Plan First is Michigan’s limited-benefit Medicaid program that pays for family planning and reproductive health care at no cost to enrollees whose household income is at or below 195% of the federal poverty level. For 2026, that ceiling works out to roughly $31,122 a year for one person and $42,198 for a household of two.1ASPE. 2026 Poverty Guidelines: 48 Contiguous States It fills a specific gap: people who earn too much for full Medicaid but still can’t afford contraception, STI care, or a sterilization procedure on their own.
Plan First is not comprehensive coverage. It pays for family planning services and closely related care, and nothing else.
Who Qualifies
Three things determine eligibility: income, residency, and immigration status. Your income must be at or below 195% of the federal poverty level under the Modified Adjusted Gross Income (MAGI) methodology, which counts your household, not just you. You must live in Michigan. And you must meet the same citizenship or immigration requirements that apply to other Medicaid programs.2Michigan Legislature. Proposed Medicaid Policies – Plan First Family Planning Group
You cannot be pregnant when you apply. If you enroll and then become pregnant, you would move into a pregnancy-related Medicaid category, because Plan First does not cover prenatal care or delivery.2Michigan Legislature. Proposed Medicaid Policies – Plan First Family Planning Group
One point that catches people off guard: the current program has no age or gender restrictions. Earlier versions of Plan First limited enrollment to women aged 19 through 44, but the state plan amendment that created the current Medicaid group removed those limits.2Michigan Legislature. Proposed Medicaid Policies – Plan First Family Planning Group
If you already have Medicaid coverage that includes family planning, or private insurance that does, you generally don’t need Plan First. MDHHS uses the information on your application to place you in the most beneficial Medicaid category you qualify for, so it’s worth applying even if you’re not sure which program fits.
What Plan First Pays For
Covered services fall into a handful of categories:3Michigan Legislature. Plan First Family Planning Program
- Family planning office visits, including contraceptive counseling, preconception counseling, and annual wellness visits related to reproductive health.
- All FDA-approved contraceptive methods and supplies, from oral contraceptives to IUDs, implants, and natural family planning.
- Screening, testing, counseling, and treatment for sexually transmitted infections identified at a family planning visit. This includes HPV and Hepatitis B vaccines, cervical cancer screening, and treatment of pre-cancerous conditions. HIV and Hepatitis testing and counseling are covered; ongoing treatment for either is not.
- Laboratory work tied to any of the covered services.
- Voluntary sterilization procedures and follow-up care.
Sterilization: The 30-Day Consent Rule
If you’re considering sterilization through Plan First, federal Medicaid rules require at least 30 days, and no more than 180 days, between the date you sign the written consent form and the date of the procedure. You must be at least 21. The waiting period drops to 72 hours only in cases of premature delivery or emergency abdominal surgery.4eCFR. 42 CFR Part 441 Subpart F – Sterilizations If the consent form is dated fewer than 30 days before surgery, Medicaid will deny the claim, regardless of whether the patient wanted the procedure.
What Plan First Does Not Pay For
This is where the program is easiest to misunderstand. Plan First is a limited-benefit category, not health insurance. It does not cover:
- Abortion services.5State of Michigan. Plan First Brochure
- Infertility treatment.5State of Michigan. Plan First Brochure
- Prenatal care, labor, and delivery.
- Hospital stays and emergency room visits.
- Prescription drugs unrelated to family planning.
- General primary care, such as treatment for diabetes or high blood pressure.
- HIV/AIDS or Hepatitis treatment. Testing and counseling for both are covered; ongoing treatment is not.3Michigan Legislature. Plan First Family Planning Program
If a provider spots something during a Plan First visit that falls outside covered services, the program won’t pay for treating it. You can be referred elsewhere, but you’ll need other coverage or you’ll pay out of pocket. If you qualify for Plan First on income, check whether you also qualify for the Healthy Michigan Plan or a different Medicaid category with broader benefits.
Plan First Does Not Satisfy the ACA Coverage Requirement
Federal tax regulations exclude optional state family planning coverage from the definition of minimum essential coverage under the Affordable Care Act.6eCFR. 26 CFR 1.5000A-2 – Minimum Essential Coverage Practically, that means Plan First alone won’t satisfy any coverage mandate you’re subject to, and MDHHS won’t send you a Form 1095-B for Plan First enrollment, since that form reports only minimum essential coverage.7Internal Revenue Service. Instructions for Forms 1094-B and 1095-B If you need full coverage, look into the Healthy Michigan Plan or a marketplace plan through HealthCare.gov.
How to Apply
You apply for Plan First the same way you’d apply for any other Michigan Medicaid program. The old dedicated Plan First application form (MSA-1582) is no longer accepted; MDHHS now uses one unified application for all healthcare assistance programs.8State of Michigan Department of Health and Human Services. Apply for Healthcare Assistance Three ways to submit:
- Online through the MI Bridges portal at newmibridges.michigan.gov. Public computers are available at local MDHHS offices and MI Bridges community partner organizations.9MI Bridges. Apply For Benefits
- By paper, using the DCH-1426 form, downloadable from the MDHHS website or available at any local office.8State of Michigan Department of Health and Human Services. Apply for Healthcare Assistance
- In person or by phone through your local MDHHS office.
MDHHS uses the information you provide to decide which Medicaid category fits. You may land in Plan First, or you may qualify for something broader. The agency may also ask for verification documents or an interview before approving or denying the application.9MI Bridges. Apply For Benefits Keep copies of what you submit.
Choosing a Provider
Plan First enrollees are not placed in a Medicaid managed care plan. You can see any Medicaid-enrolled, licensed provider who offers family planning services. There’s no network to stay inside, and no referral requirement. You pick the provider, book the visit, and Plan First pays the covered portion directly.
Keeping Your Coverage
Plan First requires periodic renewal, like other Medicaid categories. MDHHS mails renewal notices ahead of your redetermination date. When one arrives, confirm your information, report any changes to income or household, and return the paperwork by the deadline. Missing the deadline can end your coverage even if you’re still eligible. You can check your renewal date and manage your case through MI Bridges.
If Your Application Is Denied
If MDHHS denies your application, cuts your benefits, or terminates your coverage, you’ll get a written notice explaining the decision. You have 90 days from the mailing date of that notice to request an administrative hearing.10State of Michigan. Medicaid Hearings Brochure To request one, fill out the DCH-0092 Request for Hearing form and fax or mail it to the Michigan Office of Administrative Hearings and Rules (MOAHR) at the address on the form.11State of Michigan. Beneficiary Support
Under federal rules, MDHHS must issue a final decision within 90 days of receiving your hearing request in standard cases.12eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries Separate from the hearing process, you can file a beneficiary complaint online or by mail with the MDHHS Customer Services Division.11State of Michigan. Beneficiary Support