222.01 Family Planning MA Eligibility Criteria SR 13-30, 07/13 (FAM-A)

All general, categorical, technical, and financial factors related to the determination of categorically-needy medical assistance applies to Family planning medical assistance (MA). To be eligible for Family Planning MA:

• net income must be less than or equal to 185% of the federal poverty guidelines. See Section 222.05, Family Planning MA Income Requirements, for more information;

• if female, the individual cannot be pregnant; and

• individuals cannot already be Medicaid recipients.

- If the individual has applied for another category of Medicaid but has not yet been determined eligible for that program, the individual may receive Family Planning MA, if eligible and the individual applies for Family Planning MA, while the eligibility determination is pending for this other category of assistance. Once the individual opens for the other category of Medicaid, however, the individual is no longer eligible for Family Planning MA.

- Similarly, if an applicant is in a spenddown status for any category of In and Out medical assistance, meaning the individual has not yet opened for Medicaid, the individual may receive Family Planning MA during the spenddown period, if eligible and the individual applies for Family Planning MA. Once the individual opens for Medicaid, however, the individual is no longer eligible for Family Planning MA.

- Individuals may receive Family Planning MA, if eligible and the individual applies for Family Planning MA, while also concurrently receiving QMB or SLMB.

Additional Non-Financial Eligibility-related requirements

• There is no resource test associated with Family Planning MA.

• Both males and females are eligible for Family Planning MA and there is no age requirement, however family planning and family planning-related services are only available to eligible individuals who have reached reproductive maturity.

• Family Planning MA applicants are entitled to retroactive medical assistance, if eligible, but In and Out medical assistance is not available.

• Qualified entities who have been trained by DHHS may make presumptive eligibility decisions for Family Planning MA. See Section 131.01, Presumptive Eligibility, for more information.