Family Planning Medicaid in Georgia operates as a limited-benefit health program known as Planning for Healthy Babies (P4HB). This state initiative aims to reduce unintended pregnancies and improve birth spacing by providing comprehensive family planning and preventative services. The P4HB program focuses specifically on reproductive health care to help eligible Georgia residents prevent or delay pregnancy. This program is not a substitute for full Medicaid coverage or standard health insurance.
Who Qualifies for Georgia’s Family Planning Coverage
The Georgia Department of Community Health (DCH) established eligibility requirements for the P4HB program, primarily targeting women who lack comprehensive health insurance. Applicants must be Georgia residents, capable of becoming pregnant, and between the ages of 18 and 44. A requirement for enrollment is that the applicant must not be eligible for full Medicaid coverage or any other managed care program.
Financial eligibility is determined by household income, which cannot exceed 211% of the Federal Poverty Level (FPL). This income threshold is higher than the limits for many traditional Medicaid categories, allowing more low-income women to qualify. Applicants must also be either U.S. citizens or legally residing non-citizens.
Specific Healthcare Services Covered
The P4HB program offers services strictly limited to family planning and preventative reproductive health care. Comprehensive contraceptive methods and supplies are covered at no cost. These include long-acting reversible contraceptives (LARCs) like IUDs and implants, shorter-term options such as pills, patches, and injections, and barrier methods and emergency contraception supplies.
Routine gynecological and preventative examinations are included, such as annual physical exams, pelvic exams, and Pap tests for cervical cancer screening. The program also covers necessary procedures for permanent contraception, specifically tubal ligation, for women who meet age and consent requirements. Treatment for complications arising from sterilization procedures is also covered.
Testing and treatment for Sexually Transmitted Infections (STIs) are covered, provided the infection is diagnosed during a family planning visit. This includes medication and follow-up care for common STIs. Enrollees also receive family planning counseling, patient education, and referrals to other social services or primary health care providers.
Services Excluded from Coverage
Because P4HB is a limited-benefit program, it does not provide the full scope of health services available under standard Medicaid. The program explicitly excludes coverage for all abortion services or related procedures. Infertility services, including diagnostic testing and treatment, are also not covered, as the program focuses on pregnancy prevention.
Comprehensive primary care, such as routine doctor visits for general illness or injury, is not covered. Once a woman becomes pregnant, her eligibility for P4HB ends, and she must apply for full Pregnancy Medicaid; therefore, prenatal and maternity care are not covered benefits. Specialized health services like dental, vision, mental health care, and treatment for complex STIs (e.g., HIV/AIDS and Hepatitis) are also excluded.
How to Apply and Maintain Enrollment
Eligible individuals can apply for the Planning for Healthy Babies program through methods managed by the Georgia Department of Community Health (DCH) and the Division of Family and Children Services (DFCS). The most common method is online through the Georgia Gateway customer portal, which allows electronic submission of documentation. Paper applications can also be printed from the Georgia Medicaid website and submitted by mail or in-person at a local DFCS office or public health department.
Applicants must provide documentation verifying Georgia residency, U.S. citizenship or qualified immigration status, and proof of income. Once enrolled, coverage is granted for 12 months. To maintain continuous coverage, enrollees must complete an annual redetermination process to confirm they still meet all eligibility criteria. Report any changes in household income or insurance status promptly to avoid a lapse in coverage.