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Medicaid Family Planning Benefit Program

What is the Medicaid Family Planning Benefit Program (FPBP)?

FPBP is a New York State Medicaid program that provides family planning benefits to men and women ages 10-64 with family incomes up to 200% of the federal poverty level.

For example, a single person (with no children) applying on his or her own can make up to approximately $21,000/year to qualify for FPBP. We strongly encourage you to call (212) 965-7000 or 1 (800) 230-PLAN to make an appointment with one of PPNYCís Entitlement Counselors in order to find out more.

How do I know if Iím eligible for FPBP?

PPNYC has Entitlement Counselors in all four PPNYC health centers (in the Bronx, Brooklyn, Manhattan, and Staten Island). They can help determine if you are eligible for FPBP or other programs, and can help you fill out the application. To find out more, please call (212) 965-7000 or 1 (800) 230-PLAN to make an appointment with one of PPNYCís Entitlement Counselors.

Where can I apply?

PPNYC has Entitlement Counselors in the Bronx, Brooklyn, Manhattan, and Staten Island. They can help you fill out a simple, confidential application. Call (212) 965-7000 or 1 (800) 230-PLAN to make an appointment with one of PPNYCís Entitlement Counselors.

Is my application confidential?

Yes. Your application for FPBP Ė and all other programs Ė is kept confidential. As always, any services you receive at PPNYC will also be kept confidential.

If Iím under 21, can I still apply on my own?

Yes. Adolescents (younger than 21 years of age) can apply for this program on their own. If you are under 21 years old, your eligibility will be based on your own income, not your parentsí income. Even if you are living at home with family, their income is not included. You do not need to bring in any information related to their income. Your application will be kept confidential.

What if I have health insurance through my parents, but I donít want to use it. Can I still apply for FPBP?

Maybe. If you have commercial health insurance (i.e., Aetna, Oxford, etc.) through your parents or if you have Child Health Plus, but do not want to use it for confidentiality reasons, you can still apply for FPBP. Call (212) 965-7000 or 1 (800) 230-PLAN to make an appointment with one of PPNYCís Entitlement Counselors to discuss this option.

What happens if I donít qualify for the program?

If you donít qualify for FPBP or decide not to apply, you may still be able to use PPNYCís free or low-cost services.

How will I know when my coverage starts?

If you qualify, you will get a Medicaid card that covers family planning services at any Medicaid provider or pharmacy. Bring this card with you when you go for your family planning visit or when you pick up your birth control at the pharmacy. If you are approved for the program, you will receive this card in about four to six weeks.

Whatís covered?

  • All types of birth control
  • Emergency contraception (the "morning-after" pill) and follow-up
  • GYN exams, including Pap tests
  • Pregnancy testing and counseling*
  • Male and female sterilization
  • STD testing, counseling, and treatment*
  • HIV counseling and testing* 
  • Colposcopy, cryotherapy, and LEEP*

*when part of a family planning visit 

What is not covered?

Abortion services and pregnancy services are not covered under this program (see "What happens if I become pregnant?" below). Other services that are not family planning-related, such as dental care, are also not covered under FPBP.

Where can I get services?

Once you are enrolled in FPBP, you can visit any Medicaid provider for family planning and gyn services. There is no limit to the number of visits. Your visit will be covered as long as the provider offers family planning services and accepts Medicaid.

You will not have to pay when you go to the pharmacy for your birth control prescriptions Ė including Ortho-Evra, the birth control patch Ė as long as the pharmacy accepts Medicaid.

Do I need approval from a plan or my primary doctor?

No. You do not need a referral. There are no managed health care plans attached to FPBP, so you donít have to join a plan. FPBP covers family planning services at any Medicaid provider and birth control at the pharmacy.

How long does the FPBP coverage last?

If you qualify, you will be covered for family planning and gyn benefits for a full year and then you can re-certify.

What happens if I become pregnant?

FPBP does not cover abortion services or prenatal care. However, our Entitlement Counselors can help you enroll in another Medicaid program that does cover abortion services and all pregnancy-related services. To find out more, please call (212) 965-7000 or 1 (800) 230-PLAN and make an appointment with an Entitlement Counselor.

What documents do I need to bring in?

1. Photo ID (bring one): Driver's license, Passport, School ID, Other official photo ID
2. Proof of age (bring one): Birth certificate, Adoption or foster care records, Official hospital or school records
3. Proof of citizenship or immigration status (bring one): Birth certificate, Passport, Naturalization certificate, INS form -- "Green" card
4. Proof of residency (dated within the last 6 months -- bring one): Photo ID with address; Postmarked envelope, bill, magazine, etc.; Utility bill; Letter or lease agreement
5. Social Security Number: Preferably, bring your Social Security card, or at least bring your number
6. Proof of recent, monthly income (bring all that provide income for you):

  • Four recent, consecutive pay stubs
  • Unemployment or Social Security award letter or check stub
  • Workerís compensation award letter or check stub
  • Child support or alimony letter or check stub
  • Letter from employer
  • Letter of support from family member 
  • If a full-time student, program card or class schedule

7. Documentation of any child care expenses
You first must call (212) 965-7000 or 1 (800) 230-PLAN to make an appointment with one of our Entitlement Counselors. If you are unsure about whether you can obtain these documents, speak with the Entitlement Counselor. Even if you cannot bring the documents, come to your appointment anyway.  We'll find some way to get you the services you need.

 


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