Illinois Healthy Women Program (Family Planning Waiver) Expansion
Participating Physicians, Advanced Practice Nurses, Federally Qualified Health Centers, Rural Health Clinics, Encounter Rate Clinics, School Based Clinics, Local Health Departments, Pharmacies, Hospitals and Hospital Clinics
||December 4, 2007|
|| Illinois Healthy Women Program (Family Planning Waiver) Expansion|
Illinois Healthy Women (IHW) provides family planning services to low-income women, ages 19 through 44. Women may now be determined eligible for IHW benefits through an application process. The IHW application process is in addition to the automated process through which women are enrolled in IHW after losing coverage under a more comprehensive Healthcare and Family Services (HFS) medical program.
Applying for IHW Coverage:
Appendix A, Provider Information-at-a-Glance (pdf)
, included with the notice, details the IHW eligibility criteria.
Women who are pregnant or have been sterilized are not eligible for this program. Please encourage women who meet the eligibility requirements for IHW to complete an application, which may be downloaded from the IHW Web site. Instructions on how to order IHW materials (applications, brochures, fact sheets) are also available on the IHW Web site.
IHW Covered Services:
IHW offers a limited package of services specific to family planning, birth control and family planning related reproductive healthcare. IHW covers services outlined in Appendix A, Provider Information-at-a-Glance (pdf)
, when billed with a family planning diagnosis code in the V25 series. Any provider who is enrolled with HFS may provide services to participants of the IHW program. No separate enrollment is required.
The department’s coverage and billing requirements applicable to family planning, birth control and related reproductive healthcare services for other coverage groups also apply to IHW. Co-payments do not apply to family planning services, birth control, generic prenatal vitamins, generic multivitamins with folic acid, or generic medications prescribed for the treatment of sexually transmitted infections (STIs). However, co-payments may apply to non-generic prescription drugs, such as those prescribed for the treatment of STIs.
Medications prescribed to treat STIs require prior approval. Prior approval is also required for multivitamins, but is not required for prenatal vitamins. Either the physician's office or the pharmacy may request the prior approval by calling 1-800-252-8942, and supplying the following information:
Recipient ID number
- Physician ID, name & phone number
- Pharmacy ID, name & phone number if known
- Name of medication or NDC number of medication
- Diagnosis or ICD-9-CM
Physicians are urged to include the diagnosis on the prescription, as it is required for the pharmacy to make a prior approval request.
Please refer IHW participants to low-cost primary healthcare services, as needed. Healthcare resources for referrals include:
- The HFS Health Benefits Hotline at 1-866-468-7543 (TTY: 1-877-204-1012).
- The Illinois Department of Human Services Help Line, at 1-800-843-6154, select Option 5 (TTY: 1-800-447-6404). Providers may also call the Provider Help Line, at 1-800-804-3833 (TTY: 1-877-434-1082).
- The Illinois Department of Public Health, Office of Women's Health, Women's Health-Line at 1-888-522-1282 (TTY: 1-800-547-0466), when a patient enrolled in IHW is suspected of having breast or cervical cancer or a precancerous condition.
- The AIDS/HIV & STD Hotline, operated by the Illinois Department of Public Health, at 1-800-243-2437 (TTY: 1-800-782-0423) for assistance in locating HIV/AIDS treatment resources.
- Local mental health centers, which can be found by calling 1-800-843-6154, for women who are experiencing perinatal depression.
Questions about IHW should be directed to 1-800-226-0768 (TTY:1-877-204-1012). Provider enrollment and billing inquiries should be directed to 1-877-782-5565.
Thank you for partnering with HFS to provide quality healthcare services to our program participants.
Theresa A. Eagleson, Administrator
Division of Medical Programs