How States Can Leverage Medicaid Family Planning Programs to Keep People Covered Following HR 1 Implementation 

Changes to Medicaid under HR 1, or the One Big Beautiful Bill Act (OBBBA), are expected to result in more than 10 million people losing health care coverage. However, many states have a little-known tool that can catch people with another form of safety net coverage: Medicaid Family Planning Programs (MFPPs).  

MFPP are partial-benefit Medicaid programs that provide coverage for a broad suite of sexual and reproductive health services and related preventative care. Thirty-four states have MFPPs on the books, but enrollment and utilization are often low because providers and patients are unaware of this coverage and the scope of the benefit. MFPPs have higher-income eligibility limits than Medicaid ACA expansion, and enrollees are not subject to work or community engagement requirements nor twice per year redeterminations. The programs can also protect coverage for new moms who do not qualify for full benefits once their postpartum coverage ends. States working to mitigate coverage loss can incorporate MFPP coverage into their strategies by making MFPP enrollment easy, expanding covered services, and ensuring patients know how and where to use their coverage. 

What States Can and Should Do Now to Maximize MFPP Coverage 

Maximize Covered Services 

Family planning and related care is more than just birth control. MFPPs facilitate access to many of the basic services that patients receive from primary care clinicians but might not think of as family planning. This includes well-person annual physicals, pap smears, sexually transmitted infection testing, HIV prevention, and screening lab tests with zero out-of-pocket cost. In many states, both men and women are eligible for this coverage. 

States can review MFPP fee schedules and covered codes to ensure their program is providing robust coverage. Robust MFPP coverage both keeps people connected to clinically recommended care and is fiscally responsible for the state. The federal government pays for 90% of the costs of family planning care provided under Medicaid, including MFPPs, and pays for family planning-related services at the regular federal medical assistance program, or FMAP, rate. Maximizing covered services improves patient care while saving state dollars by preventing unplanned or mistimed pregnancies and helping to ensure medical conditions are managed. 

Make Enrollment Easy 

To protect coverage and prevent churn, states can simplify MFPP enrollment by incorporating MFPP applications into their streamlined application for other health insurance and medical assistance and using “opt-out” enrollment.  

Among states with MFPPs, 17 have an “opt-in” application, requiring medical assistance applicants to select “yes” in response to a prompt like “Do you want to apply for family planning services?” to be considered for MFPP coverage. (See table.) Under this design, individuals who don’t see themselves as in need of family planning services because they aren’t ready for a family or don’t consider themselves in need of contraception, but would nevertheless benefit from no-cost, related reproductive health care, may choose not to opt in. Not only do these individuals risk losing access to covered care, community health centers and other safety-net providers will see increases in uncompensated care. In addition, enrolling and disenrolling people from Medicaid is costly for states. 

Under an opt-out application, which is used in Illinois and Texas, qualified applicants who otherwise would go without any coverage are enrolled in MFPP coverage unless they deselected the option to apply for it. Other states have a “cascading application” with no opt in/out box, which automatically considers applicants for MFPP coverage if they are ineligible for full benefits. In 2026, Connecticut transitioned to a cascading application and Illinois transitioned to an “opt-out.” Within months, each saw a 200% increase in MFPP enrollment, demonstrating that making enrollment more accessible quickly connects people to coverage.  

Opt-out and cascade applications are especially important in light of HR 1. With these application types, all individuals except those who deselect the option will be enrolled in MFPP coverage through the ex parte renewal process at redetermination if they qualify and are no longer eligible for full benefits. While implementing an opt-out application for new applicants, states can add a pop-up in online redetermination portals that informs redeterminees they will be considered for MFPP coverage if ineligible for full coverage, unless they opt-out. This change will ensure eligible people can seamlessly transition to MFPP coverage instead of being disenrolled from the Medicaid program. 

Finally, states can improve enrollment processes by adopting presumptive eligibility under the state’s MFPP. Presumptive eligibility allows access to immediate, temporary family planning coverage at the point of care. This is especially crucial in states without real-time eligibility determinations for Medicaid. With presumptive eligibility, providers can quickly enroll uninsured patients, reducing barriers to patient care and improving community health center sustainability. 

Help Patients Understand Their Coverage and Options 

Not all patients who qualify for MFPP coverage will consider themselves in need of “family planning” coverage. Helping patients understand the full scope of MFPP benefits can reduce stigma, increase enrollment, and keep more patients connected to coverage and care.   

States can improve patient understanding of MFPP benefits by developing clear, plain-language messaging that highlights MFPP eligibility and covered services, including services that benefit men and people who may not currently be planning for a family. States should include clear instructions on how to enroll in coverage and where to use benefits in patient-friendly materials. Partnering with trusted, safety-net providers in communities can help ensure consistent messaging and patient education. Primary care associations, sexual and reproductive health care providers, and community-based organizations that work with people to access resources are well-positioned to share program information with the patients and clients they’ve already built relationships with. Such partnership also improves providers’ understanding of the program, leading to greater confidence using the program to reimburse the care they provide.  

 A Powerful Tool to Protect Coverage and Safety-Net Providers 

Maximizing MFPPs, including enrollment, covered service, and member messaging, will ensure more people are served in the MFPP safety net instead of becoming entirely uninsured amidst H.R.1 cuts. These programs can help lower uninsured rates and reduce uncompensated care, thereby supporting the sustainability of community health centers and other safety-net providers facing an influx of uninsured patients. MFPPs are a powerful tool that is already in the toolbox for most states. ICAN! provides no-cost training and technical assistance to states, policymakers, and providers on MFPPs and can support states as they leverage these tools to protect access to care at this critical moment.