Arkansas implemented a five-year family planning demonstration project, the Family Planning Demonstration Waiver, effective September 1, 1997. The purpose of this project was to expand family planning services to women of childbearing age, including those who lose Medicaid coverage after a sixty day postpartum period and who are not currently certified in any other Medicaid category. This Family Planning Demonstration Waiver project has been extended effective August 1, 2003.

Individuals found eligible under this waiver will receive family planning services only. They will not be eligible for any additional Medicaid benefits.

Eligible women will be assured freedom of choice in selecting any Medicaid family planning provider from among the following provider types: family planning agencies, obstetrician/gynecologists, family physicians, nurse practitioners, federally qualified health centers, rural health clinics, and local health department clinics.

Recipients will have access to all family planning clinical services provided under the Arkansas Medicaid State Plan. These services currently are:

1.      Basic Visit (one per year) - Medical history; medical examination, including head, neck, breast, chest, pelvis, abdomen, weight, blood pressure, extremities; breast self-exam instruction; counseling and education regarding the full range of contraceptive methods available; HIV/STD prevention; prescription for any contraceptives selected by the recipient.

2.   Periodic/Follow-up Visit (three per year) - Follow-up medical history; weight and blood pressure; contraceptive problem resolution; reissuance of contraceptive methods.

3.   Laboratory Services - Laboratory services, as appropriate, such as syphilis serology; Papanicolaou smear; gonorrhea culture; other STD assays; sickle cell screening; hemoglobin/hematacrit; urinalysis; pregnancy test. 

4.   Other Services - Other services, as appropriate, such as Norplant system insertion, removal and removal with reinsertion; IUD insertion and removal; Depo-Provera; sterilization services; and annual post-sterilization follow-up visit.

Abortion services are not included as family planning services under the State Plan.

12/05/07

Eligibility under the Family Planning Waiver is limited to women of childbearing age who do not have creditable coverage or Medicaid.  Childbearing age is defined as ages 14 - 44. However, women who fall outside this range who are at risk for unintended pregnancy will be allowed to participate.  Creditable coverage is defined as any insurance that pays for family planning services.

04/04/07

Women who are not currently certified as Medicaid eligible and who wish to apply for family planning services only may apply at DHS county offices, the local Arkansas Department of Health (ADH) Unit, Community Health Centers , Arkansas Health Education Centers, Federally Qualified Rural Health Clinics, or other designated clinics and centers.  Form DCO-64, Application for Family Planning Assistance, will serve as the application for Family Planning Waiver.  Form DCO-662 will also be completed if applicable.  The application will be registered in the Family Planning Waiver category.  

A separate application will be made for each individual who requests family planning services.  A minor may make her own application.  Parental signature is not required on the application of a minor.  

Applicants will be informed that their Medicaid card will entitle them to family planning services with the provider of their choice.  Family Planning Waiver recipients are not required to select a Primary Care Physician (PCP).  Each applicant will be given a copy of "Your Guide to Family Planning Services".   

New recipients of Family Planning Waiver who are given a new case number will not be required to have a photo Medicaid ID card.  If a case is certified using an existing case number, the recipient will use her previously issued photo ID card.  

DHS will provide applications and other necessary forms to private providers of family planning services.  The family planning provider may assist the applicant in completing the DCO-64 and forwarding the form to DHS.  

All applications taken outside the DHS office will be forwarded to the DHS office in the applicant's county of residence no later than 10 days after the date of the initial eligibility determination.  Providers, with the exception of ADH, may preserve the application date by FAXING the application to the DHS county office the same day the form is completed.   Whether received by Fax or through the mail, the DHS office will honor the date the form is first received.  Applications taken at ADH do not have to be FAXED to DHS to preserve the date.  On ADH applications, the actual date the application is taken will be used as the application date, regardless of the date of receipt.   

Applicants for Pregnant Woman (PW) Medicaid will be informed of their potential eligibility for Family Planning Waiver after the birth of the child. If found eligible for PW Medicaid, family planning services will be available to the woman following the postpartum period if she cannot qualify for or does not wish to receive continuing Medicaid benefits. If she indicates on the application for PW that she would like family planning services, no additional application for postpartum family planning services is required. The applicant should also be informed that if she is recertified for Medicaid benefits after the pregnancy in another category she can still receive family planning services with her Medicaid card.

