Medicaid Coverage of Family Planning Benefits: Findings from a 2021 State Survey
Key Findings
KFF estimates based on the Census Bureau’s March Current Population Survey (CPS: Annual Social and Economic Supplements), 2021.
Report
Section 1927(d)(2) provides that the following drugs or classes of drugs, or their medical uses, may be excluded from coverage or otherwise restricted:
(A) Agents when used for anorexia, weight loss, or weight gain.
(B) Agents when used to promote fertility.
(C) Agents when used for cosmetic purposes or hair growth.
(D) Agents when used for the symptomatic relief of cough and colds.
(E) Agents when used to promote smoking cessation.
(F) Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations.
(G) Nonprescription drugs, except, in the case of pregnant women when recommended in accordance with the Guideline referred to in section 1905(bb)(2)(A), agents approved by the Food and Drug Administration under the over-the-counter monograph process for purposes of promoting, and when used to promote, tobacco cessation.
(H) Covered outpatient drugs which the manufacturer seeks to require as a condition of sale that associated tests or monitoring services be purchased exclusively from the manufacturer or its designee.
(I) Barbiturates.
(J) Benzodiazepines.
(K) Agents when used for the treatment of sexual or erectile dysfunction, unless such agents are used to treat a condition, other than sexual or erectile dysfunction, for which the agents have been approved by the Food and Drug Administration.
“Family planning related services are medical, diagnostic, and treatment services provided pursuant to a family planning visit that address an individual’s medical condition and may be provided for a variety of reasons including, but not limited to: treatment of medical conditions routinely diagnosed during a family planning visit, such as treatment for urinary tract infections or sexually transmitted infection; preventive services routinely provided during a family planning visit, such as the HPV vaccine; or treatment of a major medical complication resulting from a family planning visit.” CMS, SHO# 16-008, Medicaid Family Planning Services and Supplies, June 14, 2016; accessed at https://www.medicaid.gov/sites/default/files/federal-policy-guidance/downloads/sho16008.pdf.
[1] “Family planning related services are medical, diagnostic, and treatment services provided pursuant to a family planning visit that address an individual’s medical condition and may be provided for a variety of reasons including, but not limited to: treatment of medical conditions routinely diagnosed during a family planning visit, such as treatment for urinary tract infections or sexually transmitted infection; preventive services routinely provided during a family planning visit, such as the HPV vaccine; or treatment of a major medical complication resulting from a family planning visit.” CMS, SHO# 16-008, Medicaid Family Planning Services and Supplies, June 14, 2016; accessed at https://www.medicaid.gov/sites/default/files/federal-policy-guidance/downloads/sho16008.pdf.
American Society for Colposcopy and Cervical Pathology.