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The purpose of this memorandum is to notify providers of changes to the Plan First Program. Plan First is changing from an “opt out” program that individuals were automatically enrolled in, to an “opt in” program that individuals must choose to be enrolled in.

Plan First is a limited-benefit program that covers family planning services only (ex. contraceptives, sexually transmitted infection testing, and family planning education). The income limits for Plan First coverage are higher than the income limits for other full-benefit Medicaid categories that cover non-pregnant adults.

Since the implementation of the Plan First program, individuals aged 19-64 who did not meet the eligibility requirements for full-benefit Medicaid were automatically evaluated and, if eligible, enrolled in Plan First coverage. Prior to Medicaid Expansion, most individuals in this age group who were not pregnant, did not have a disability or did not have children were only eligible for Plan First. With the implementation of Expansion in 2019, many of these adults became eligible for full-benefit coverage, resulting in a sharp decline in Plan First enrollment.

Therefore, DMAS has elected to move Plan First to an “opt in” model. The Medicaid application and renewal form has been changed to ask the applicant if they would like to be evaluated for eligibility in this covered group if they are not eligible for full-Medicaid coverage. 

Individuals who are currently covered under Plan First will continue to be covered through the program and will be allowed to “opt in” to continue their coverage at their next eligibility determination.