016.20.01 Ark. Code R. § 017 - Medical Services Policy MS 31000-31050 - Breast and Cervical Cancer Medicaid ; DCO-129 - Breast and Cervical Cancer Medicaid Application for Assistance
MS - BREAST AND CERVICAL CANCER MEDICAID Eligibility Requirements
The Breast and Cervical Cancer Prevention and Treatment Act of 2000 (BCCPTA) gives states the option of providing Medicaid benefits to uninsured women under age 65 who are in need of treatment for breast or cervical cancer. Eligible participants must be identified through the Centers for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early | Detection Program (NBCCEDP) as needing treatment for breast or cervical cancer, including pre-cancerous conditions and early stage, recurrent or metastatic cancer.
Arkansas elected to implement this program effective December 1, 2001 by expanding the Breast Care program currently administered by the Arkansas Department of Health (ADH). This program includes a federally funded program that covers breast and cervical cancer screening and diagnosis as well as a state program that covers breast cancer screening, diagnosis and treatment.
The county DHS offices will not be involved in the screening process or in determining eligibility for this program.
To qualify for this new category, a woman must meet the following eligibility requirements:
To be eligible for Breast and Cervical Cancer Medicaid, a woman must be screened under the CDC Breast and Cervical Cancer Early Detection Program. Women are considered screened under the CDC program if their clinical services were provided all or in part by CDC Title XV funds, or the service was rendered by a provider funded at least in part by CDC Title XV funds, or if they are screened by another provider whose screening activities are pursuant to CDC Title XV. BreastCare provides a toll free number for women to call ( 1-877-670 -CARE) to determine if they are eligible for the program. The phone center determines eligibility based on age, income, and insurance status. If the woman is eligible, the enrollment information is entered into a computerized database. An appointment is scheduled with a provider for appropriate services while the woman is still on the phone. She receives a BreastCare identification card that she must present at each visit. When a woman is diagnosed with breast or cervical dysplasia/cancer, the ADH regional care coordinators will complete a form to determine if the individual is potentially eligible for Medicaid in another category before the Breast and Cervical Cancer Medicaid application is approved.
The term "creditable coverage" in this category means any insurance that pays for medical bills incurred for the diagnosis and treatment of breast and cervical cancer. A woman having the following types of coverage would be considered to have creditable coverage and would normally be ineligible for Breast and Cervical Cancer Medicaid:
* A group health plan
* Health insurance coverage - benefits consisting of medical care under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer
* Medicare Part A and B
* Medicaid
* Armed Forces insurance
* A medical care program of the Indian Health Service (MS) or of a tribal organization
* A state health risk pool
There may be some circumstances where a woman has creditable coverage, but is not actually covered for treatment of breast or cervical cancer. In instances such as pre-existing condition exclusions, or when the lifetime limit on benefits has been exhausted, a woman is not considered covered for this treatment. In these types of circumstances, the woman may be eligible for Breast and Cervical Cancer Medicaid if she meets all other eligibility criteria.
If a woman has limited coverage, such as limited drug coverage or limits on the number of outpatient visits, or high deductibles, she is still considered to have creditable coverage. However, if she has a policy with limited scope coverage such as those that only cover dental, vision, or long term care, or a policy that covers only a specific disease or illness, she is not considered to have creditable coverage, unless the policy provides full coverage for breast and cervical cancer.
There is no requirement that a woman be uninsured for any specific length of time before she is found eligible for Medicaid under this program. If a woman loses creditable coverage for any reason, she can become immediately eligible for Medicaid coverage in this category, assuming she meets all other eligibility criteria.
To be eligible for BreastCare, a woman must be under 65 years of age. If a woman turns 65 during her period of coverage her eligibility will terminate as of the date of her birthday. At the attainment of age 65, the DHS caseworker should determine if the woman is eligible in another Medicaid category, and assist the woman in continuing her coverage under Medicare. No minimum age limit has been established by state or federal law.
The usual rules that govern citizenship and alienage apply to Breast and Cervical Cancer Medicaid. To be eligible, an individual must either be a citizen or a qualified alien (MS 3310 #3, MS 3324). If a woman is not a U.S. Citizen, ADH will request and document verification of alien status.
