Extended Family Planning
Extended Family Planning (EFP) is automatically processed for pregnant women. This user guide describes the automated process.
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Women, who receive pregnancy-related Medicaid, are eligible to receive EFP benefits after their pregnancy terminates. EFP covers contraception and contraceptive services; screening and treatment for sexually transmitted infections; physical exams and laboratory tests related to family planning; drugs, supplies or devices related to women's health services; and patient education and counseling. |
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The EFP batch process is used only when a pregnant woman does not report the termination of her pregnancy or the birth of her child. For women who do report, eligibility for EFP is performed online as part of change reporting.
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Process Steps
To process the automatic enrollment of a pregnant woman in EFP:
1. A batch process runs on the first day of the month to identify women whose pregnancy related Medicaid will terminate at the end of the month.
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Pregnancy related Medicaid ends two months after the pregnancy due date as reported on the pregnant woman’s application. |
2. In the batch process, Medicaid eligibility is redetermined.
3. If a woman is not eligible for continued Medicaid, she is determined eligible for EFP.
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EFP eligibility is granted for a 12 month period. Women may be eligible for an additional 12 months of EFP coverage. |
4. Since EFP does not offer full Medicaid coverage, the system also checks eligibility for QHP, APTC, or CSR eligibility.
5. A Change in Benefits Notice informing the woman that her Medicaid benefits will be reduced is generated.
6. A Combined Notice of Eligibility generates, informing the woman of her new EFP eligibility and her QHP, APTC, or CSR eligibility, as appropriate.
Results of the Procedure
The applicant’s eligibility status changes from pregnancy-related Medicaid to Extended Family Planning. If eligible, the applicant can also choose to enroll in QHP, CSR, or APTC health plans.
