*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: June 1, 2012 |
|
03.45.30.05 - Application Process for MA-BC |
Archived: June 1, 2016 (Previous Versions) |
Women who are screened through the Sage Screening Program and are potentially eligible for Medical Assistance (MA) using the Breast/Cervical Cancer (MA-BC) basis of eligibility may complete an initial eligibility determination through either of the following:
l Their health care provider (using a process known as presumptive eligibility).
l Their county agency (using the usual application process).
Note: If an applicant submits an application form designed for a different population, contact the applicant to gather any missing information.
Presumptive eligibility is a process for providers to grant eligibility to applicants before all mandatory eligibility factors are verified. For MA-BC, women meeting certain criteria are presumed to be eligible for an initial period to ensure they will receive timely treatment for breast or cervical cancer.
If the initial eligibility determination is presumptive, the county agency must complete a follow-up determination for ongoing MA eligibility.
Presumptive Eligibility Determinations.
Ongoing Eligibility Determinations.
Presumptive Eligibility Determinations
There are providers around the state who are certified to make presumptive eligibility determinations. These providers will determine presumptive eligibility for MA for Breast/Cervical Cancer (MA-BC) and will forward information to county workers when they grant presumptive eligibility to their patients. See Presumptive Eligibility Providers for MA-BC for a list of participating providers.
1. Obtain the client's signed consent to share the Sage Screening Program form with the county agency.
2. Complete a Temporary Medical Assistance Authorization (DHS-3525B) and fax a copy to the county's designated MA-BC staff along with the completed Sage Enrollment form.
3. Give the applicant the Minnesota Medical Assistance Breast and Cervical Cancer Coverage Group Application/Renewal (DHS-3525) or refer her to ApplyMN at www.applymn.dhs.mn.gov.
4. Give the enrollee copy of the DHS-3525B to the applicant as temporary proof of eligibility until she receives a Minnesota Health Care Programs membership card.
Note: She must complete and return the DHS-3525 to the county agency or submit an MA-BC application with ApplyMN within 30 days from the date of the Temporary Medical Assistance Authorization.
Approve MA-BC effective the first day of the month presumptive eligibility was determined by the provider. Complete the approval on MAXIS and MMIS the day you receive the forms from the provider.
1. Do not approve retroactive coverage until the woman is determined eligible for ongoing MA-BC.
2. Allow the applicant 30 days from the date of the Temporary Medical Assistance Authorization to submit a completed MA-BC Application/Renewal.
3. Close MA-BC for the first month for which you can give ten-day notice if you do not receive the completed MA-BC Application/Renewal or another approved DHS health care application by the due date.
4. Do not close MA-BC before the end of the 30-day presumptive eligibility period, even if the woman is found ineligible for ongoing MA-BC or MA under another basis.
Ongoing Eligibility Determinations
Providers who do not determine presumptive eligibility may do either of the following:
1. Give applicants a copy of their Sage Enrollment form.
2. Give applicants an MA-BC Application/Renewal or refer them to ApplyMN at www.applymn.dhs.mn.gov to submit an application to their county agency.
3. Forward the completed forms to the county agency.
Counties need to take these steps to determine MA-BC eligibility for all MA-BC applicants (those with presumptive eligibility and those without):
1. Review the MA-BC Application/Renewal to determine if the applicant is potentially eligible for MA under one of the bases noted in MA for Breast/Cervical Cancer.
2. If the applicant appears to have another MA basis, compare the income on the Sage Enrollment form to the income limit for the applicant's basis and household size. If she appears eligible without a spenddown:
n Call her to obtain additional information to determine MA eligibility.
n Send a Minnesota Health Care Programs Application (DHS-3417) to complete and return if you are unable to reach her by phone or if the additional information collected appears to support MA eligibility.
3. For applicants who were found presumptively eligible, continue MA-BC until you receive a health care application or until the end of the presumptive eligibility period.
4. For MA-BC applicants who were not found presumptively eligible, pend the application. Deny MA-BC if the applicant fails to return a health care application within 45 days.