If a PW application is made after termination of a pregnancy, and the applicant indicates on the application form that she desires family planning services, no additional application for postpartum family planning services is required. The application for PW Medicaid will be used to register the Family Planning Waiver category on the system.

In the event the request for family planning services was not made on the application for PW, the DCO-645 may also serve as the request for family planning services for Medicaid certified pregnant women whose newborn infants have been referred for Medicaid coverage. A new application or office interview are not required. The DCO-645 will be used to register the Family Planning Waiver category on the system.

System notices of PW approval will remind a PW that postpartum family planning services are available if she contacts DHS to request the services. Additional notices will be system generated to Pregnant Woman category recipients 30 days prior to the end of the postpartum period, advising them to sign and return the notice to obtain extended family planning services.

12525 Eligibility Requirements 

It will not be necessary to re-determine eligibility for postpartum family planning services for women previously certified in a Pregnant Woman category who request services no later than the last day of the postpartum period until the first annual re-evaluation. The "No Look Back" policy will apply, i.e., any income increases which may have occurred since PW certification will be disregarded. If there is a break between the end of the postpartum period and the date family planning services are requested, a new application form, DCO-64, will be required. The "No Look Back" policy will not apply, and eligibility must be re-determined.

 For new applicants, the following eligibility requirements must be met.

1.   Income - Net income cannot exceed 200% of the Federal Poverty Income Guidelines (FPL) for the appropriate number of persons included in the budget (re: Appendix F). The income disregards (Re. MS 11405) will be given. Each employed person in the assistance unit will be allowed a standard deduction of $90 from gross earnings for work related expenses and mandatory deductions. There is no option to verify actual expenses. Also, each employed person may be allowed a child care deduction. The amount of the deduction will be the monthly amount of child care paid for a child/children included in the assistance unit up to the following maximums:

a.$175 per child per month for a child age two and over.

b.$200 per child per month for a child under the age of two.

The childcare deduction will be applied to the remaining earnings after deducting the $90 earned income deduction(s).

Income will not be verified. The applicant's declaration of gross monthly income will be accepted and used in computing net countable income.

Lump sum payments will be disregarded as income.  

An adult female applicant will be budgeted with her minor children and the natural/adoptive father or step-father of her children if he is living in the home.  Step-children may also be included in the budget if living in the home.  Children may be excluded from the budget if their income would cause the parent to be ineligible.  Children may also be excluded for other reasons, and the reason need not be stated.

If services are requested for a minor who is living with her parents, the income of the minor's parents will be disregarded. The minor will be budgeted on a separate application with only her children, if any, and the father of her children, if living in the home. If more than one minor in a household requests services, each will be budgeted with her children and the children's father, if in the home, in separate applications. If the parent of a minor and a minor both request services, the minor may be included in both budgets.

2.  Resources - Resource limits for Family Planning Waiver are shown below:

Household Size          Resource Limit

1                               $2,000

2                               $3,000

3                               $3,100

4                               $3,200

5                               $3,300

6                               $3,400

Resources will not be verified. The applicant's declaration of resources will be accepted without verification. Refer to MS 11310 for resources that are disregarded.

Vehicles will be totally disregarded in determining countable resources.

An adult female will be budgeted with her children, and the natural/adoptive father or step-father of her children if he is living in the home. Step-children may also be included in the budget if living in the home. Children may be excluded from the assistance unit if inclusion of their resources would cause their mother to be ineligible. Children may also be excluded for other reasons without stating the reason.

If services are requested for a minor who is living with her parents, the resources of the minor's parents will be totally disregarded. Each minor parent living in the home will be budgeted only with her children, if any, and the father of the children, if he is living in the home.

3.   Citizenship or Alien Status (Re. MS 3310 #3 and MS 3324) The applicant's signature on the application form is sufficient to meet the citizenship requirement if the applicant checks "yes" for citizen. Questionable allegations of U.S. citizenship as well as the immigration status of all aliens must be verified.

