Unlocking The Maryland Medical Assistance Family Planning Program

1. Unlocking The Maryland Medical Assistance Family Planning Program Angela T. Burden, RN, BSN, MA Director of Quality Improvement

2. Who Is Eligible? • Women who have lost Medicaid coverage in the Maryland Children’s Health Program category (P02/P11) after their pregnancy-related period of eligibility. • AND • She does not otherwise qualify for the Medical Assistance Program • *She may have other medical coverage, but the MFPP card, as with other Medical Assistance Programs, is the payer of last resort (she must use the other insurance coverage first).

3. How The Program Works • A woman loses her pregnancy-related MCHP coverage two months after the pregnancy ends, including if the pregnancy ends in miscarriage, etc. • DHMH automatically mails a purple and white Medical Assistance Family Planning Program Card and information concerning renewal and locations where the card is accepted (the woman should not have to do anything to activate coverage). • Women are entered into a P10 MA coverage category. • Woman must keep their address and contact information current with DHMH for renewal purposes.

4. What Is Covered? • Office medical visits and hospital outpatient department visits for family planning purposes which include: • Complete initial and annual physical exam, including auscultation of the heart and lungs • Annual pelvic exam, including PAP smear • Breast Exam • Rectal Exam, if indicated • Basic education regarding human sexuality and reproduction • Screenings for STD’s and HIV • Advice and counseling regarding all family planning methods, including natural methods, and sterilization procedures • Referrals for illness, disease, or pregnancy • Pregnancy tests, if indicated • Lab and Blood test • Pharmacy supplies and devices to prevent conception

5. Family Planning Methods Offered • Abstinence – 100% effective - abstaining from sexual intercourse. • Birth Control Pills – A pill available by prescription that must be taken everyday at the same time to be most effective. • Condoms – A latex or polyurethane condom is placed over a man’s penis to keep semen from entering the woman’s vagina. You may also use a female condom. Latex and polyurethane condoms help protect you from AIDS and sexually transmitted diseases. • Diaphragms – A small rubber cup that must be inserted into the vaginal canal prior to sexual intercourse. It covers the cervix, and is used in conjunction with a sperm-killing foam or jell. It is available by prescription only.

6. Family Planning Methods (Cont’d) • Spermicides – Do not require a prescription. They contain nonoxynol-9, a chemical that kills sperm. The foam, jelly, or cream is inserted into the vagina prior to sexual intercourse. It must be used each time you have sex. • IUD – The Intrauterine Device (IUD) must be inserted into a woman’s uterus by a licensed medical practitioner (doctor or nurse clinician). • The Patch (Ortho Evra) – Is a patch that is applied to the skin that releases ingredients similar to The Pill. Each patch is good for one week (you apply a new patch each week for three weeks every month – one week off to allow for a period).

7. Family Planning Methods (Cont’d) • NuvaRing– The NuvaRing is a flexible donut-shaped vaginal ring that releases ingredients similar to the Pill. It is placed in the vagina foe three weeks at a time. It is available by prescription only. • Depo-Provera (a shot) – Is an injection (shot) that works for three months. You must get a shot every three months from a health care provider. • Implanon – Is a new FDA-approved small, thin, implantable hormonal contraceptive that is effective for up to 3 years. It requires insertion by a qualified medical practitioner.

8. Family Planning Methods (Cont’d) • Sterilization (tubal ligation) – This method is permanent. Use this method only if you are sure you do not want any more children. It is also known as “getting your tubes tied.” • Emergency Contraception (EC) – This method is used within 120 hours of unprotected intercourse. Talk to you provider to see if this is an option for you, or call 1-877-99-GO4EC (1-877-994-6432). • Fertility Awareness Methods – This is a methods that couples use to avoid or achieve pregnancy based on the timing of intercourse. You must get special training to use these methods.

9. What Is Not Covered? • Treatment for STD’s • Therapeutic Abortions • Medical, fertility or other gynecological problems • Infertility services, including reversal of sterilization

10. Duration of Benefits (Effective 7/1/2003) • Women who began their FP coverage prior to July 1, 2003 will have (5) five years of continuous coverage unless they: • Becomes eligible for another Medical Assistance Program, including Primary Adult Care (PAC). • Moves out of the state • No longer needs birth control due to tubal ligation • Or, contacts DHMH to be removed from the program.

11. Duration of Benefits Continued • Women who began their FP coverage after July 1, 2003 currently receive (2) two years of continuous coverage, and must complete a financial renewal process in order to continue receiving benefits under the MFPP. The renewal process is yearly thereafter until the woman reaches the end of the five-year maximum eligibility period. • ** Effective FY ’09 (July 2008) Family Planning Renewal will be done yearly. There will be no initial two-year eligibility period. And maximum eligibility will be reduced to four years. • __________________________________________

12. Duration of Benefits Continued • Women can be cancelled prior to the five-year period for the following reasons: • Exceeds the qualifying family income level of 250% of the Federal Poverty Level (FPL) – (about $33,000/year or less than $2,750/month for a family of two). • Fails to respond to written requests for income information • Becomes eligible for another Medical Assistance Program • Moves out of the state • No longer needs birth control due to tubal ligation • Or, contacts DHMH to be removed from the program • *Women will receive a notice containing these messages with their FP card.

13. How The Renewal Process Works • 10 weeks before coverage is scheduled to end, the woman will receive a letter explaining the renewal process and a Request for Information Worksheet asking for self-declaratory financial information. • The woman has 45 days to respond to the letter. The deadline will be posted on the letter. • If she responds, within 30 days she will receive either an acceptance or rejection letter based on what she reports as income or residency. • If she does not respond to the letter within 45 days, her coverage will automatically terminate at the end of her eligibility period. • Incomplete worksheets will be returned requesting corrections within 10 business days.

14. Renewal Process - Continued • If the recipient’s letter is returned with a new address, DHMH will send the letter to the new address and make corrections in MMIS. • If there is no forwarding address, and the letter is stamped “return to sender,” the woman’s enrollment will end at the conclusion of her eligibility period. The Worksheet will be placed in a file for 120 days. If the woman contacts DHMH, a Request for Information Sheet will be sent. The woman will have ten business days to complete and return the worksheet.

15. What’s In The Renewal Package? • Each recipient receives: • A two-page letter • A two-page Request for Information Worksheet • A Rights & Responsibilities Sheet requiring signature • Two brochures: “You Deserve Continued Health Care,” & “Family Planning for You”

16. How You Can Help • Encourage clients to call 1-800-456-8900 with current contact information. • Encourage clients to call the above number if they have questions about the renewal process • Remind clients to return the required forms within the stated deadline posted on their letter. And that request will be sent after the first two years, and yearly thereafter until their five years is exhausted. • Remind clients to sign and date the Rights & Responsibilities sheet. • Encourage clients to call the 1-800-456-8900 number if they do not automatically receive their purple and white card in the mail.

17. Contact Information • Help is available from DHMH: Contact the • Department of Health & Mental Hygiene • Maternal and Child Health Line (for re-enrollment issues, to request cards, verify eligibility, locate providers, etc.) at : • 1-800-456-8900.