Medical Assistance for People with Breast or Cervical Cancer
2.5.1.1.1 Applications
People, who are screened through the Minnesota Department of Health (MDH) Sage Screening Program or the American Indian Cancer Foundation (AICAF) Screen Our Circle Program and are found to need treatment or diagnostic services for breast or cervical cancer, are potentially eligible for Medical Assistance for People with Breast or Cervical Cancer (MA-BC).
Application Paths
The person must apply for MA-BC. There are two paths to requesting an MA-BC eligibility determination.
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A temporary eligibility determination, referred to as presumptive eligibility (PE), may be granted by a Minnesota Health Care Programs (MHCP) provider participating in the Sage Screening Program or Screen Our Circle Program.
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Some people do not have presumptive eligibility determined and directly apply for MA-BC using the Minnesota MA Application/Renewal Breast and Cervical Cancer (DHS-3525) form.
Forms
Temporary Medical Assistance Authorization (DHS-3525B)
The Temporary Medical Assistance Authorization (DHS-3525B) is completed by the provider and authorizes presumptive eligibility.
Minnesota MA Application/Renewal Breast and Cervical Cancer (DHS-3525)
The Minnesota MA Application/Renewal Breast and Cervical Cancer (DHS-3525) form is for people who were screened by the Sage Screening Program or Screen Our Circle Program, need treatment or diagnostic services for breast or cervical cancer and are seeking MA-BC coverage. Enrollees also use this form to renew eligibility for coverage.
Application Filer
The applicant or an authorized representative is the application filer. Only a person meeting the definition of an application filer or an authorized representative can sign the application or renewal. See section 1.3.1.2 MHCP Authorized Representative policy for more information.
Date of Application
The date of application is the date the county, tribal or state servicing agency receives DHS-3525.
Presumptive Eligibility
PE provides immediate MA-BC coverage for people who need to begin treatment. PE is granted to people who meet the MA-BC presumptive eligibility criteria as determined by a Sage or Screen Our Circle PE provider.
Once a Sage or Screen Our Circle PE provider has granted PE, no additional eligibility criteria may be applied. A person approved for PE cannot be required to attest to or provide more information about her state residency,citizenship or immigration status, household composition, income or other factors. All eligibility factors relevant to PE have been considered by the Sage or Screen Our Circle PE provider when PE is granted.
Temporary MA-BC eligibility is effective on the first day of the month PE is approved by a Sage or Screen Our Circle PE provider and continues through the end of the month following the month it was approved.
The Sage PE provider must complete and submit to the county, tribal or state servicing agency:
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MDH Sage Enrollment form or AICAF Screen Our Circle Enrollment form
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Copy of Temporary Medical Assistance Authorization (DHS-3525B)
The county, tribal or state servicing agency must enter MA-BC eligibility in MAXIS and MMIS per the DHS-3525B the day the form is submitted. MA-BC must be opened for a person approved for PE by a Sage PE provider, in accordance with the date of the Temporary Medical Assistance Authorization, regardless of other health care applications that are pending.
If a person who has PE does not submit an application for on-going MA-BC coverage or is not eligible for ongoing MA-BC, PE ends the last day of the month following the month PE was approved.
A person approved for PE who is denied ongoing MA-BC eligibility is entitled to receive coverage for the full PE period.
Ongoing Eligibility for MA-BC
To have an ongoing eligibility determination for MA-BC, a person approved for PE must complete the Minnesota MA Application/Renewal Breast and Cervical Cancer (DHS-3525) form. The DHS-3525 must be submitted to the county, tribal or state servicing agency within 30 days of the date the presumptive eligibility is approved by a Sage or Screen Our Circle PE provider. The county, tribal or state servicing agency must process the application for ongoing MA-BC within 45 days. An applicant may complete and submit the DHS-3525 on the same date PE is approved.
Retroactive Coverage
A person may request retroactive coverage. The earliest date of eligibility is three months before the date of application or the first day of the month in which the person was screened by Sage or Screen Our Circle, whichever is later. The person must have paid or unpaid medical expenses during the retroactive period that would be covered by MA. People who are granted presumptive eligibility for MA-BC must be found eligible for ongoing MA-BC before retroactive eligibility is granted.
Legal Citations
Code of Federal Regulations, title 42, section 1100-1103
Code of Federal Regulations, title 42, section 435.213
Code of Federal Regulations, title 42, section 1396r–1b
Public Law 106-354 October 24, 2000
Public Law 107-121 January 15, 2002