Providers will refer aliens and applicants whose citizenship is questionable to the DHS office in the applicant's county of residence. DHS will determine eligibility for these individuals.

4.   Residency (Re. MS 2200) need not be verified unless questionable.

5.   Social Security Enumeration - Requirements at MS 1390 must be met.

6.   Mandatory Assignment of Rights to Medical Support - Mandatory assignment of rights to     medical support/third party liability (Re. MS 1350) will apply.

A referral to the Office of Child Support Enforcement (OCSE) is not required. A woman is not required to cooperate with OCSE during her eligibility for Family Planning Waiver services.

The caseworker will have a maximum of 45 days from the date of application to dispose of the application by approval, denial, or withdrawal.

Prior to certification, the caseworker will screen applications taken at ADH. If an application is incomplete, i.e., lacks basic information needed for registration and eligibility determination, signatures, or dates, the county office will return the application to ADH for correction and/or completion with a written request to provide the missing information. The application date will not be amended unless the application is returned for applicant's signature. The application date will be the date the form is signed by the applicant.

For applications taken at other out-stationed cites, the caseworker will contact the client rather than the provider to obtain additional information if the application is incomplete. The application date will remain the date the application form was first received at DHS unless the application is returned for the applicant's signature.

The caseworker will also verify that the case of a woman previously certified in a Pregnant Woman category has been closed, that she is not an open member in any other case (except QMB, SMB or MN-SD), and that she has requested Family Planning services only. If the request was made on the application for PW or DCO-645, followed up by an office visit, telephone call, signed returned system notice DCO-55 or other written request, the Family Planning Waiver case may be certified.

When eligibility for new applicants has been established, or when a woman previously certified in a Pregnant Woman category has requested family planning services only in person, by telephone, or in writing, the caseworker will approve on the system.

1. If a previous case number exists, it will be used for Family Planning Waiver eligibility.

2. The case budget will reflect the total countable income for the case. The case budget unit will include the eligible woman, any of her children or step-children living in the home, if she chooses to include them in the budget, and the natural/adoptive father or step-father of the children if he is living in the home.

3. The Medicaid Begin Date will be the date following the end of postpartum coverage for PW categories or the date of application for new recipients. The date of application for women seen at ADH will be the date the application, DCO-64, was signed. The date of application for women who apply through Family Planning providers other than ADH will be the date the application is first received by the DHS office either by FAX, mail or other means. Retroactive coverage will not be authorized for this category.

4. Notify applicant by system notice.

The caseworker will complete the following tasks when denying an application:

1. Record pertinent information in the case narrative.
2. Complete denial on the system.
3. Notify applicant by system notice.
4. For withdrawal only, obtain a signed statement from the applicant that she wishes to withdraw her application.

5. If an application that originated at an out-stationed site is denied for any reason, notify the provider of the denial.

Women certified under the Family Planning Waiver will remain eligible for 12 months from the date of certification. An annual reevaluation must be done to verify continued eligibility.

Cases approved under this waiver will not be subject to Second Party Review or Quality Assurance Reviews. Any erroneous payments made during a period of Family Planning Waiver eligibility will not be considered overpayments

As family planning services are not covered by Medicare, an individual may be approved for Family Planning Waiver services and for QMB or SMB for the same coverage periods. An individual may also be approved for Family Planning Waiver services and for a spend-down at the same time.

Cases in this category must be reevaluated every year. Changes in family income and resources will be disregarded until time for the yearly reevaluation. Address changes will be processed when reported.

Loss of eligibility will occur when the eligible individual:

1. Moves from Arkansas.
2. Becomes pregnant.
3. Requests closure.
4. Dies.
5. Is found to be over the income or resource limit at the yearly reevaluation.

When closed due to pregnancy, the system notice advises the client to contact the caseworker for possible PW coverage.

If the Family Planning Waiver program terminates, instructions will be provided regarding the closure of cases.

If a case is closed due to pregnancy or another reason, a new application, DCO-64, will be required to reopen the case. When reapproving a case for Family Planning Waiver services, the case number previously used will be utilized.