There is no income limit imposed by state or federal law for Breast and Cervical Cancer Medicaid. However, the BreastCare program currently takes only applicants with income of 200% or less of the federal poverty level for their family unit size (See Appendix F for current amounts).
Income will be self-declared with no verification required.
There is no resource test for the Breast and Cervical Cancer Medicaid program. Medicaid asset/eligibility standards cannot be imposed on women in this program.
During the period of coverage, a woman is entitled to the full range of Medicaid benefits. Coverage is not limited to treatment of breast or cervical cancer.
When a patient who is currently enrolled in BreastCare is diagnosed with breast or cervical cancer, providers will notify ADH. The provider will complete the Diagnosis Verification Form with the diagnosis and treatment recommendations. ADH will notify the regional care coordinator who will contact the patient within 72 hours. The care coordinator will assist the patient in completing the application for Breast and Cervical Cancer Medicaid (DCO 129), the Medicaid Screening Form, the Third Party Resource form (DMS-662) and the Primary Care Physician Selection and Change Form (DMS-2609). The care coordinator will obtain documentation of alien status if appropriate.
Applications for Breast and Cervical Cancer Medicaid will be forwarded to the Arkansas Department of Health for processing.
Preliminary eligibility will be determined by ADH. The back of the DCO-129 will be completed by the ADH worker. If the applicant appears eligible, the ADH worker will forward the DCO-129 along with any supporting documentation (e.g., documentation of alien status, DMS-662, etc.) to the DHS Central Eligibility Unit for the final determination and certification to the system.
When a patient has a current diagnosis of breast or cervical cancer at the time of enrollment, the phone center will contact the provider to verify the diagnosis and treatment recommendations. The patient will be enrolled in BreastCare for the purpose of meeting eligibility criteria for Breast and Cervical Cancer Medicaid. The phone center will notify ADH. The ADH care coordinator will contact the patient within 72 hours to assist them with the Medicaid enrollment process. When the Medicaid application is approved, the phone center will end the patient's eligibility for BreastCare.
Applicants potentially eligible for another category of Medicaid will be referred to DHS. Their applications for Breast and Cervical Cancer Medicaid will be held until other Medicaid eligibility is determined. If the Medicaid application is denied, the DCO-129 will be sent to DHS for processing of the Breast and Cervical Cancer Medicaid.
Applications will be processed within 45 days, barring unusual circumstances. If ADH determines that the applicant is not eligible, the application will not be forwarded to DHS. ADH will send a notice of denial with reason for denial to the applicant.
Individuals inquiring at DHS about Medicaid for Breast and Cervical Cancer should be referred to the toll free number to see if they are eligible for the program ( 1-877-670 -CARE).
A woman eligible in this category will continue to be eligible as long as she is receiving treatment for breast or cervical cancer, is under age 65, and is not otherwise covered under creditable insurance coverage. Cases are reevaluated each year by ADH. A new application form will not be needed. ADH will send an electronic notice to the DHS Central Eligibility Unit that the woman is still eligible. The DHS Central Eligibility Unit will update the reevaluation date on the system. ADH will notify DHS when treatment has ended or that the woman no longer meets the eligibility requirements for the program. DHS will send a 10-day notice via the DCO-700 that the case will be closed, and case closure will be keyed after the 10th day. The patient will be instructed to call the BreastCare phone center 1-877-670 -2273 to reenter the BreastCare program.
A woman is not limited to one period of eligibility. A new period of eligibility and coverage would commence each time a woman is screened under a CDC program and found to need treatment for breast or cervical cancer, and meets all other eligibility criteria.
If a woman is still receiving treatment for the initial breast or cervical cancer diagnosis, and the cancer spreads to other parts of her body, she would continue to be eligible for additional treatment if the metastasized cancer is either a known or presumed complication of breast or cervical cancer. However, if the first treatment period is over and her Medicaid eligibility has been terminated, she must be re-certified as eligible for the CDC program to renew her Medicaid eligibility for the treatment of recurrent breast or cervical cancer.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.