Family Planning

Providers who meet certain criteria might qualify to provide services. These criteria include:

• Must deliver the types of services available through the program.
• Have completed the Medicaid enrollment process and been approved through the Texas Medicaid & Healthcare Partnership.
• Can certify that they do not perform or promote elective abortions or affiliate with an entity that performs or promotes elective abortions, in accordance with the FPP rules located in the Texas Administrative Code (TAC) Title 1, Part 15, Chapter 382, Subchapter B, §§382.115.

• Contraceptive services
  • Barrier devices (e.g., condoms, spermicides)
  • Hormonal contraceptives (e.g., oral contraceptives, injectable contraceptives)
  • Long-acting reversible contraceptives
  • Counseling and education on sexual abstinence
• Pregnancy testing and counseling
• Preconception health screenings (e.g., screening for obesity, hypertension, diabetes, cholesterol, smoking, and mental health)
• Sexually transmitted infection services
• Sterilization (e.g., tubal ligation, hysteroscopic occlusion, vasectomy)
• Screening for postpartum depression
• Clinical breast exams
• Breast and cervical cancer screening and diagnostic services
  • Radiological procedures, including mammograms
  • Screening and diagnosis of breast cancer
  • Diagnosis and treatment of cervical dysplasia
• Immunizations

Please see list of reimbursable codes and the Texas Medicaid Provider Procedures Manual.

Long-acting reversible contraception (LARC) is a highly effective contraceptive option with high rates of patient satisfaction and method continuation. To learn more about implementing the Texas Medicaid policy on providing LARC services, see the Texas LARC Toolkit (PDF).

Some examples of long-acting reversible contraception include an intrauterine device (IUD) and a birth control implant. To learn more about LARCs, see the Texas LARC Toolkit (PDF).

Contraception, except emergency contraception, is provided through a family planning clinic or by prescription at an on-site or local pharmacy.

All Family Planning Program services provided at an HHSC Family Planning Program funded clinic, including non-reimbursable services, must be offered a sliding scale fee. However, no client shall be denied services based on an inability to pay. Please visit the Family Planning Program Policy Manual for more information regarding co-pays and the suggested co-pay table.

If a client covered by FPP does not want to pay out-of-pocket for services not covered by the program, providers must refer them to another physician or clinic. Providers should make referrals when health issues are identified, and necessary services related to those health issues are not covered under the program.

Individuals in need of treatment for postpartum depression must be referred to a provider of behavioral health services. Providers must have arrangements in place for appropriate referral of individuals to behavioral health providers in their area.

The Texas Health and Human Services Commission (HHSC) prefers referrals to local indigent care services, but 2-1-1 Texas can assist with locating other primary care providers, if needed.

The HHSC Breast and Cervical Cancer Services (BCCS) program offers free breast and cervical cancer screening and diagnostic services throughout Texas to eligible women. Additionally, the program provides Medicaid coverage to eligible women diagnosed with breast or cervical cancer and cervical dysplasia management and treatment for BCCS-enrolled women.

Family Planning Program providers should refer clients with a primary need of cancer screening to a BCCS contractor for further assistance. If a client has a diagnosed breast or cervical cancer, she may be eligible for Medicaid for Breast and Cervical Cancer (MBCC). MBCC provides access to cancer treatment services through full Medicaid benefits to qualified women. If a client needs treatment, she MUST be referred to a BCCS contractor to determine if she meets eligibility criteria. BCCS contractors will assist referred clients with the application process, determination of presumptive eligibility, and navigation to additional resources if indicated.   

• Females and males aged 64 years and younger
• Have a countable household income at or below 250% of the federal poverty level
• Ineligible for Medicaid and Healthy Texas Women (HTW)

Note: Services may be provided to individuals with third-party insurance if the confidentiality of the person is a concern or if the person's insurance deductible is 5% or more of their monthly income.

