Apply online at www.access.wisconsin.gov - click on "Apply for Benefits"
The Family Planning Only Services (FPOS) Program provides men and women with certain family planning-related services and supplies to prevent unplanned pregnancies. Thanks to the Wisconsin Medicaid Family Planning Only Services, you might qualify to receive these services at no cost to you.
If you have questions about the FPOS Program, including questions about covered services, you can call Member Services at 1-800-362-3002, Monday through Friday, from 8:00 a.m. to 6:00 p.m.
To be eligible for the FPOS Program, you must:
- Be a U.S. citizen or have a qualifying immigration status.
- Be of childbearing or reproductive age.
- Have income at or below $3,075.30* per month. Only your own income is counted. Your assets are not counted.
- Not be enrolled in Wisconsin Medicaid or BadgerCare Plus. (You can be enrolled in private health insurance while you are enrolled in the FPOS Program.)
* This income limit is effective February 1, 2017. The income limit is based on federal guidelines, which may change each year.
Only certain services are covered under the FPOS Program, and those services must be related to a family planning office visit. For example, Pap tests are only covered under the FPOS Program when they are completed at a family planning office visit or with a referral from a family planning provider.
Services that may be covered under the FPOS Program if they are provided at an initial, yearly, or follow-up family planning-related office visit include the following:
- Contraceptive services and supplies (for example, birth control pills and condoms)—you must have a prescription from a doctor or nurse practitioner
- Natural family planning supplies
- Pap tests
- Routine preventive primary services that are family planning-related
- Tests and treatment for sexually transmitted diseases or infections like chlamydia, herpes, gonorrhea, and syphilis, as well as certain other lab tests
- Tubal ligation for women or voluntary sterilizations for men 21 years old or older
Only certain services are covered under the FPOS Program. Services not covered under the FPOS Program include, but are not limited to, the following:
- Inpatient hospital services
- Other services provided during a family planning-related visit that are not family planning-related
If you apply for or get coverage from the FPOS Program:
- You can choose where to send written information. Written information can be sent to an address other than your home address.
- If you are younger than 18 years old, your local agency will not contact your parents or other caretakers.
- If you are younger than 18 years old, you will not be referred to a child support agency.
What do I need to apply?
To apply you will need:
- Computer with internet access and a printer
- Copy of your picture ID (Driver's License or Blugold ID)
- Copy of your birth certificate or passport (only if you were NOT born in Wisconsin)
- Copies of your paystubs for 30 days prior to your application OR a statement signed by your supervisor/manager indicating the date your employment began, the average number of hours you work per week, and your rate of pay/salary.
- Summary of the current semester tuition charges AND financial aid/loan/scholarships from My Blugold CampS
- Print off the tracking number from your application after you submit it online. It will be the first page of the application summary (has your name, date of application, and the tracking number)
Apply online at access.wisconsin.gov. If needed, Student Health Services has a computer/printer available and is more than happy to help you when applying. A staff member is here from 8am-11am and 1pm-3pm to help you with any questions you may have. Please allow yourself about 30-40 minutes to finish your application. Once you submit your application fax (recommended, can use fax machine at Student Health Service) the supporting documents to (855)-293-1822 or mail it to:
- This application is only about YOU (unless you have a spouse or children)
- Use your local address
- Income limits DO NOT include income of parents or roommates
- If you are not the primary carrier of the health insurance you may be on, DO NOT list yourself as having health insurance
- SAVE your username and password, you will need this if you choose to ever reapply
- When you receive a booklet of information regarding the program that does not mean that your application has been processed and/or approved. Once your application has been processed, you will receive a letter stating your application was approved and the date for which you became eligible for benefits.
- You should also receive a white card that says Forward Health on it and lists your name and member ID number. You will need this card if you ever need to receive services/supplies at another clinic or pharmacy. A new card is not issued with re-applications.
- Please be aware if for ANY reason your application for Family Planning Only Services is denied you will be financially responsible for services and/or supplies rendered during your family planning visits.