Provider Notice issued 08/02/2023

The Illinois Department of Healthcare and Family Services (HFS) launched the HFS Family Planning (FP) Program, a new category of medical coverage for Illinoisans, effective November 30, 2022. The 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. All program enrollees will be covered via fee-for-service.

Eligibility

This program includes a presumptive eligibility (PE) component as well as ongoing coverage. Just as with Medicaid Presumptive Eligibility for pregnant individuals (MPE), FP Presumptive Eligibility (FPPE) is short-term, and a full application needs to be completed for ongoing coverage under the FP Program. FPPE coverage is available regardless of immigration status.

For this program, only the individual’s income is counted (not the household income). The current income eligibility is up to $3,250 per month for an individual. This amount will be adjusted annually. Applicants can request 90 days of retroactive eligibility on their applications for ongoing coverage. Specific eligibility criteria for this program can be found on the HFS Family Planning Program page for customers, as well as our MPE and FPPE Provider page that will include training materials for providers. Standard citizenship and immigration status rules apply for ongoing coverage under the HFS Family Planning Program.   

HFS Family Planning Program Covered Services

Eligible individuals can receive family planning and related services. Examples of covered services include an annual preventive exam, all Food and Drug Administration (FDA)-approved methods of contraception, and permanent methods of birth control (tubal ligation or vasectomy). Additional examples include cervical cancer screening and treatment, screening mammograms, breast cancer gene (BRCA) genetic counseling and testing as applicable, vaccines that support reproductive health, abortion care, and transportation for family planning visits.  

Covered services are the same during the presumptive eligibility period and for ongoing coverage. The services covered under the HFS Family Planning Program’s partial Medicaid benefit package are posted on a new HFS Family Planning Program fee schedule on HFS’ Medicaid Reimbursements webpage. For any services required due to medical complications that are not identified in the fee schedule, providers must submit attachment detail with their electronic claim for HFS review.

Provider Requirements

PE for this program is determined by MPE providers certified by the Department just as they now determine MPE coverage for pregnant individuals. In accordance with federal requirements, the HFS Family Planning providers must enter into and abide by the terms of an MPE/FPPE Provider Agreement with HFS.

All current MPE providers and new medical facilities wishing to become FPPE providers will need to complete a revised Presumptive Eligibility Provider Agreement that incorporates language on FPPE and MPE and must complete HFS training. If you are a provider planning to apply to become an HFS Family Planning PE provider, you must submit your new agreement prior to using this new function in the ABE Provider Portal. If you are an MPE provider that does not intend to use this new function you will still need to complete the new agreement, but your deadline to submit the new agreement will be October 1, 2023. To obtain the new agreement send your request to HFS.MPE.FPproviders@illinois.gov.

Additional information, including an ABE Guide and a training Webinar schedule, is posted on the HFS MPE and FPPE Provider page.

Illinois Department of Public Health (IDPH) Illinois Family Planning Program

The IDPH Illinois Family Planning Program provides family planning services to individuals who are under-insured, uninsured, or insured but otherwise lack access to health care through state and federal Title X support. Providers should help connect individuals to the IDPH Illinois Family Planning Program when they are not eligible for coverage under the HFS Family Planning Program. This includes individuals who are:

·over the HFS Family Planning Program’s income limit

·not eligible for ongoing coverage under the HFS Family Planning Program due to their immigration status

·non-Illinois residents

·individuals seeking additional privacy, including minors who cannot sign their own Medicaid applications

Title X providers can be found at the Office of Population Affairs Family Planning Clinic locator website: https://opa-fpclinicdb.hhs.gov/. IDPH Illinois Family Planning Program providers offer family planning services via telehealth.

Questions regarding this notice may be directed to HFS.MPE.FPproviders@illinois.gov.

Kelly Cunningham, Administrator
Division of Medical Programs