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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 209 Chapter 1 Application/Redetermination Process

1.24.2 REDETERMINATION PROCESS An annual redetermination for Breast and Cervical Cancer Medicaid (BCC) is required. For the redetermination, the West Virginia Breast and Cervical Cancer Screening Program (WVBCCSP), which is managed through the Office of Maternal Child and Family Health (OMCFH), sends the client a blank DFA-BCC-1 Medicaid application and a CDC Certificate of Diagnosis form. The client is responsible for having their doctor complete the blank CDC Certificate of Diagnosis stating the client is still actively receiving cancer treatment. The treating physician will fax the completed CDC Certificate of Diagnosis to WV BCCSP. If the client remains eligible for WVBCCSP, the completed DFA-BCC-1 application and the CDC Certificate of Diagnosis are then forwarded by WVBCCSP to the client’s local DOHS Office. Once the Worker receives the required documents from WVBCCSP, the review process must be completed by the Department. The Worker sends the client a Medicaid application to determine if the client is eligible for one of the mandatory Medicaid coverage groups. The BCC case remains open in Regular BCC while the determination is being made. Failure to complete or cooperate in the Medicaid application process will result in closure of the BCC case. If determined eligible for a mandatory Medicaid group, the BCC coverage is terminated and takes the Worker approves the client for the appropriate mandatory Medicaid coverage group. If the client is not eligible for a mandatory Medicaid coverage group, complete the required override for BCC Medicaid and confirm the benefit. The Worker must scan the documents into the client’s case record and make appropriate case comments. If the client needs disenrolled from WVBCCSP due to age, obtaining other insurance, no longer a West Virginia resident, treatment completion or death, the WVBCCSP Case Manager will notify the local DOHS office. The Worker will then need to determine eligibility for any other types of Medicaid before termination. NOTE: To be eligible for BCC, the client must first be a patient of the WVBCCSP. WVBCCSP has separate eligibility guidelines from BCC. While BCC Medicaid does not have an income limit, WVBCCSP has an income limit of 250% FPL. For more information on the West Virginia Breast and Cervical Cancer Screening Program, contact WVBCCSP at 304-558-5388 or 1-800-642-8522.