No. If an applicant or family member receives the following services, they are considered adjunctively eligible for the HHSC Family Planning Program at an initial or renewal eligibility screening:

• Children's Health Insurance Program (CHIP)
• Supplemental Nutrition Assistance Program (SNAP)
• Temporary Assistance for Needy Families (TANF)
• Special Supplemental Nutrition Program for Women, Infants and Children (WIC)

Proof of participation is required.

However, if an applicant does not participate in the above services, they will be asked to prove income eligibility.

Note: If the methods used for income verification jeopardize the individual's right to confidentiality or impose a barrier to receipt of services, the contractor must waive this requirement and approve full eligibility. Reasons for waiving verification of income must be noted in the individual's record.

Yes.

Pregnant women can be enrolled in FPP and CHIP Perinatal simultaneously. While pregnant women may be served in FPP, there are only limited prenatal services available for coverage. As a result, providers should make every effort to assist pregnant women to receive more comprehensive prenatal and perinatal care including enrollment and referral to Medicaid for Pregnant Women, CHIP Perinatal, and/or the Title V Maternal Child Health Fee-For-Service Program.

If a woman becomes pregnant while she is covered by FPP, contractors may bill FPP for allowable services provided in clinical prenatal care visits for women during the Medicaid for Pregnant Women and CHIP Perinatal enrollment processes.

If a client is 17 years of age or younger, they must have a parent or legal guardian apply, renew, and report changes on their behalf to receive Family Planning Program services.

All program services must be provided with consent from the minor's parent, managing conservator, or guardian as authorized by Texas Family Code, Chapter 32, or by federal law or regulations.

To learn more about health and health-related legal issues that apply to minors, see the Responsibilities for Treatment of Minors within the Family Planning Program and Healthy Texas Women Program as well as the DSHS resource, Adolescent Health Guide.

If an individual is found ineligible for Medicaid and Healthy Texas Women (HTW) they can apply to FPP.

Individuals should contact a clinic that provides Family Planning Program services by using the clinic locator. Clinic staff will assist with the program application and determine whether the individual is eligible.

The eligibility assessment may be completed over the phone or in the office. The completed eligibility form must be kept in the individual's record and must show the individual's poverty level and the co-pay amount they may be charged.

If eligibility is determined over the phone, the contractor is authorized to sign the form on the applicant's behalf using a digital ID or handwritten signature.

The name printed on the applicant's Social Security card or government-issued identification.

HHSC FPP contracted providers must screen all family planning applicants for eligibility in the following programs that provide family planning services, in this order:

• Medicaid
• Healthy Texas Women (HTW)
• HHSC FPP

Once a client is deemed ineligible for Medicaid and HTW, the clinic will determine whether a client is eligible for FPP.

It can take up to 45 days for Medicaid/HTW applications to be processed. If questions arise, clients should contact 866-993-9972 to discuss the status of their application.

An individual is eligible for services beginning the date the contractor determines the individual eligible for the program and signs the completed application. Services delivered while a client's application was pending may be billed to FPP for up to 95 days prior to determining eligibility.

Clients must reapply annually.

The client must let the clinic know if there are changes to their information.

Coverage can start once a client is deemed eligible for the program.

No.

Potential clients can search for a FPP clinic here: Family Planning Program | Healthy Texas Women. The clinic will determine whether a client is eligible.

By phone:

For provider questions regarding billing/claims: 800-925-9126 (Texas Medicaid & Healthcare Partnership contact center, select option 5)

For client questions or to find a provider: 800-335-8957 (select a language, then select option 5)

By email:

For potential and/or current client questions related to the HHSC FPP: famplan@hhs.texas.gov

For provider questions related to HHSC FPP billing/claims: healthytexaswomen@tmhp.com

For questions related to your HHSC FPP contract: psps_contracts@hhs.texas.gov

For questions related to HHSC FPP policy and clinical guidelines: famplan@hhs.texas.gov