Plan First, is a Montana Medicaid Waiver that covers family planning services for eligible women. Some of the services covered include office visits, contraceptive supplies, laboratory services, and testing and treatment of STDs.
General Eligibility Criteria
- Montana Resident
- Female 19 through 44
- Able to bear children and not presently pregnant
- Annual household income up to and including 200% Federal Poverty Level
- Applicant cannot presently have any other family planning services coverage (self declared or claims identified)
Family Size |
200% Poverty |
| 1 | $22,980 |
| 2 | $31,020 |
| 3 | $39,060 |
| 4 | $47,100 |
| 5 | $55,140 |
| 6 | $63,180 |
| 7 | $71,220 |
| 8 | $79,260 |
PRIMARY DOCUMENTATION OF CITIZENSHIP AND IDENTITY |
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PRIMARY DOCUMENTS --verifies both citizenship and identity |
EXPLANATION |
U.S. Passport |
U.S. Passport does not have to be currently valid to be accepted, as long as it was originally issued without limitations. Do not accept any U.S. Passport as verification of citizenship if it was issued with limitations; it may, however, be used as proof of identity. Through 1980, spouses and children were sometimes included on one passport. Citizenship and identity of all included persons can be established. |
Certificate of Naturalization (Form N-550 or N-570) |
Issued by Department of Homeland Security (via USCIS) |
Certificate of Citizenship (Form N-560 or N-561) |
Issued by Department of Homeland Security (via USCIS) for individuals who derive citizenship through a parent |
* Tribal Documents |
Issued by federally recognized Indian Tribe evidencing membership, enrollment in, or affiliation with such Tribe. Document must identify the federally recognized Indian Tribe that issued it, identify the individual by name and confirm the individual’s membership, enrollment in or affiliation with the Tribe. |
SECONDARY DOCUMENTATION OF CITIZENSHIP ONLY |
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SECONDARY DOCUMENTS -- verifies citizenship only |
EXPLANATION |
A U.S. public birth record showing birth in: * Any of the 50 U.S. States * District of Columbia * American Samoa * Swain's Island * Puerto Rico (if born on or after January 13, 1941) * Virgin Islands (if born on or after January 17, 1917) * Northern Mariana Islands (if born after November 4, 1986) * Guam (if born on or after April 10, 1899) |
The document must be issued by the State, territory or local jurisdiction and have been issued before the person turned five years old. If the birth record document was amended after the individual was age five, it is considered fourth level evidence of citizenship. |
Certification of Report of Birth Abroad (Form DS-1350) |
Issued by Department of State (Washington D.C.) to citizens born outside the U.S. who acquired citizenship at birth |
Consular Report of Birth Abroad of a Citizen of the United States of American (Form FS-240) |
Issued by Department of State consular office. Children born outside the U.S. to U.S. military personnel usually have this documentation. |
Certification of Birth Abroad (Form FS-545) |
Issued by Department of State consulate prior to November 1, 1990. |
United States Citizen Identification Card (I-197) or prior version (I-179) |
The former INS issued I-179 from 1960 until 1973. I-197 issued from 1973 until April 7, 1983. Neither form is currently issued, but both are still valid evidence of citizenship. |
American Indian Card (I-872) |
Must be issued by Department of Homeland Security and have classification of ‘KIC” – Texas Band of Kickapoo’s living near the U.S./Mexican boarder |
Northern Mariana Card (I-873) |
The former INS issued I-873 to collectively naturalized U.S. citizens born in the Northern Mariana Islands before November 4, 1986. The card is no longer issued, but is still valid evidence of citizenship. |
Final Adoption Decree |
Decree must show the child's name and a U.S. place of birth. If adoption is not finalized and child's birth state will not release a birth certificate prior to final adoption, a statement from a state approved adoption agency that shows the child's name and U.S. place of birth is acceptable. Adoption agency must state that the source of birth place information is from the child's original birth certificate. |
Evidence of U.S. Government Civil Service Employment |
Must show employment by the U.S. government prior to June 1, 1976. |
Official Military Record of Service |
Document must show a U.S. place of birth. Can use a DD-214 or similar official document showing a U.S. place of birth. |
Child. Citizenship Act of 2000 |
Evidence of meeting automatic criteria of U.S. citizenship as outlined in this Act. |
THIRD LEVEL DOCUMENTATION OF CITIZENSHIP ONLY |
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THIRD LEVEL DOCUMENTS -- verifies citizenship only |
EXPLANATION |
Extract of hospital record on hospital letterhead. |
Must be established at time of person's birth and be created at least five years before initial application date and indicate a U.S. place of birth. For children under age 16, the document must have been created near the time of birth OR five years before the application. DO NOT ACCEPT SOUVENIR BIRTH CERTIFICATE ISSUED BY THE HOSPITAL. All hospital-issued birth certificates are considered to be souvenirs. |
Life, health or other insurance record |
Must show a U.S. place of birth and have been created at least five years before the initial application date. |
Religious Records |
Must be recorded in the U.S. within three months of birth and show a U.S. place of birth. Must show either the date or individual’s age at the time the record was made. The record must be ‘official’ and recorded with the religious organization. (Entries in a family bible are NOT considered religious records) |
Early School Records |
Must show a U.S. place of birth. The record must also show the child’s name, date of admission to the school, date of birth, and the name(s) and place(s) of birth of the child’s parents. |
- CMS- Follow-up Questions
- CMS Questions and Montana Answers
- Custom Agreement For Medicaid Non-Covered Services
- Family Planning Waiver
- Family Planning Waiver Public Forum
- FP BN Worksheet Draft
- Plan First Application (Preferred method is the online application)
- Plan First Eligibility as of 10/05/2011
- Plan First Info Tips On Application Completion
- Plan First Provider Information
- Plan First Synopsis
- Service Code Table
How to Apply:
The easiest way is to Apply Online.
For more information:
Plan First Brochure
1-855-854-1399 In-State Toll Free
1-406-444-6446 Out-of- State and Helena Area
Email: planfirst@mt.gov


