Extended Family Planning Services Recipient -
Approval Notice
Recipient's name: ________________________________
Your application for extended family planning benefits under a special
Medicaid program has been APPROVED. Your eligibility is approved
from __________ through __________, not to exceed one year. It will be
necessary to reapply to continue to be eligible for this special
program.
Under this program, Medicaid will pay for:
- Physical exams including a pap smear
- Birth control supplies such as pills, depo (the shot),
condoms and diaphragms
- Pregnancy tests and limited treatment for sexually transmitted
diseases
You can receive these family planning services from any Medicaid
provider, such as, a doctor (family practitioner, OB/GYN), certified
nurse midwife, nurse practitioner, physician assistant, or a county
health department, family planning center, a birthing center, or a
rural or federal health clinic.
If you have concerns or questions about program services, please
contact your local county health department.
