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Title 8: Medicaid Page 24 Iowa Department of Health and Human Services Employees’ Manual Chapter F: Coverage Groups Breast and Cervical Cancer Treatment Revised February 28, 2025 Responsibilities of the Client

2. Mrs. R is diagnosed with cervical cancer and applies for Medicaid in September 2001. Also living with Mrs. R is her husband and two children, ages 18 and 22. The worker determined that due to family income, Mrs. R would only be eligible for Medically Needy with zero spenddown. Medicaid eligibility for Mrs. R is established under BCCT effective September 1, 2003. The worker conducts the annual review in August 2004. Since Mrs. R’s youngest child is over age 19, the worker simply confirms with Mrs. R that she does not have a child under the age of 19 living with her. No income information is requested, since Mrs. R is not eligible for a mandatory coverage group. Since Mrs. R is under age 65, continues to not have creditable health insurance coverage, and continues to receive treatment, eligibility under BCCT continues. Notice of Decision Legal reference: 42 CFR 435.917, 441 IAC 76 (Rules in Process), 7.7(1) No notice of decision needs to be issued if BCCT eligibility:  Continues, or  Ends but Medicaid eligibility is continuing under another coverage group, other than Medically Needy with a spenddown. Adequate and timely notice is required when Medicaid eligibility is ending, including when the individual fails to comply with the annual review process. Case Maintenance The following sections address procedures for:  Handling changes in health insurance  Conducting an automatic redetermination Health Insurance Changes Determine if an individual has creditable health insurance coverage when:  They report a change in their health insurance coverage, or  They report that health insurance coverage has begun. The following types of coverage are considered creditable coverage:  Medicare Part A or Part B  A group health plan