Basic Considerations

Effective July 1, 2001, the Department of Community Health (DCH) began implementation of the Women’s Health Medical Assistance (WHM) Class of Assistance (COA) for women who have been screened under the National Centers for Disease Control and Prevention (CDC) Breast and Cervical Cancer Early Detection Program (NBCCEDP), established in accordance with the requirements of section 1504 of the Public Health Service Act , and found to need treatment for breast or cervical cancer; section 1504 of the Public Health Service Act , including pre-cancerous conditions and early stage cancer. This is a Non-MAGI Class of Assistance. Refer to Section 2663 - Non-Modified Adjusted Gross Income (MAGI) Budgeting .

Public Health or one of its partner affiliates completes the breast and/or cervical cancer screening in accordance with the(CDC guidelines established under Title XV.

To be eligible under the WHM COA an A/R must meet the following conditions:

Screened for breast or cervical cancer under the CDC National Breast and Cervical Cancer Early Detection Program in accordance with Title XV guidelines and diagnosed and found to need treatment for breast or cervical cancer or a precancerous condition of the breast or cervix.

Have no creditable health coverage as defined in section 2704(c) of the Public Health Service Act, for treatment of the individual’s breast or cervical cancer, including health insurance, Medicare Part A or Part B of Title XVIII of the Social Security Act and Medicaid.

There may be limited circumstances where the member has creditable coverage but is in a period of exclusion such as a pre-existing condition or where lifetime limits have been exhausted. In these situations, the member is considered uninsured.

Due to monthly QA, a woman who is currently receiving MA under the Pathways COA program remains eligible to apply for and receive WHM if all other eligibility criteria are met.

Is under age 65

Must be a Georgia resident.

U.S. citizen or a lawfully admitted immigrant in the U.S. An A/R who does not meet the citizenship/immigration status requirement may qualify for this COA using EMA criteria. EMA is not completed as part of the PE process. Refer to Section 2054 - Emergency Medical Assistance for clarification on this policy.

Biologically born a woman or Qualified Transgender