Title 16
16000 Federal Poverty Level Related Programs
Family Planning is a category of eligibility created under the Section 1115 Demonstration Waiver that was approved by CMS on May 17, 1995. Family Planning services are extended 24 months to women who lose Medicaid (categorical or expanded population) for non-fraudulent reasons. The intention is to promote the reduction of unintended pregnancies, low birth weight infants, fetal death, and improve women's health and strengthen family functioning by spacing children and tracking related gynecological problems and sexually transmitted diseases. Coverage for this group of eligibles is effective January 1, 1996.
16500.1 Eligibility Requirements
Women may receive Family Planning services if they meet the following conditions:
1. age 16 through age 50
2. were receiving Medicaid but lost Medicaid eligibility on or after 12/31/95 for non fraudulent reasons. Women who lose eligibility as a QMB, SLMB, or QI or who were eligible for emergency services and labor and delivery only, are not eligible for the family planning extension. Fraud is defined by Section 1128B of the Social Security Act. The individual must be convicted of fraud by a court of competent jurisdiction.
3. continue to meet Delaware residency requirements
4. do not have comprehensive health insurance coverage. Comprehensive health insurance covers hospital, physician, laboratory, and radiology services.
5. are not inmates of a public institution such as a correctional facility or mental health institution
6. for the second year of the extension, have countable family income at or below 200% of the Federal Poverty Level.
Family income will be determined using the methodology of the Federal Poverty Level related programs. Resources are not counted.
12 DE Reg. 1322 (04/01/09)
16500.2 Procedures for Determining Eligibility
This program is an extension of benefits like the Transitional Medicaid program. A separate application is not required. These recipients will receive a Medicaid card that indicates they are eligible for Family Planning Package including Family Planning and Related Services.
Women eligible under this program are excluded from enrollment into the Diamond State Health Plan or Diamond State Partners. When the Medicaid case is closed, system processing will automatically disenroll women from managed care using the Medicaid closing effective date. Family planning and related services will be paid on a fee-for-service basis.
16500.3 Redetermination of Eligibility
A redetermination will be completed at a one year interval after the beginning of the extension period to determine if the woman's family income is at or below 300% FPL.
16500.4 Benefits
Women eligible under this program are not eligible for the usual Medicaid covered services. They are eligible for family planning and related services only. Family planning services are defined as those services provided to females of childbearing age to temporarily or permanently prevent or delay pregnancy. The covered and noncovered services for Family Planning and Related Services are listed in the Delaware Medical Assistance Program Provider General Policy Manual.
16500.5 Termination of Eligibility
DCIS will automatically track the 24 month extension and send a notice to individuals who have received the family planning services for 24 consecutive months. If a woman becomes eligible for Medicaid before receiving 24 consecutive months of family planning, the 24 month count starts over when she again loses Medicaid.
