Family Planning Presumptive Eligibility (FPE) is a short-term coverage program for Maryland Medicaid family planning benefits. FPE is designed to provide a pathway to longer-term Medicaid Family Planning Program coverage by allowing participants to have timely access to family planning health care services through an on-site, temporary eligibility determination. Individuals may apply for FPE at any participating Maryland Family Planning Program Delegate Service Site.
Family planning services include:
● Advice about birth control methods;
● Physical exams, including pelvic and breast exams;
● Screenings, such as pap smears and for sexually transmitted infections, when done as part of the family planning visit;
● Birth control pills and devices, such as IUDs;
● Emergency contraception; and
● Permanent sterilization (must be aged 21 or over).
The Family Planning Program and FPE do not cover any other health care services except family planning services. The Family Planning Program and FPE do not cover prenatal, abortion, or infertility services.
Maryland Family Planning Program Delegate Service Sites authorized to serve as Qualified Entities may perform FPE determinations. If an individual is found eligible for FPE, the Maryland Family Planning Program Delegate Service Site may bill for services covered under the Maryland Medicaid Family Planning Program during a temporary coverage period of up to 60 days even if the individual is ultimately determined to be ineligible for the Family Planning Program or comprehensive benefits through Medicaid or the Maryland Children’s Health Insurance Program (MCHP).
Individuals may apply for FPE at any participating Maryland Family Planning Program Delegate Service Site. They must provide true and accurate information about their income and family circumstances on the FPE application. FPE coverage begins on the day the eligibility determination is made. An individual is eligible for one period of FPE coverage in any twelve-month period.
Maryland Family Planning Program Delegate Service SItes: How to Become a Qualified Entity
To become a qualified entity, a provider must be a registered Maryland Family Planning Program Delegate Service Site and an actively enrolled Maryland Medicaid provider. Qualified entities must enter into an agreement with MDH, which governs responsibilities related to FPE determinations, training obligations, privacy requirements, and access to the Maryland Health Connection Presumptive Eligibility Portal.
To become a qualified entity, please complete the agreement form located below and submit here.
FPE Entity Agreement: Must be completed in order to become an FPEQE. Submit completed forms here.
FPE Worker Agreement: Must be completed for each FPE Worker before they may access the Maryland Health Connection FPE Portal. Submit completed forms here.
FPE Training Slides
FPE Training Video
Please direct questions regarding FPE to firstname.lastname@example.org.