On this page you can find (in order):
- What you need to have with you at your enrollment appointment
- What services your program covers
- How you can tell if you are eligible for a program
To access the Family Planning Benefit Program application and application instructions in English and in Spanish, click here. For the Emergency Medicaid application, click here. To view our Frequently Asked Questions, click here.
What You Need to Bring to Your Enrollment Appointment
Different programs require different documentation for enrollment. Please check the column below your program to determine what documents you must provide at the time of your appointment. You must provide all of the documentation necessary for your application before you can use your coverage.
|Required Documents||Family Planning Benefit Program (FPBP)||Medicaid||Sliding Fee Scale||County Cancer Services Programs|
|Proof of Identity||X||X||X|
|Proof of Residency||X*||X*|
|Social Security Number||X|
|Proof of Individual Income (for the past 4 weeks)||X**||X**||X**|
|Proof of Household Income (for the past 4 weeks)||X***||X ***||X***|
*College students may not use mail sent to a dorm or other university address to prove residence. Recent mail (from the last six months) from your permanent home address must be provided instead. Other forms of proof of residency are: postmarked mail sent to you within the last six months (envelopes must not have a clear window; magazines must have lasered address, not a sticker), utility bills (gas, electric, cable or water), recent bank statements, or a driver's license issued within the last three months.
**Bring all that apply:
- one recent month's worth of consecutive paycheck stubs OR a letter from your employer on company letterhead, signed and dated, stating how much you make per hour and how many hours you work each week
- l unemployment award letter/benefit check
- l child support/alimony check stub
- l workers comp. award letter/benefit check
- l signed and dated statement from friend/family member stating that they support you
***If married, proof of spouse income MUST be documented.
Each program covers a specific range of services. See the chart below to determine what services are covered under your program.
|Services||Family Planning Benefit Program (FPBP)*||Medicaid||Sliding Fee Scale||Healthy Women Partnership|
|Cancer Screening, Colposcopy, Cryotherapy and LEEP||X***||X||X|
|Abortion (surgical and medication)||X|
*Some other services, including STI testing and treatment, may also be covered depending on the details of your visit. Call (518) 434-5678 for more information.
**These services are only covered by FPBP if they are administered in the course of a visit where family planning is discussed.
***Colposcopy, Cryotherapy and LEEP procedures are only covered by FPBP if the pap test that came back abnormal was taken at a visit where family planning was also discussed.
****Covered in some circumstances.
Qualifying for a Program
Each program has its own eligibility criteria. Check the chart below to see if you might qualify.
|Qualifications||Family Planning Benefit Program (FPBP)||Medicaid||Sliding Fee Scale||Healthy Women Partnership|
|US Citizen or Legal Immigrant||X||X|
|Dependant Upon Individual Income Level*||X||X||X|
|Dependant Upon Household Income Level*||X||X|
|Previous Enrollment in Medicaid^||
*Enrollment in the Family Planning Benefit Program and Medicaid, and placement on our sliding fee scale, depends partly on income levels. Please call (518) 434-5678 for more information.
^If you were recently pregnant, and had Medicaid when your pregnancy ended, you may qualify for the Family Planning Extension Program (FPEP). Call (518) 434-5678 for more information.
Have questions about these programs? Visit our FAQ page, or call (518) 434-5678 to speak with our staff.