by the FDA with a prescription, STI and HIV screening, cervical and breast cancer screening, HPV vaccine, HIV testing, healthy woman visits, and screenings for intimate partner violence.
Federal Medicaid law classifies family planning services and supplies as a “category of mandatory benefits” that states must cover. However, few states reported covering accelerated couples therapy (EPT), which is supported by the CDC as an effective method of controlling the transmission of STIs. Most states that responded to the survey have contracts with managed care organizations (MCOs) under a capitated structure to provide Medicaid services, including family planning. Prescription drug coverage is another important element of Medicaid coverage for family planning services. So does family planning cover dental? The answer is no.
While family planning covers a wide range of health care services related to reproductive health, it does not include dental care. If you need dental care, you will need to seek out other sources of coverage.