Medicaid of NC: Family Planning Update

Attention: ‘Be Smart’ Family Planning Service Providers

‘Be Smart’ Program Transitions from Waiver to State Plan Amendment

An amendment to the Medicaid State Plan was approved by the Centers for Medicare & Medicaid Services (CMS) to convert the "Be Smart" Family Planning Waiver - to the "Be Smart" Family Planning Program, effective October 1, 2014.
The name change reflects that the program is no longer a waiver (demonstration), but the "Be Smart" designation will be maintained to minimize confusion.
Under the "Be Smart" program, eligible beneficiaries receive basic family planning services and supplies: annual exams and physicals, most FDA-approved birth control, screenings and treatment for sexually transmitted infections, screening for HIV, and sterilizations for both women and men.
Changes to the "Be Smart" program associated with the State Plan Amendment include:

• Expanded coverage to include the same family planning services and supplies that general (full-coverage) Medicaid beneficiaries receive. The program will continue to cover one annual exam or physical per year and up to six inter-periodic visits per year.


• Removal of eligibility restrictions based on age. It will cover family planning services and supplies to all individuals who meet the state's income and other eligibility guidelines.


• Expanded coverage, screening and treatment for sexually transmitted infections (STI) and screening for HIV, which can occur at any of the six inter-periodic family planning visits per year. Under the Waiver, screening and treatment for STIs and screening for HIV was limited to one visit and one course of treatment per year, all of which were required to be performed in conjunction with, or pursuant to, the annual exam.


• Coverage of non-emergency medical transportation to and from family planning appointments. This service was not previously covered under the Waiver.

Examples of services not covered under the new program are:

• Emergency room visits 


• Ambulance services


• Inpatient hospital services


• Treatment for complicated women's health care problems, such as endometriosis


• Non-family planning services, including psychological and psychiatric services, infertility services, hysterectomies, abortions, AIDS and cancer treatment, dental and optical services, chiropractic services, or services required to manage or treat a medical condition, such as diabetes or hypertension, and,


• Other health care problems discovered during a screening, such as breast lumps.

Eligible beneficiaries of the new family planning program will have incomes of no greater than 195% of the federal poverty level. There are no co-payments for the "Be Smart" program.
More information about the "Be Smart" Family Planning Program can be found on DMA's Family Planning web page at www.ndhhs.gov/dma/services/familyplanning.htm.
‘Be Smart’ Family Planning Program
DMA, 919-855-4260
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