Last Updated: January 2005

FAMILY PLANNING SERVICES AND REPRODUCTIVE RIGHTS UNDER MEDICAID MANAGED CARE

Q. What are “Free Access” services?

A. Under New York State Law, anyone enrolled in a Medicaid managed care plan is entitled to free access family planning and reproductive health services including exams, pregnancy testing, birth control, abortion, sterilization and STD testing and treatment when part of a family planning visit. Free access means that a person can get these services from any doctor or clinic he/she chooses that accepts Medicaid.

The person does not need a referral from his/her primary care provider. He/she does not need prior approval from the health plan. These services are free, so the person will not be charged for them. There is no limit: one can visit out-of-network family planning providers as many times as the individual needs to. All visits are confidential, regardless of age. Parental consent is not required.

All Medicaid managed care plans are required to inform their clients of their rights regarding free access to family planning and reproductive health services.

Q. What are family planning services?

A. Family planning services include many women’s health services, and also include services for men. The family planning services that are covered under Medicaid include:

Birth Control and Pregnancy Testing:

• All types of birth control: pills, condoms, diaphragms, Ortho-Evra (the birth control “Patch”), IUDs, Depo Provera, Norplant and foams
• Pregnancy testing and counseling
• Emergency contraception: the “morning after” pill
• Sterilization: getting your tubes tied for a woman, and vasectomy for a man

STD and HIV tests

• STD testing and treatment, when part of a family planning visit
• HIV testing and counseling, when part of a family planning visit

Women’s Health:

• Abortion (medical and surgical)
• These services, if provided during a family planning visit:
• Pelvic and breast exams
• Testing for high blood pressure and anemia (low blood count)
• Pap smears (a test for cancer)
• Colposcopy (a test to determine the cause of abnormalities found in Pap smears)
• Cryotherapy (an outpatient procedure done to treat cervical dysplasia, a precancerous condition caused by abnormal cells on the surface of the cervix)
• LEEP (another procedure used to treat cervical dysplasia)
  

Q. Does your client need to get family planning or reproductive health care services from a doctor or clinic that is in his/her Medicaid managed care health plan’s network (approved list of providers)?

A. No. Your client can get birth control or reproductive health care services from any doctor or clinic that accepts Medicaid, in or out of the health plan.

• If your client goes to a doctor or clinic outside of his/her health plan for these services, make sure that the doctor or clinic:
  • takes Medicaid
  • offers the services that you need
    
    
• Carry both of his/her cards (the Medicaid benefit card and the health plan card) with him/her. In addition to using his/her Medicaid benefit card when accessing family planning services outside of his/her plan’s network, he/she will also need to use his/her Medicaid benefit card for other services, including pharmacy.

Q. Does an individual need a referral from his/her primary care provider (“PCP” or family doctor) at the health plan before going for birth control or reproductive health care services?

A. No. The individual doesn’t need to ask his/her health plan doctor first. He/she doesn’t need a referral or approval.

Q. Can a minor (someone under 18) get family planning services? Does a minor need permission from a parent to get these services?

A. A person under the age of 18 can get family planning services. He/she does not need permission or consent from a parent to get family planning services.

Q. Is a visit to a doctor for family planning confidential?

A. All family planning services are confidential, regardless of age. Information shared with the doctor will be kept private.

Q. What if your client’s Medicaid managed care health plan does not cover birth control or abortion?

A. Your client can still get any birth control or reproductive health care services listed on the previous page, including birth control and abortion—even if his/her health plan does not cover them. To get these services, go to any doctor or clinic that takes Medicaid and provides the services needed. Advise the client to take his/her regular Medicaid card to the visit.

There are currently two plans that do not cover family planning services – Fidelis and Community Premier Plus.

Q. How can one find a doctor or clinic for birth control or reproductive health care services?

A. The individual can ask his/her health plan for a list of the doctors and clinics in the network that provide birth control and reproductive health care services and have offices in locations that are convenient for the person. If the individual calls Fidelis or Community Premier Plus for a list of doctors and clinics, they will ask the NY State Department of Health (SDOH) to mail him/her a list of doctors or clinics in your borough.