Subject: Waiver renewal.

     Effective Date: Upon approval by Centers for Medicare and Medicaid Services (CMS).

     Document Description: Services available to men and women with incomes at or below two hundred percent of the federal poverty level with a goal of reducing unintended pregnancy.

     The objectives of TAKE CHARGE are:

•	Decrease the number of unintended pregnancies;
•	Increase the use of contraceptive methods;
•	Increase the availability of family planning services for low-income men and women; and
•	Raise the providers' awareness regarding the importance of client centered education, counseling and risk reduction to increase successful use of contraceptive methods.

     The TAKE CHARGE program is for both men and women. To be eligible, an applicant must:

•	Be a United States citizen;
•	Be a resident of Washington state;
•	Have income at or below two hundred percent of the federal poverty level;
•	Apply voluntarily for family planning services at the office or clinic of a TAKE CHARGE provider; and
•	Need family planning services but have no family planning coverage through another MPA program or health insurance plan.

     Clients who are pregnant, sterilized, in the military on active duty, or incarcerated are not eligible for TAKE CHARGE.

     Covered Services for Women:

•	An initial or annual comprehensive family planning preventive medicine visit with some limited STD screening.
•	Cervical, vaginal and breast cancer screening at the time of the annual exam or as medically necessary.
•	Office visits directly related to a family planning problem when medically necessary.
•	FDA approved prescription and nonprescription contraceptives.
•	Sterilization.

     Covered Services For Men:

•	FDA approved nonprescription contraceptive methods including condoms and spermicides.
•	Education and counseling for risk reduction for those men whose female partners are at risk for unintended pregnancy.
•	Vasectomy.

     If you would like to provide official written comments or would like more information regarding the TAKE CHARGE waiver renewal, please contact Maureen Considine, ARNP, by June 1, 2011. (See contact information below.)

     To receive a copy of the interpretive or policy statements, contact Maureen Considine, ARNP, TAKE CHARGE Family Planning, P.O. Box 45530, Olympia, WA 98504-5530, phone (360) 725-1652, fax (360) 664-4371, e-mail Maureen.considine@dshs.wa.gov.

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