What changes under the new Medicaid State Plan Amendment (SPA) program?
· Continues to cover outpatient and office family planning services currently covered under the Family Planning Waiver (FPW).
· No longer restrictions for eligibility based on age to receive family planning services.
· Will cover non-emergency medical transportation to and from family planning appointments for current recipients.
· Covers screening and treatment for Sexually Transmitted Infections (STIs) and screening for Human Immunodeficiency Virus, or HIV (beyond the annual exam) available at any or all of the medically necessary six inter-periodic office visits.
· Family planning services will be expanded to cover the same or similar outpatient and office family planning services that are covered under the regular Medicaid program.
Eligible Beneficiaries for the SPA
- Females (no age restrictions).
- Males (no age restrictions).
- Income at or below 185% of the federal poverty level.
- U.S. citizens or documented immigrants.
- Residents of North Carolina.
- Not incarcerated.
- Not pregnant.
- Not permanently sterilized, or unable to have children.
· Not on Medicare.
• Applicants cannot choose the Medicaid “Be Smart” Family Planning Services
– The local county Department of Social Services (DSS) must first determine if eligible under a more comprehensive Medicaid coverage category
• For married persons living together, Medicaid considers the spouse’s income in determining eligibility
• For persons under 21 living at home with a parent or legal guardian, Medicaid considers the parents’ or guardian’s income in determining eligibility
• No auto-eligibility
• No presumptive eligibility