This article is a section taken from Minnesota Family Planning Program (MFFP), a part of the revisions and additions to the Minnesota Health Care Program Eligibility Policy Manual.

MFPP Application

People may apply for Minnesota Family Planning Program ( MFPP) in the following ways.

Minnesota Family Planning Program Application (DHS-4740)

People seeking coverage under MFPP submit this form to Minnesota Department of Human Services (DHS).

Presumptive Eligibility with a Certified MFPP Provider

The applicant completes the first page and the signature page of the MFPP Application (DHS-4740) at the Certified MFPP Provider’s office. The provider reviews the application and either approves or denies temporary eligibility. See the MFPP Presumptive Eligibility policy for more information.

Application Submission

People of any age can apply for MFPP. Minors can apply for MFPP on their own. Minors do not require anyone’s consent to apply for MFPP.

Signature Requirement

Applicants must sign the application. Minor applicants do not need the signature of a parent or guardian.


MFPP applicants and enrollees can designate an address other than their home address as their mailing address.

Retroactive Eligibility

People may request retroactive eligibility for MFPP for up to three months prior to the month of application. A person may use the MFPP Application (DHS-4740) to apply for ongoing MFPP coverage, ongoing MFPP, and retroactive coverage, or to apply only for months of retroactive MFPP coverage. Retroactive MFPP coverage is not available to people who apply only for presumptive eligibility.

A person may be eligible for one, two, or three months of retroactive MFPP coverage. The person qualifies for retroactive coverage for each month they meet the MFPP eligibility requirements and has paid or unpaid medical expenses that would be covered by MFPP.

Legal Citations

Minnesota Statutes, section 144.343
Minnesota Statutes, section 256B.78

CREDIT: The content of this post has been copied or adopted from the Minnesota Healthcare Programs Eligibility Policy Manual, originally published by the Minnesota Department of Human Services.

This is also part of a series of posts on Minnesota Healthcare Eligibility Policies.