Oregon’s Family Planning
Medicaid Waiver:
Family Planning Expansion Project
(FPEP)
NASHP Conference 2007
Rian Frachele, Manager
Women’s & Reproductive Health,
Oregon Public Health Division
971-673-0364
rian.frachele@state.or.us

Family Planning Medicaid
Waivers
Family planning waivers prevent unintended

pregnancies and do not increase federal
spending
26 states have waivers to expand eligibility for

family planning services
Most states raise the qualifying income level;

some enroll postpartum women about to lose
coverage
Federal match rate for family planning is 90%

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FPEP Overview
Began in 1999, currently authorized through
•
October 2009
Covers women, men, and teens with incomes
•
up to 185% of FPL
100,000+ clients served annually through
•
network of 160+ local clinics
To maximize access, clients enroll at point-of-
•
service based on three eligibility criteria:
Oregon residency

Income

U.S. citizenship (or Lawful Permanent Residency)

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Support to Request the
Waiver
Previous Governor strong supporter of

teen pregnancy prevention
 Next Governor authored the Oregon
Health Plan
 Initial research and discussions with
Medicaid agency

Seizing the Opportunity
Teen pregnancy prevention policy

package was presented to the
Legislature
Ways and Means interest in the expanding

the teen pregnancy prevention led to an
opportunity to request family planning
waiver
Used State General Funds that had been

issued to supplement Title X agencies as
match
 $22.5m Federal match annually
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Developing the Waiver
Conduct focus groups with family

planning clients
 Simplified application
 Enrollment at clinic site
 Up to a year’s supply of contraception
at the time of the visit
 Establish advisory workgroup of
provider community
 Partner with advocacy groups 6

Improving Client’s Access to
Family Planning Services
Family planning clients served:

 Title X – 56,000
 FPEP – 101,000
 Teen pregnancies per 1,000 females:
 Before waiver – 72.8 (1997)
 After waiver – 47.1 (2005)
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Citizenship Verification:
One-Time Visit Strategy
New & re-enrolling clients lacking proof of

citizenship allowed one visit, including birth
control supplies, with documentation to be
provided later
Preserve same-day service for clients and

reimbursement for providers
State General Funds pay for one-time visits

provided to clients determined ineligible
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DRA Implications
11,045 clients would have been denied

eligibility without one-time only visits
 Even with the one-time only exception,
preliminary visit numbers appear to
have fallen 18% (Nov. – Feb.)
 Would have decreased 38% without
exception
 Title X Clinic impact
 Clinic staff layoffs, clinic closures,
clinic hours reduced 9

Next Steps
State will coordinate and pay for birth

certificates for clients born in another
state
 State will conduct targeted outreach to
restore client enrollment
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Savings
Using the CMS budget neutrality

methodology, Oregon’s waiver reflects
savings of $790,003,388 from 1999 to
2009:
 State - $395,013,218
 Federal - $394,990,170
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