Provider Notice issued 07/01/2026

Hospital Services Covered Under the Family Planning Program

This notice provides clarification to hospital providers regarding covered services under the Family Planning Program. Specifically, hospitals should reference the ‘Hospital Services (837I)’ tab of the Excel version of the Family Planning fee schedule on HFS’ Medicaid Reimbursements webpage for a list of covered hospital services.

The Healthcare and Family Services (HFS) Family Planning Program offers limited medical coverage for reproductive health and family planning related services for eligible Illinois residents, regardless of age or gender, who are not enrolled in full benefit Medicaid coverage. Starting November 30, 2022, eligible enrollees who do not qualify for full benefits are automatically enrolled into the HFS Family Planning Program unless they opt out. All program enrollees are covered via fee-for-service, billed directly to the Department and are not enrolled in HealthChoice Illinois plans. As with all other Medicaid programs, recipient eligibility may be verified using MEDI, where a limited coverage case type of ‘Family Planning Services’ will be returned, or the Automated Voice Response System (AVRS) at 1-800-842-1461.  On the EDI 271 Healthcare Eligibility/Benefit Response, indicator 82 and ‘Family Planning Services’ will be returned.

Eligible individuals can receive family planning and related services at no out-of-pocket cost. Examples of covered services include an annual preventive exam, STI testing and treatment including HIV screening and prevention (PrEP/PEP), all Food and Drug Administration (FDA)-approved methods of contraception, and certain preconception care and cancer screenings. 

Covered hospital-based procedures include, screening mammograms, abdominal/uterine ultrasounds, colposcopies and LEEP, hysteroscopies, D&Cs, tubal ligations and vasectomies. Hospitals should review the fee schedule to ensure covered services are correctly billed to the Department instead of the patient. See the fee schedule linked above for a full list. 

Covered services are the same during the short-term, family planning presumptive eligibility (FPPE) period and for ongoing coverage. 

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.

Laura Phelan, Administrator
Division of Medical Programs