Family and Children's Medicaid MA-3250 Breast and Cervical Cancer Medicaid

III. Policy Fundmentals and/or RULES for BCCM

A. Aid Program/Category and Medicaid Classification

The woman is authorized in the MAF aid program/category with one of the following classifications:

1. W- Citizen receiving full coverage.

2. T- Qualified alien receiving full coverage.

3. U- Qualified alien eligible for emergency services only.

4. V- Non-qualified alien eligible for emergency services only.

This coverage group (BCCM) does not require the woman to have an eligible child for her to be eligible for Medicaid.

B. Date of Application

The date of application is the date that a "complete" application is received from a BCCCP screening provider in the agency. This may be by fax or mail.

1. A complete application is one that meets the following criteria:

a. The information is legible.

b. DMA-5079 is signed and dated by the applicant and BCCCP screening provider.

c. Section I and the name, mailing address, social security number and date of birth of applicant are completed on the DMA-5079.

d. DMA-5081, Verification of Screening and Diagnosis for Breast and Cervical Cancer Medicaid is completed and signed by a physician, including patient's name, date of diagnosis, estimated length of treatment.

2. Each county should establish a fax/mail in log to register and track incomplete as well as complete applications. Refer to MA-3207, Receiving Mail In Applications for an example of a mail in log which may be adapted.

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C. Certification Period

The certification period for this coverage group is based on the woman's course of treatment for cancer as established by a physician and approved by the Division of Public Health (DPH). A DMA-5081, Verification of Screening and Diagnosis for Breast and Cervical Cancer Medicaid, must be completed by a physician giving an estimated length of treatment.

The certification period may be up to 12 months. Even if the course of treatment is estimated by the physician to be more than 12 months, the certification period for Medicaid coverage can be no longer than 12 months.

If the course of treatment is estimated to be less than 12 months, the certification period must be the actual number of months the DPH states on the DMA-5081.

A review is completed at the end of the certification period to determine if she continues to be eligible for BCCM. Refer to V.C. for redetermination procedures.

1. The certification period begins with the first day of the application month the woman is found to meet all eligibility requirements for BCCM.

2. The certification period ends on the last day of:

a. The twelfth month, or

b. The last month of the estimated period of treatment stated on the DMA-5081.

3. A redetermination is completed at the end of the certification period.

4. The eligibility period ends after the woman's first follow-up visit when the DPH determines her course of treatment is completed, or it has been

determined the woman no longer meets the criteria for this eligibility category.

For example, the woman turned 65 years old or has obtained major medical insurance coverage. Terminate the woman's BCCM case after she has been evaluated for any other Medicaid program and timely notice has been given. See V.

5. A woman is not limited to one period of eligibility. A new period of eligibility and coverage would occur each time a woman is screened through BCCCP and is found to need treatment of breast or cervical cancer.

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D. Retroactive Coverage

The applicant may request up to 3 months of retroactive coverage under BCCM. Retroactive coverage only applies if as of the earlier date, the woman met eligibility requirements. This includes having been screened and found to need treatment for breast or cervical cancer in the retroactive month.

The retroactive months are separate from the ongoing certification period.

E. Covered Services and Medicaid ID Card

1. Coverage is not limited to only treatment of breast or cervical cancer. The woman is eligible for all Medicaid covered services. Refer to MA-5100, Medicaid Covered Services.

2. Recipients will receive a gray Medicaid identification card.

3. Refer to MA-3505, Medicaid ID Card, for procedures on returned Medicaid cards.

F. Child Support Referrals

Referral to Child Support Enforcement is not required unless the woman is a caretaker of children receiving Medicaid. If a woman is approved for MAF-W who has children receiving Medicaid, complete a referral on the child's case and send to Child Support Enforcement.

If a child of the MAF-W recipient is approved for Medicaid, complete a referral on the child's case and send to Child Support Enforcement.

A referral screen is displayed only when the woman is between 18 and 21 years of age for the BCCM case. Do not send a referral on this case to Child Support since there are no children in the MAF-W case.

G. Transportation

Breast and Cervical Cancer Medicaid recipients are eligible for Medicaid funded transportation services.

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H. Copayment

Copayments are the same as other Medicaid programs. There is no co-payment for women under age 21. For women age 21 and over, refer to MA-3540, Medicaid Covered Services.

I. Managed Care

These recipients are ineligible for managed care.

J. Federally Recognized Indian Tribes

Medical care programs of the Indian Health Service (IHS) or of a tribal organization are sometimes considered creditable coverage under the Public Health Act. However, not all women are covered under such programs. In North Carolina, Medicaid is considered the primary payer when Indian Health Services is involved. Therefore, even if the woman can use IHS, she is eligible for BCCM.

K. Automated Inquiry and Match Procedures

Reaction to the BENDEX, BEER, FRR, and ESC/UI and other reports are not required unless the woman goes into another Medicaid program.

This coverage group is excluded from COLA since there is no income or asset test for BCCM.

L. Appeals/Hearing Request

BCCM applicants/recipients have the same right to request a hearing as other Medicaid a/r’s. Refer to MA-3430, Notice and Hearings Process, for procedures on appeals.