Family Planning Only

What is Family Planning Only?

Family Planning Only provides coverage to individuals for family planning services to help them take charge of their lives and prevent unintended pregnancies.

More information

Family Planning Only coverage brochure | Cobertura solamente para planificación familiar (Spanish brochure)

What services are covered?

Family Planning Only covers:

• One comprehensive preventive family planning visit every year (365 days) based on nationally recognized clinical guidelines and any necessary family planning-related follow-up visits.
• Counseling, education, and/or risk reduction.
• Education and supplies for Food and Drug Administration (FDA) approved contraceptives, natural family planning, and/or abstinence.
• Permanent methods such as tubal sterilization (tubes tied), or vasectomy.
• When appropriate, pregnancy testing.
• Sexually transmitted infection screening, testing, and treatment, when clinically appropriate, according to nationally recognized guidelines, or medically necessary for safe and effective use of the client’s chosen contraceptive method.
• Cervical cancer screening
• Human papillomavirus (HPV) and Hepatitis B vaccinations.

Am I eligible?

You may be eligible if you have annual household income at or below the amounts below* and are:

• Uninsured and not eligible for Apple Health (Medicaid) coverage**, or
• Insured and seeking confidential family planning services.

*The income standards listed in these examples are subject to change annually every April.
**You can also make an informed choice to waive your right to apply for Apple Health on the Family Planning Only application.

How do I apply?

First, go to Washington Healthplanfinder or call 1-855-923-4633 to learn if you are eligible for Apple Health coverage or a subsidized Qualified Health Plan with full health care coverage, which includes family planning.

If you're not eligible for Apple Health, make an informed choice to waive your right to apply for Apple Health, or you need confidential services, contact your Apple Health provider and apply for benefits over the phone or in-person. There are many assisters across the state that can help with navigating health care coverage. Learn how to get help with coverage.

If you're a teen, you may be eligible for Apple Health coverage on your own. Read more information about health coverage for teens and young adults. Visit the Department of Health's (DOH) Teen Hub for other questions related to reproductive health and resources.

You can also apply by:

• Fax: 1-866-841-2267
• Email: Apple Health
• Phone: call the Health Care Authority (HCA) at 1-800-562-3022 ext. 12533 (translation services available)
• Mail: HCA MEDS, PO Box 45531, Olympia, WA 98504-5531 without provider assistance.
  • Securely transmit or mail the Application for Family Planning Only services (translated forms available).

You can reapply for Family Planning Only coverage every 12 months, as long as you are eligible.

What does it mean to apply for confidential services?

You have the option to seek confidential family planning services when applying for Family Planning Only coverage. Selecting this option will put you under a protected status in which you:

• Choose a preferred mailing address,
• Don’t have Explanation of Benefits (EOB) mailed to you, and
• Are routed to a live person instead of an automated system when you call in.

Where can I get services?

Services are available from any eligible Apple Health provider. Find a provider who accepts Apple Health. Your provider will help you fill prescriptions at the pharmacy of your choice.

What are covered methods for preventing pregnancy?

Contraception (commonly referred to as birth control), including all FDA-approved contraceptive methods, such as pills, patches, intrauterine devices (IUDs), implants, and more are covered.

HCA reimburses certain over the counter (OTC) family planning supplies without a prescription. Per Apple Health policy, the following OTC contraceptives may be dispensed without a prescription:

• Condoms (including internal condoms)
• Spermicides (foam, gel, suppositories, and cream)
• Emergency contraception
• Oral contraception (birth control pills)

Read the flyer on how to access OTCs for Apple Health clients.

Emergency contraception is a covered benefit and can be provided by any Apple Health provider. Apple Health also covers over-the-counter emergency contraception from pharmacies without a prescription.

Hormonal contraception, prescriptions, and OTC can be filled in 12-month supplies unless indicated otherwise by prescribers or clients. Supply may vary by pharmacy.

To access contraceptive supplies at the pharmacy, you will need to go to the pharmacy counter (not the retail counter) with your Apple Health ProviderOne services card.

View the Family Planning billing guide for more coverage details.

Waiver authority for the program

On May 9, 2018, the Health Care Authority (the Agency) received approval for renewal of the Section 1115 Family Planning Only Demonstration Waiver for five years (through June 2023). The approval letter, Special Terms and Conditions, and Expenditure Authority can be found on CMS’s website under Washington Family Planning Only Program and then clicking on “Demonstration Approval.”

The Health Care Authority intends to submit an application to extend the Section 1115 Family Planning Only Demonstration Waiver for five years (through July 2028). The current waiver, which expired on June 30, 2023, covers limited family planning and family planning-related services for people in need of contraceptive care and enrolled in Family Planning Only program. The purpose, client eligibility requirements, and benefit package will remain the same. The only potential change is the elimination of the family planning pregnancy-related program, due to implementation of the After-Pregnancy Coverage program.

• Public notice for additional 30-day public comment period on Family Planning Only Demonstration Waiver renewal application (12/19/22-01/19/23).
• Draft application for the Section 1115 Family Planning Only Demonstration Waiver, updated 12/22.
• Interim evaluation report for the current cycle of the 1115 Family Planning Only Demonstration Waiver, submitted to CMS on 11/30/22.
• Interim evaluation report CMS approval letter.
• Draft application for the Section 1115 Family Planning Only Demonstration Waiver, updated 9/22.
• HCA response for FPO waiver webinar public comment period from September 30, 2022 submission.
• Slides from the public hearing held on June 30, 2022.
• Washington Family Planning Only Demonstration Temporary Extension (through June 30, 2024) letter.
• Family Planning Only extension acceptance letter, 5/25.
• Washington Family Planning Only Program - CMS Extension Approval, 4/25.