Family Planning Only

What services are covered?

Family Planning Only covers:

• One comprehensive preventive family planning visit every year (365 days) and any necessary family planning-related follow-up visits.
• Counseling, education, and/or risk reduction.
• Education and supplies for Food and Drug Administration (FDA) approved contraceptives, natural family planning, and/or abstinence.
• Permanent methods such as tubal ligations (tubes tied), hysteroscopic sterilization, or vasectomy.
• When appropriate, pregnancy testing and cervical cancer screening.
• Sexually transmitted infection screening, testing, and treatment, when clinically appropriate, according to nationally recognized guidelines, or medically necessary for safe and effective use of the client’s chosen contraceptive method.
• Human papillomavirus (HPV) and Hepatitis B vaccinations.

For more details on coverage, see the Family Planning billing guide.

How do clients apply?

For details on Family Planning Only for clients, visit the Family Planning Only client webpage. To assist your patients in applying, share the Family Planning Only client brochure (available in multiple languages). Apple Health can be applied for anytime throughout the year.

To aid clients seeking contraceptive choices, share the over the counter birth control options for Apple Health (Medicaid) flyer, available in English and Spanish.

What does it mean to apply for confidential services?

Clients have the option to select that they are seeking confidential family planning services when applying for Family Planning Only coverage. Selecting this will put them under a protected status where they:

• Choose a preferred mailing address,
• Don’t have Exploration of Benefits (EOB) mailed to them, and
• Are routed to a live person instead of an automated system when they call in.

How do I enroll as a provider?

To learn more about provider enrollment, determine eligibility, or revalidate, visit the Become an Apple Health provider page.

Is there provider training?

HCA will continue to update materials and host presentations for providers, patient navigators or assisters, billing staff, or anyone who works with the family planning programs. We will also host FPO office hours to address questions or concerns. See dates, times, and registration links below.

If you would like to request a specific training or program presentation, email HCA Family Planning Only.

FPO office hours

Presentations and materials

Frequently asked questions

What sets eligibility for family planning programs apart from other programs?

There are a few key differences:

• Income eligibility thresholds are higher, up to 260% of FPL and who are not otherwise enrolled in Apple Health or CHIP.
• Teens and victims of intimate partner violence who need confidential family planning services.
• Those who are undocumented can receive coverage under the state-funded program.

Are those who identify as males eligible?

Yes. Gender is not a factor in determining eligibility.

Will changes to the Family Planning Only programs cause changes to RAC codes or ACES program codes assigned to these programs?

Changes to the Family Planning Only programs will not cause any changes to RAC codes or ACES program codes.

What is a qualified immigrant?

Qualified immigrants are those who are lawfully permitted to remain in the U.S. See the citizenship and immigration status guide for details.

How do I know which drugs are covered, including over the counter drugs?

Visit the Pharmacy page to learn about Apple Health pharmacy and prescription drugs, including how Apple Health (including FPO) pays for over the counter birth control products.

What is the Shield Law and how does it protect reproductive and gender-affirming care?

Washington’s Shield Law, enacted in 2023, protects people in Washington from civil and criminal actions in other states that restrict or criminalize reproductive and gender-affirming care. Please read the Reproductive and Gender-Affirming Care: Shielding Providers, Seekers, and Helpers from Out-of-State Legal Actions by the Washington Office of the Attorney General.

Waiver authority for the program

Section 1115 Family Planning Only Demonstration Waiver

On May 9, 2018 the Health Care Authority (the Agency) received approval for renewal of the Section 1115 Family Planning Only Demonstration Waiver for five years (through June 2023). The approval letter, Special Terms and Conditions, and Expenditure Authority can be found on CMS’s website under Washington Family Planning Only Program and then clicking on "Demonstration Approval."

HCA intends to submit an application to extend the Section 1115 Family Planning Only Demonstration Waiver for five years (through July 2028). The current waiver expires on June 30, 2023 and covers limited family planning and family planning-related services for people who are in need of contraceptive care and are enrolled in the Family Planning Only programs. The purpose, client eligibility requirements, and benefit package will remain the same. The only potential change is the elimination of the Family Planning pregnancy-related program, due to the implementation of the After-Pregnancy Coverage program.

• Public notice for additional 30-day public comment period on Family Planning Only Demonstration Waiver renewal application (12/19/22-01/19/23).
• Draft application for the Section 1115 Family Planning Only Demonstration Waiver, updated 12/22.
• Interim evaluation report for the current cycle of the 1115 Family Planning Only Demonstration Waiver, submitted to CMS on 11/30/22.
• Interim evaluation report CMS approval letter.
• Draft application for the Section 1115 Family Planning Only Demonstration Waiver, updated 9/22.
• HCA response for FPO waiver webinar public comment period from September 30, 2022 submission.
• Slides from the public hearing held on June 30, 2022.
• Washington Family Planning Only Demonstration Temporary Extension (through June 30, 2025) letter.