MedicaidCoverageHigh impact
Hospital Services Covered Under the Family Planning Program
Illinois Medicaid - HFS·IL · OB-GYN, General Surgery, Family Medicine +1 more·Provider Notice
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
Illinois HFS clarified that hospital-based family planning services are covered under the Family Planning Program and must be billed directly to the Department rather than patients. Hospitals should reference the Hospital Services (837I) tab on the HFS Medicaid fee schedule to identify covered procedures including screening mammograms, ultrasounds, colposcopies, LEEP, hysteroscopies, D&Cs, tubal ligations, and vasectomies. Eligible individuals receive these services at no out-of-pocket cost.
Action Required
By July 1, 2026: Billing team must download and review the Hospital Services (837I) tab from the HFS Medicaid Reimbursements webpage fee schedule to identify all covered family planning procedures. Update billing software to route family planning claims directly to the Department (HFS) instead of billing patients or secondary payers. Train billing staff to verify Family Planning Services eligibility in MEDI or via AVRS (1-800-842-1461), where eligibility indicator 82 will display. Ensure encounter forms and billing templates correctly identify family planning procedures so they are billed with zero patient cost. Failure to bill these services to HFS instead of patients will result in improper collections and potential compliance issues.