Application Process for MA-BC (Archive)

Women who are screened through the Sage Screening Program A free statewide comprehensive breast and cervical cancer screening program administered by the Minnesota Department of Health whose primary objective is to increase the proportion of low or moderate income age-appropriate women who are screened for breast and cervical cancer. 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).

Presumptive eligibility is a process for granting 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.

County Agency Eligibility Determinations.

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Presumptive Eligibility Determinations

There are presumptive eligibility providers around the state. 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.

l  Provider action:

n  Obtain the client's signed consent to share the Sage Screening Program form with the county agency.

n  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 Screening Program form.

n  Give the applicant the enrollee copy of the DHS-3525B as temporary proof of eligibility until she receives:

m A Minnesota Health Care Programs membership card.

m A Minnesota Medical Assistance Breast and Cervical Cancer Coverage Group Application/Renewal (MA-BC Application/Renewal) (DHS-3525).

Note:  She must complete and return the DHS-3525 to the county agency within 30 days.

l  County action:

n  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.

n  Do not approve retroactive coverage until the woman is determined eligible for ongoing MA-BC.

n  Allow the applicant 30 days from the date of the Temporary Medical Assistance Authorization to submit a completed MA-BC Application/Renewal.

n  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 form by the due date.

n  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.

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County Agency Eligibility Determinations

Providers who do not determine presumptive eligibility may do either of the following:

l  Give applicants a copy of their Sage Screening Program form and an MA-BC Application/Renewal to submit to their county agency.

l  Forward the completed forms to the county agency.

To determine initial MA-BC eligibility for applicants who were not determined presumptively eligible, or ongoing eligibility for those who were:

l  Review the MA-BC Application/Renewal to determine if the applicant is potentially eligible for MA under one of the mandatory bases noted in MA for Breast/Cervical Cancer.

l  If the applicant appears to have another MA basis, compare the income on the Sage Screening Program form to the income limit for the applicant's basis and household size. If the applicant appears eligible without a spenddown The amount that a person’s income exceeds the applicable MA income standard. People with an MA basis of eligibility may become eligible by incurring medical expenses equal to or greater than the amount of excess income. There are several types of spenddowns including monthly medical spenddown, six-month medical spenddown, LTC spenddown and combination LTC/medical spenddown.:

n  Contact the applicant by phone to obtain additional information to determine MA eligibility.

n  Send the applicant a Minnesota Health Care Programs Application, or HCAPP (DHS-3417) to complete and return if you are unable to contact the applicant or if the additional information collected appears to support MA eligibility.

l  For applicants who were found presumptively eligible, continue MA-BC until you receive the HCAPP or until the end of the presumptive eligibility period.

l  For MA-BC applicants who were not found presumptively eligible, pend the application. Deny MA-BC if the applicant fails to return the HCAPP within 45 days.

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