Family Planning Only
Providers can find information on the Health Care Authority's (HCA) Family Planning Only program, including covered services, recent changes, client and provider enrollment, training, and more.
Automatic enrollment to end
Automatic enrollment for Family Planning Only – Pregnancy Related will end with the end of the federal Public Health Emergency (PHE) on May 11, 2023.
On this page
What services are covered?
- One comprehensive preventive family planning visit every year (every 365 days)
- Counseling, education, and risk reduction
- Education and supplies for FDA-approved contraceptives, natural family planning, and abstinence
- Permanent methods such as tubal ligation ("tubes tied"), hysteroscopic sterilization, and vasectomy
- Pregnancy testing and cervical cancer screening when appropriate
- Sexually transmitted infection screening, testing, and treatment, when medically indicated by symptoms or report of exposure, and medically necessary for safe and effective use of the client’s chosen contraception
- Human papillomavirus (HPV) vaccination
For more details on coverage, see the Family Planning billing guide.
Not covered services
Family Planning only does not cover:
- Other vaccinations
- Mammograms
- Services unrelated to family planning, including
- Follow-up of abnormal pap smears
- Pregnancy care
- Evaluation and treatment of health problems like diabetes, asthma, or high blood pressure
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).
Reapplying
Clients can reapply for Family Planning Only coverage every 12 months for as long as they are eligible.
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 webinars for providers, patient navigators or assisters, billing staff, or anyone who works with the family planning programs. Email HCA Family Planning Only for more information.
Recordings and materials
| Year | Materials |
|---|---|
| 2023 |
TBD |
| 2021 | |
| 2020 | |
| 2019 |
Frequently asked questions
- What sets eligibility for family planning programs apart from other programs?
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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?
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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?
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Changes to the Family Planning Only programs will not cause any changes to RAC codes or ACES program codes.
- What is a qualified immigrant?
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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?
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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.
Waiver authority for the program
- Section 1115 Family Planning Only Demonstration Waiver
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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. This change will take effect when the end of the federal Public Health Emergency (PHE) is declared. There is currently no established end date for the PHE.
- View public notice for additional 30-day public comment period on Family Planning Only Demonstration Waiver renewal application (12/19/22-01/19/23).
- View the draft application for the Section 1115 Family Planning Only Demonstration Waiver, updated 12/22.
- View the interim evaluation report for the current cycle of the 1115 Family Planning Only Demonstration Waiver – submitted to CMS on 11/30/22.
- View the draft application for the Section 1115 Family Planning Only Demonstration Waiver, updated 9/22.
- View the HCA response for FPO waiver webinar public comment period from September 30, 2022 submission.
- View the slides from the public hearing held on June 30, 2022