DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
                 
 
            SMDL#14-003 
            ACA# 31 
 
 
April 16, 2014 
 
RE:   Family Planning and Family Planning Related 
Services Clarification 
 
Dear State Medicaid Director:   
 
This letter is intended to provide clarification regarding the coverage of family planning-related 
services provided to individuals eligible under the optional categorically needy state plan group 
created by section 2303 of the Affordable Care Act.  Individuals who would qualify under this 
new family planning eligibility group, if the state elects to offer it, are defined as individuals 
(men and women) who are:  1) not pregnant, and 2) whose income does not exceed the income 
eligibility level established by the state plan.  This state option was effective March 23, 2010.   
 
Background 
Family planning services receive Federal financial participation at an enhanced rate of 90 
percent, while family planning related services are matched at the states regular Federal medical 
assistance percentage.  The Affordable Care Act indicates that family planning related services 
are considered those medical, diagnosis and treatment services provided pursuant to a family 
planning visit.  The Centers for Medicare & Medicaid Services (CMS) issued earlier guidance on 
family planning related services in a letter to State Medicaid Directors on July 2, 2010, which 
indicated that these services were to be provided as part of or as follow up to a family planning 
visit.  We are providing additional clarification on how family planning related services are to be 
provided pursuant to a family planning service.   
 
Clarification of Family Planning-Related Services 
Sound clinical practice and the provision of high-quality, comprehensive care dictates that 
specific family planning services are provided along with certain family planning-related 
services.  The United States Preventive Services Task Force recommends high-intensity 
behavioral counseling to prevent sexually transmitted infections (STI) for all sexually active 
adolescents and for adults at increased risk for STIs (where increased risk includes patients with 
an active STI).1  In addressing the needs of a patient with an active STI, providers will, as a 
matter of course, provide behavioral counseling on contraceptives.  Contraceptive counseling is a 
family planning service.  Therefore, CMS has determined that services such as the diagnosis and 
                                                 
1 http://www.uspreventiveservicestaskforce.org/uspstf/uspsstds.htm  Page 2  State Medicaid Director 
 
treatment of an STI are always provided pursuant to a family planning service. These services 
will be eligible for Medicaid coverage as family planning related services, regardless of the 
initial purpose of the visit.   
 
States continue to have the authority to adopt reasonable definitions of the scope of family 
planning-related services for purposes of the coverage available to this eligibility group.  In 
addition, states must ensure that providers of family planning services use correct billing 
procedures to properly code claims, and that states use the correct federal reimbursement rate 
when claiming for family planning and family planning related services.   
 
Clarification of Family Planning Visits for Men 
In our 2010 SMD letter, CMS noted that one example of a family planning-related service would 
be a family planning visit for men.  This family planning visit may include a physical and 
laboratory tests, as well as contraceptive counseling.  CMS is clarifying that a visit for 
contraceptive counseling for men should be considered a family planning visit, not family 
planning-related.  CMS does not believe there is any reason to make a distinction between 
contraceptive counseling for men versus women.  Therefore, these services for men would also 
be eligible for the enhanced Federal Financial Participation (FFP) available for a family planning 
service.   
 
States may begin to claim FFP based on this policy clarification effective with the date of 
issuance of this letter.  CMS will not consider retrospective claims for additional FFP.     
 
Prior letters on this subject were issued on July 2, 2010 and can be accessed at 
http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD10013.pdf. 
 
If you have any questions regarding this information, please contact Barbara C. Edwards, 
Director, Disabled and Elderly Health Programs Group, at 410-786-7089.   
 
            Sincerely,  
 
            /s/ 
 
            Cindy Mann  
            Director  
 
 
cc:   
 
CMS Regional Administrators  
 
CMS Associate Regional Administrators  
Division of Medicaid and Childrens Health Operations 
 
 
  Page 3  State Medicaid Director 
 
Matt Salo 
Executive Director 
National Association of Medicaid Directors  
 
Melinda Becker,  
Director, Health and Human Services Committee  
National Governors Association  
 
Ron Smith 
Director  
Legislative Affairs  
American Public Human Services Association  
 
Debra Miller  
Director for Health Policy  
Council of State Governments  
 
Joy Wilson  
Director, Health Committee  
National Conference of State Legislatures 
 
Christopher Gould  
Director, Government Relations  
Association of State and Territorial Health Officials  
 
Alan R. Weil, J.D., M.P.P.  
Executive Director  
National Academy for State Health Policy