Clients will be enrolled in the Program under the following conditions:

1. (1) The waiver applicant must self-declare that she is not pregnant at the time of application.
2. (2) The waiver applicant must be actively seeking family planning services.
3. (3) The waiver applicant must not have had a tubal ligation or a hysterectomy.
4. (4) The waiver applicant must provide proof of citizenship and identity.
5. (5) The waiver applicant must have an income at or below 185% of the current federal poverty level.
6. (6) The waiver applicant must complete and sign the application.
7. (7) The waiver applicant must have lost full Medicaid and the FMMIS or subsequent system verifies this loss of full Medicaid.
8. (8) The waiver applicant must be age 14 to 55.
9. (9) Only county health department staff who have completed training in the Program eligibility process will determine eligibility for this Program.
10. (10) Applications for the Program may be mailed or hand delivered by the client to the CHD.
11. (11) A face-to-face interview for eligibility determination is not required.
12. (12) A supervisor within the CHD will verify the application and its approval or denial.
13. (13) Approval/denial letters, with a description of the appeal process, must be provided to the applicant by the county health department staff.
14. (14) The client who is approved for the program will receive primary care referral information. The client is not required to see a health care professional at the CHD.
15. (15) Eligibility for this Program must be re-determined annually.

Rulemaking Authority 154.011, 381.0011(13), 381.0051(7) FS. Law Implemented 154.011, 381.0051 FS. History–New 8-9-04, Amended 2-17-08.