Family Planning Benefit Program
What is the Family Planning Benefit Program (FPBP)?
The FPBP is a public health insurance program for New Yorkers who need family planning services, but may not be able to afford them. It is intended to increase access to confidential family planning services and to enable teens, women and men of childbearing age to prevent and/or reduce the incidence of unintentional pregnancies.
How do I know if I qualify for the FPBP?
You may be eligible for the FPBP if:
- You are a female or male of childbearing age;
- You are a New York State resident;
- You are a U. S. citizen*, national**, Native American, or have satisfactory immigration status;
- You meet certain income requirements (currently under 223% of the Federal Poverty Level) ; and
- You are not already enrolled in Medicaid or Family Health Plus.
You may still be eligible for the FPBP if you are already covered by other health insurance (including Child Health Plus) but you wish to apply only for Family Planning Services coverage. You may choose to apply only for the Family Planning Benefit Program and not to apply for Medicaid/Family Health Plus/Child Health Plus comprehensive public health insurance coverage.
*United States Citizen: For the purposes of qualifying as a United States citizen, the United States includes the 50 states, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands and the Northern Mariana Islands. Nationals from American Samoa or Swain's Island are also regarded as United States citizens for the purpose of Medicaid eligibility.
**National: A "national" is a person who is not a U.S. citizen, but who owes permanent allegiance to the United States and may enter and work in the U.S. without restriction. A "national" who is otherwise qualified may, if he becomes a resident of any state, be naturalized upon completing the applicable requirements. Examples of nationals are: (1) persons born in American Samoa and Swain's Island after December 24, 1952; and (2) residents of the Northern Mariana Islands who did not elect to become U.S. citizens.
What health services are covered by the FPBP?
Family Planning Services include:
- Most FDA approved birth control methods, devices, and supplies (e.g., birth control pills, injectables, or patches, condoms, diaphragms, IUDs)
- Emergency contraception services and follow-up care
- Male and female sterilization
- Preconception counseling and preventive screening and family planning options before pregnancy
- Transportation to family planning visits
- Retroactive coverage (up to 3 months, if eligible)
The following additional services are considered family planning only when provided within the context of a family planning visit and when the service provided is directly related to family planning:
- Pregnancy testing and counseling
- Comprehensive health history and physical examination, including breast exam and referrals to primary care providers as indicated (Mammograms are not covered).
- Screening and treatment for sexually transmitted infections (STI's)
- Screening for cervical cancer and urinary tract or female-related infections
- Screening and related diagnostic laboratory testing for medical conditions that affect the choice of birth control, e.g. a history of diabetes, high blood pressure, smoking, blood clots, etc.
- HIV counseling and testing
- Counseling services related to pregnancy, informed consent, and STD/HIV risk counseling
- Bone density scan (only for women who plan to use or are currently using Depo-Provera)
- Ultrasound (to assess placement of an intrauterine device)
If you are eligible for the FPBP, you will receive a Common Benefit Identification Card (CBIC), if you do not already have one, which must be used each time you need covered Family Planning services. Recipient co-pays are not required for covered Family Planning Services. Family Planning Benefit Program recipients are exempt from Managed Care Health Insurance Plan enrollment.
Where do I get family planning services covered by the FPBP?
There are many health care providers that can provide confidential family planning services under this program, including hospital based and free-standing clinics, family planning clinics, county health department clinics, federally qualified health centers, rural health centers, obstetricians and gynecologists, physicians, licensed midwives, nurse practitioners, pharmacies, and laboratories. If you need help in locating a Medicaid enrolled family planning provider in your area, please call toll free at 1-800-541-2831 for assistance.
How do I apply for the FPBP?
You can go to a Family Planning Services Provider for a presumptive eligibility screening and/or to get an FPBP application and enrollment assistance. You may access a list of these locations by visiting our website at Family Planning Program Sites.
If you need your application to remain completely confidential with regard to your residence address, you must clearly tell us this on your application and give us a safe and confidential mailing address and contact phone number so we may reach you if needed to further determine your eligibility for the FPBP
What do I need to provide with my application when applying for the FPBP?
You will need to bring or send in documentation for each of the items listed below:
- Full legal name as it appears on your birth certificate
- Social Security Number (you do not have to provide the actual card, just the number)
- Proof of your citizenship or immigration status. If you are a U.S. citizen (born in the U.S. or one of its territories) and provide a valid Social Security Number (SSN), a match with Social Security Administration (SSA) will verify your SSN, date of birth/age and U.S citizenship. If SSA verifies this information, no further proof is needed. The SSA match cannot verify birth information for a naturalized citizen. You will need proof of naturalization (e.g., Naturalization Certificate (N-550 or N-570) or a U.S. passport)
- Proof of your age (if not verified by SSA), like a birth certificate, or a passport
- Proof of earned income, like recent paycheck stubs (if you are working), a letter from your employer or a 3 month profit and loss statement if you are self-employed
- Proof of your unearned income, from sources like Social Security Benefits, NYS Disability Benefits, or Unemployment Benefits
- Proof of where you live, like a rent receipt, letter from your landlord, mortgage statement, or postmarked non-window envelope from mail you received recently
- Health Insurance benefit card or policy statements (if you are covered by any other health insurance)
- You do not need to bring or send in proof of your resources, such as bank statements, vehicles you own or insurance policies. Resources are not counted in determining eligibility for the FPBP.
How do I know if my income qualifies me for the FPBP?
The chart below shows how much income you can receive in a month and still qualify for the FPBP. The income levels depend on the number of your family members who live with you .
|Number in Family||Monthly Gross Income|
|For each additional person, add:||$774|
- *Income levels are subject to yearly adjustments.
Gross income refers to the income before any taxes or deductions are taken.
The income of the person applying will only be used in the eligibility determination.
What are my rights when applying for the FPBP?
Refer to the Medicaid page of this site for information regarding your right to a timely eligibility determination and your right to appeal an eligibility decision if you are dissatisfied. Even if you are initially denied for the FPBP, your circumstances may change and you may reapply at any time.
What do I do if I have more Questions?
Any questions regarding this program may be addressed to: Medicaid@health.state.ny.us , or you may call 1-800-541-2831 for further information.