2693.3 Uninsured Provision

The individual must be uninsured and she cannot be otherwise covered under any other form of creditable coverage, as defined by the Health Insurance Portability and Accountability Act, for treatment of breast or cervical cancer. Persons who have such coverage, including Medicare, are not eligible. If a person has coverage but is in a period of exclusion, such as a preexisting condition waiting period, or has exhausted the lifetime limit for treatment, creditable coverage for cancer is considered unavailable and the person may be eligible. A plan which covers cancer treatment but requires a high deductible be met IS considered available and would render the woman ineligible.

Persons eligible under other Medicaid groups are not eligible for coverage under this category, with the exception of spenddown coverage. A person meeting the criteria for another group must be placed in the other group and would not be eligible for coverage under this category until such eligibility ceased. A screening by the worker is required at the time of application. Persons may be eligible under this group while a disability decision is pending. If approved for SSI, coverage shall be switched given adequate notice requirements.