WSR 17-20-066
[Filed October 2, 2017, 11:39 a.m.]
Title or Subject: Section 1115 Extension Application.
Effective Date: January 1, 2018.
Description: The health care authority (the agency) intends to submit an application to extend the Section 1115 Family Planning Only Demonstration Waiver for five years (through December 2022). The current waiver expires on December 31, 2017. It covers limited family planning and family planning-related services for women and men who are enrolled in the agency's two programs -- Family planning only extension and take charge.
The purpose, client eligibility requirements, and benefit package will remain the same. The name will change to family planning only to reduce confusion inherent in two program names.
The purpose of the family planning only program is to:
Assure access to family planning services.
Decrease unintended pregnancies and births.
Lengthen intervals between births.
Reduce state and federal medicaid expenditures for averted births from unintended pregnancies.
The following groups are eligible for services under the family planning only program:
Recently pregnant women who lose medicaid coverage after their pregnancy coverage ends. These women are automatically enrolled for ten months.
Uninsured women and men with family incomes at or below two hundred sixty percent federal poverty level (FPL), seeking to prevent an unintended pregnancy.
Teens and domestic violence victims who need confidential family planning services and are covered under their perpetrator's or parent's health insurance and are at or below two hundred sixty percent FPL.
Coverage is for twelve months, starting on the first day of the month the application was signed. Applications are available on the agency web site or at specified providers who can assist with completion of the application. Services are currently provided at specified clinics across Washington state (listed on the agency web site).
The family planning only program provides the following services on a fee-for-service basis: All FDA-approved contraceptives; natural family planning; over-the-counter contraception; emergency contraception; sterilization; contraceptive education, counseling, and management; limited STI/STD testing and treatment related to successful use of the chosen contraceptive method; cervical cancer screening according to national clinical guidelines when associated with a family planning visit; office visits and limited ancillary services related to the above services. There are no cost-sharing requirements to receive services under this program.
Because eligibility and services will remain the same, this extension is anticipated to have no effect on annual aggregate expenditures or enrollment. Based on fiscal year 2016 experience we expect enrollment of approximately four thousand clients with an expenditure of $1.5 million for each year of the five year renewal period.
Washington will evaluate two goals of the 1115 family planning only demonstration, (a) ensure access to family planning and/or family planning-related services and (b) improve or maintain health outcomes for the target population as a result of access to family planning and/or family planning-related services by testing the following hypotheses:
1. Enrollees will utilize family planning services and/or family planning related services.
2. Beneficiaries will maintain coverage for one or more 12 month enrollment period.
3. Health outcomes will improve as a result of the demonstration.
4. Beneficiaries will have a higher rate of using more effective contraceptive methods compared to other members of Medicaid beneficiaries.
This evaluation will use comparative quantitative analysis of administrative data for two groups: The demonstration population and the general medicaid population. Data sources include the agency's claims files and a database that joins birth certificate data with claims data called the first steps database. Details of the evaluation design can be found in the extension application.
The demonstration's expenditure authority falls under the state's Title XIX plan and section 1115 (a)(2) of the Social Security Act. Requirements not applicable to the expenditure authorities are:
1. Methods of Administration: Transportation: Section 1902 (a)(4) insofar as it incorporates 42 C.F.R. 431.53. To the extent necessary to enable the state to not assure transportation to and from providers for the demonstration population.
2. Amount, Duration, and Scope of Services (Comparability): Section 1902 (a)(10)(B). To the extent necessary to allow the state to offer the demonstration population a benefit package consisting only of family planning services and family planning-related services.
3. Prospective Payment for Federally Qualified Health Centers and Rural Health Centers and Rural Health Clinics: Section 1902 (a)(15). To the extent necessary for the state to establish reimbursement levels to these clinics that will compensate them solely for family planning and family planning-related services.
4. Eligibility Procedures: Section 1902 (a)(17). To the extent necessary to allow the state to not include parental income when determining a minor's (individual under age eighteen) eligibility for the family planning demonstration. To the extent necessary to allow the state to not require reporting of changes in income or household size for twelve months, for a person found income-eligible upon application or annual redetermination when determining eligibility for the family planning demonstration.
5. Retroactive Coverage: Section 1902 (a)(34). To the extent necessary to enable the state to not provide medical assistance to the demonstration population for any time prior to the first of the month in which an application for the demonstration is made.
6. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT): Section 1902 (a)(43)(A). To the extent necessary to enable the state to not furnish or arrange for EPSDT services to the demonstration population.
A link to the full public notice for the family planning only waiver extension application can be found at The agency updates this web page regularly.
Comment: The public comment period for the family planning only demonstration waiver extension application is from Wednesday, October 18 through Friday, November 17 at 5 p.m. PST. You can email comments to, fax comments to 360-725-1152, or mail comments to the address below. A copy of the draft application is available at
Two public meetings are scheduled. The agency will accept verbal and written comments at these meetings. The meetings are:
Webinar: Wednesday, October 25, 1:00-2 p.m.
Join online:
To use phone for audio: +1 (914) 614-3221
Access Code: 132-623-897
Audio PIN: Shown after joining the webinar
In Person: 626 8th Avenue S.E., Olympia, WA 98501, Room 127 - Apple Sign in at the reception desk and get a visitor badge.
Title XIX Advisory Committee Meeting
Friday, November 3, 8:30–12:00 p.m.
Call-in: 1-888-407-5039; Participant pin: 91312278
In Person: 626 8th Avenue S.E., Olympia, WA 98501; Room TBA
Sign in at the reception desk and get a visitor badge.
For additional information or a hard copy of the application, please contact Washington State Health Care Authority, Attn. Anaya Balter, Clinical Director for Women's Health, P.O. Box 45502, Olympia, WA 98504-5502, phone 360-725-1652, TDD/TTY 1-800-848-5429, fax 360-725-1152, email, web site Take charge page; public notice page