DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
 
Frequently Asked Questions (FAQs)  
Medicaid Family Planning Services and Supplies 
January 11, 2017 
 
These FAQs provide additional information and address questions raised from previous guidance 
regarding the delivery of family planning services and supplies to Medicaid beneficiaries.  
 
Family Planning Related Services in the Optional Family Planning Eligibility Group 
Q1:  Are states required to cover drugs for the treatment of sexually transmitted diseases 
(STD)/sexually transmitted infections (STI) if diagnosed during the regular family planning 
visit for individuals eligible through the optional family planning eligibility group?  What 
Federal Medical Assistance Percentage (FMAP) rate applies? 
A1:  Treatment of STDs/STIs may be covered as a family planning related service pursuant to a 
family planning visit at state option.  If a state decides to cover treatment for STD/STIs as a 
family planning related service, then drugs for the treatment for STD/STIs would be required.  
Further, such drugs would be subject to the requirements of the Medicaid drug rebate program 
under section 1927 of the Act to the extent that they are covered outpatient drugs from 
manufacturers that have Medicaid drug rebate agreements.  As with other family planning related 
services, federal funding would be available at the states regular Federal Medical Assistance 
Percentage (FMAP) rate.  
Coding 
Q2: Will CMS provide a list of codes for family planning services and supplies and family 
planning related services? 
A2: No. This is a state operational matter, and as such states should develop criteria so that 
claims for FFP at the 90 percent rate for family planning services and supplies are documented 
with codes that indicate that the underlying item or service was a family planning service or 
supply.  For claims with multiple services and codes, the enhanced Federal match rate applies 
only to the family planning services and codes.  
Informed consent and patient choice 
Q3:  If a provider performs a postpartum sterilization that does not comply with the informed 
consent requirements, how can the provider be reimbursed for the allowable portions of the 
claim?  
A3:  When a postpartum sterilization is performed that does not comply with the requirements 
for informed consent described in 42 C.F.R, Part 441, Subpart FSterilizations, Federal 
Financial Participation (FFP) is not available for costs related to the sterilization.  This applies to 
both the hospital-related costs as well as the providers costs.  States must reduce payment for  the inpatient stay by the amount that would have been paid for the sterilization alone.  Since the 
majority of non-postpartum sterilizations are performed on an outpatient basis, that amount 
would be the Medicaid outpatient rate.  In SHO #16-008, CMS identified ways states can ensure 
informed consent.  
Q4: How can states adopt policies that encourage the use of long acting reversible 
contraception (LARCs) while still maintaining patient choice? 
A4: Longstanding Medicaid regulations at 42 CFR 441.20 specifically require that beneficiaries 
must be free to choose the method of family planning to be used and must be free from coercion 
or mental pressure in making that choice. This requirement applies to all aspects of an 
individuals decision, including the decision to start or insert a method and the decision to stop or 
remove a method.  Additionally, states must ensure an individuals decision to use any 
contraceptive method does not impact their ability to access other medical services. 
Dual Eligibles 
Q5:  When treating dually eligible individuals (those with both Medicare and Medicaid), do 
providers first need to obtain a Medicare denial before seeking Medicaid coverage of long-
acting reversible contraceptives (LARCs  e.g., IUDs and contraceptive implants)? 
A5:  No. Medicare does not allow payment for contraceptive devices.  Because these items and 
services are non-coverable by Medicare, when a Medicaid-participating provider provides a 
LARC to a full-benefit dually-eligible individual, Qualified Medicare Beneficiary (QMB) Plus, 
or Specified Low-Income Medicare (SLMB) Plus beneficiary, the provider may submit a claim 
to Medicaid or otherwise seek Medicaid coverage without first obtaining a Medicare 
denial. Because LARCs are not covered by Medicare, Medicaid claims processing system should 
note the absence of coverage under Medicare and not apply standard claims processing edits 
relating to third party coverage of dually eligible individuals. 
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