400.07 BREAST AND CERVICAL CANCER PROGRAM (BCC) COE-027

The federal Breast & Cervical Cancer Prevention and Treatment Act of 2000 amended Title XIX of the Social Security Act to give states enhanced matching funds to provide Medicaid eligibility to a new group of women diagnosed with either breast and/or cervical cancer who are not otherwise eligible for Medicaid under any other category of eligibility. MS state legislation authorized DOM to cover this optional category effective July 1, 2001. Women diagnosed with either breast and/or cervical cancer must be: • Under age 65. • Have no other creditable health insurance, including Medicare and/or Medicaid. • Have household income under 250% FPL. • Have been screened for breast & cervical cancer through the CDC’s (Centers for Disease Control) screening program for the early detection of breast & cervical cancer and need treatment for breast or cervical cancer, including a pre- cancerous condition of the breast or cervix. The State Department of Health has the responsibility for the CDC screening services referred to as the Breast and Cervical Cancer Control Program (BCCCP) and is the initial point of contact for a woman seeking both screening services and coverage through this category of eligibility should she be diagnosed with either type of cancer. The HD establishes the age range of women that can be screened based on CDC funding which is generally in the age range of 50 to age 64. Women ages 40 – 49 may be screened under certain conditions. A woman must be both screened and diagnosed through the Health Department’s (HD) screening program in order to gain coverage through the BCC group. Although the HD may use outside providers to conduct the actual screening, it is the HD’s responsibility to arrange the screening and refer eligible women who have been diagnosed with breast or cervical cancer for coverage to DOM. Men cannot be screened under the BCCCP therefore men with breast cancer cannot be eligible in COE-027. Presumptive Eligibility for Women Referred by the Health Department Medicaid coverage is provided for a woman screened and diagnosed through the HD’s screening program for a presumptive period of eligibility. Presumptive eligibility begins and ends as follows: • Eligibility begins on the 1st day of the month in which the determination is made (the month of diagnosis) and ends on the date DOM makes the final determination of eligibility based on the completed short application form that the BCC applicant must complete & return to DOM. • If the short application form is not returned or if eligibility cannot be established due to citizenship/ immigration or residency issues or other creditable health coverage exists, ongoing eligibility cannot be established and the PE period must end, following an adverse action period. The Health Department determines the medical and financial eligibility of a woman screened and diagnosed with breast/cervical cancer. The HD case manager for the BCC program refers women who are medically eligible and income eligible to DOM, with confirmation of the diagnosis and the date of the diagnosis. Central Office staff inputs the presumptive eligibility and issues the individual an application form that is used to determine non-financial eligibility factors for ongoing eligibility. Central Office staff determines ongoing Medicaid eligibility and conducts annual reviews to determine continuing eligibility during the course of the woman’s active treatment for BCC. Appropriate notices are issued by Central Office staff to approve, deny or terminate eligibility under the BCC program, as appropriate. Eligibility for the Breast & Cervical Cancer Program A woman determined eligible for BCC coverage is eligible throughout the course of her active treatment for cancer or until she no longer meets the eligibility criteria as outlined above, whichever occurs first. Active treatment is the period in which the cancer is aggressively treated with chemotherapy or radiation. It does not include a period of time in which maintenance drugs are administered. While eligible, a woman receives full Medicaid coverage during the time eligibility is on file.