What Does Family Planning Medicaid Cover in NC?

Family Planning Medicaid in North Carolina covers birth control, sexually transmitted infection screening and treatment, annual reproductive health exams, voluntary sterilization, and related counseling at no cost to people who qualify.¹ Every covered service comes with zero copays and no out-of-pocket cost.² The program is narrowly focused on reproductive health, so general medical care, pregnancy care, and abortion fall outside what it pays for.

Birth Control

Nearly every FDA-approved contraceptive method is covered. That includes oral contraceptives, IUDs, implants, injections, patches, and vaginal rings. You can receive up to a 12-month supply of oral contraceptives at one time. Male and female condoms are covered when provided in a clinical setting, and spermicides are available through a pharmacy with a prescription.³

Emergency contraception such as Plan B is covered, and you can get a prescription in advance to have it on hand before you need it. North Carolina also uses state funds to cover certain over-the-counter oral contraceptives without a prescription, which only a handful of states do.⁴

STI Screening, Treatment, and HPV Vaccine

Screening and treatment are covered for most sexually transmitted infections, including syphilis, herpes, gonorrhea, and chlamydia. Testing and referrals are included for HIV and hepatitis B and C. The Gardasil 9 vaccine, which protects against HPV, is also covered.⁴

Annual Exams and Related Screenings

The program pays for one annual physical exam plus up to six additional family planning office visits in a 12-month period, with counseling and education included in those visits.⁴ Annual Pap tests and breast exams are covered, along with pregnancy testing and counseling. Depression screenings are covered up to four per year when the provider uses a validated screening tool.³

If you need a ride, non-emergency transportation to and from your family planning appointments is available.⁴

Voluntary Sterilization

Vasectomies and tubal ligations are covered, but federal rules add requirements that don’t apply to the rest of the program. You must be at least 21 years old and sign a consent form at least 30 days before the procedure. That form expires after 180 days, so if the surgery is pushed back past that window you’ll have to sign a new one.⁵ The only exception to the 30-day waiting period is premature delivery or emergency abdominal surgery, in which case the minimum drops to 72 hours. The program will not pay to reverse a sterilization later.

What the Program Does Not Cover

Because Family Planning Medicaid is a limited-benefit program, several services people often assume are included are not:

Prenatal care and delivery. If you become pregnant, you’ll need to apply for Medicaid for Pregnant Women. Pregnancy itself makes you ineligible for Family Planning Medicaid.¹
Abortion services, under any circumstances.³
Infertility treatment or any procedure aimed at helping you become pregnant.³
Sterilization reversals.
General medical care unrelated to family planning, including chronic disease management, dental, and vision.³
Inpatient hospital stays and most outpatient surgery beyond sterilization and contraceptive device removal.

If you need broader care, full Medicaid covers a much wider set of services. Since North Carolina expanded Medicaid in late 2023, adults with incomes up to 138% of the federal poverty level may qualify for comprehensive coverage, and you should apply for that first if you think you’re eligible. Family Planning Medicaid primarily reaches people whose income falls between 138% and 195% of the poverty level and who don’t qualify for full Medicaid through another category.¹

How Costs Work With Other Insurance

For enrollees, covered services carry no copay and no out-of-pocket cost.² If you also have private insurance, Medicaid acts as the payer of last resort: your private plan pays first, and Family Planning Medicaid picks up the remainder on covered services up to the Medicaid payment limit. Tell your provider about both coverages so the claims get billed in the right order.

One tax detail worth knowing: Family Planning Medicaid is not considered minimum essential coverage for federal tax purposes, so you won’t receive a Form 1095-B for this coverage and it won’t satisfy coverage requirements that some states still enforce.⁶

Who the Coverage Is For

The services above are available to North Carolina residents of reproductive age (generally women 19 through 55 and men 19 through 60) who are U.S. citizens or qualified immigrants and whose household income is at or below 195% of the federal poverty level. Pregnant people and people who are incarcerated are not eligible.¹ Using the 2026 poverty guidelines, the income limit works out to roughly $2,594 per month for a single-person household and about $5,363 per month for a household of four.⁷

If you received a covered family planning service in the three months before you applied and you were eligible at the time, North Carolina can make your coverage retroactive to cover it, so it’s worth asking your caseworker about reimbursement if you paid out of pocket for something like birth control or an STI test shortly before enrolling.⁸⁹

1
NC Medicaid. Family Planning Medicaid
2
NC Medicaid Managed Care. Copays
3
NC Medicaid. Medicaid Family Planning Services Clinical Coverage Policy No 1E-7
4
North Carolina Department of Health and Human Services. Family Planning Medicaid Coverage FAQs – Beneficiaries
5
Office of Population Affairs. Consent for Sterilization Form HHS-687
6
Internal Revenue Service. 2025 Instructions for Forms 1094-B and 1095-B
7
U.S. Department of Health and Human Services. 2026 Poverty Guidelines
8
NC Department of Health and Human Services. MA-2170 Family Planning Program
9
eCFR. 42 CFR 435.915 – Effective Date