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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 April 2024 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.700 28

then determine their eligibility in the BCCPTA covered group.

1. Application Form This covered group has a special application, BCCPTA Medicaid Application (form #032-03-384), that must be initiated by a BCCEDP provider, including those affiliated with Project Wish operating in the District of Columbia. The application includes the BCCEDP certification of the individual’s need for treatment and the information needed to determine the nonfinancial eligibility in the BCCPTA covered group. Appendix 7 to subchapter M0120 contains a sample of the BCCPTA Medicaid Application form.

If eligibility in another Medicaid covered group must first be determined, the applicant must be given the appropriate Medicaid application.

2. Application Processing Time Frames BCCPTA Medicaid applications filed by individuals who do not meet the description of an individual in the LIFC, Pregnant Women, FAMIS Plus, or SSI recipients covered groups must be processed within 10 working days of the agency's receipt of the signed application. BCCPTA Medicaid applications filed by individuals who meet the description of an individual in one of the mandatory covered groups must be processed as soon as possible, but no later than 45 calendar days of the agency's receipt of the signed application. 3. Notices If the BCCPTA Medicaid application is the only application required and no additional information is required, the eligibility decision must be made immediately and applicant must be notified of the decision within 10 working days of the agency's receipt of the application. If a decision cannot be made within 10 working days of receipt of the BCCPTA application, the worker must send a "Notice of Action on Medicaid", form #032-03-008, on the 10th day stating why action has not been taken, specifying what information is needed and a deadline for submitting the information. E. Entitlement 1. Entitlement Begin Date Eligibility under this covered group is met the beginning of the month the screening is completed if the individual later has a positive diagnosis as a result of the screening and is determined to be in need of treatment for breast and/or cervical cancer. Eligible BCCPTA individuals are entitled to full Medicaid coverage beginning the first day of the individual’s application month if all eligibility requirements are met in that month. Coverage is to be provided throughout the person’s course of treatment, and no limit is placed upon the number of years an eligible person may be covered as long as physician certifies at renewal that treatment for the breast or cervical condition is still required. 2. Retroactive Entitlement Retroactive coverage is applicable to this covered group if the individual was screened by a medical provider operating under the BCCEDP and diagnosed as needing treatment for breast or cervical cancer in the retroactive month(s).