227.01 Family Planning MA Eligibility Criteria (MAM)

SR 14-04 Dated 01/14

Previous Policy

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

• net income must be less than or equal to *196% of the federal poverty guidelines;

• 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.

 *

References: He-W 509, He-W 626, RSA 126-A:4-c, Section 1902(a)(10)(A)(ii) of the Social Security Act [42 U.S.C. 1396a(a)(10)(A)(ii)]; 42 USC 1396r-1c; 42 U.S.C. 1396a(ii)(3)