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Effective: May 1, 2007 |
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03.45.30ar2 - Medical Assistance for Breast/Cervical Cancer (MA-BC) (Archive) |
Archived: July 1, 2008 |
The Sage Screening Program (formerly the Minnesota Breast and Cervical Cancer Control Program) provides free breast and cervical cancer screening to some Minnesota women with low or moderate income. This program is administered statewide by the Minnesota Department of Health.
Women who have been screened and found to need treatment for breast or cervical cancer, including precancerous conditions and early stage cancer, may be eligible for Medical Assistance (MA) under the Breast/Cervical Cancer basis of eligibility (MA-BC) if they meet all of the following conditions:
l Have been screened by the Sage Screening Program and used program funds to pay for the screening.
l Need treatment, including diagnostic services to determine the extent and course of treatment for breast or cervical cancer, including precancerous conditions and early stage cancer.
l Are under age 65.
l Are not eligible for MA under any of the following mandatory bases:
n Children under age 19 who have a children under 21 basis of eligibility.
Note: Children ages 19-20 who are eligible under this basis may be eligible for MA-BC.
n Blind or disabled receiving SSI (or those deemed to be receiving SSI) who have income at or below 100% FPG and are eligible for the Disabled Adult Children disregard, Widow/Widowers' disregard, or Pickle disregard.
n Blind or disabled and receiving Minnesota Supplemental Aid (MSA).
Eligibility factors are listed below with any information that is unique for this group. Links to standard program guidelines are included as well.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Other Groups/Bases to Consider.
Application Process (standard guidelines)
The Minnesota Medical Assistance Breast and Cervical Cancer Coverage Group Application/Renewal, or the MA-BC Application/Renewal Form (DHS-3525), is used for women who are screened and found to need treatment through the Sage Screening Program.
Women may be determined presumptively eligible by their medical provider.
l If a provider determines presumptive eligibility, the date of application is the date the provider grants presumptive eligibility.
l If the provider does not determine presumptive eligibility, the date of application is the date the county agency receives the DHS-3525.
See Application Process for MA-BC and Presumptive Eligibility Providers.
The earliest date of eligibility for MA-BC is three months before the date of application or the first day of the month in which the woman was screened under the Sage Screening Program, whichever is later.
Note: Women who are granted presumptive eligibility for MA-BC must be found eligible for ongoing MA-BC before retroactive eligibility is granted.
Renewals (standard guidelines)
Review MA-BC eligibility annually. Mail an MA-BC Application/Renewal (DHS-3525) and Certification of Further Treatment Required (DHS-3525A) following the timelines in MA/GAMC Renewals.
Request verification of immigration status for women who report they are noncitizens and request ongoing MA-BC coverage.
Social Security Number (standard guidelines)
l Presumptive eligibility: An SSN is not required.
l Ongoing MA-BC: Follow standard MA guidelines.
MA-BC clients who declare they are U.S. citizens are not required to document their citizenship and identity as a condition of eligibility during the presumptive eligibility period. Obtain documentation for enrollees who file an application for ongoing coverage.
For noncitizens:
l Presumptive eligibility: Immigration status is not required. MA-BC coverage for the presumptive eligibility period is always federally funded.
l Ongoing MA-BC: Women must have an immigration status that qualifies them for either federally-funded MA (program MA) or state-funded MA (program NM). MA-BC is federally funded for women who have an MA-qualifying status and state-funded for those who have a program NM status.
Note: Do not require sponsor information or apply sponsor deeming provisions for MA-BC.
Residency (standard guidelines)
Follow standard MA guidelines.
Some women may have insurance barriers that prevent them from using the MA-BC basis of eligibility. If the applicant reports other health care coverage, contact her to determine if it is creditable coverage.
l If the coverage is any of the following creditable health insurance plans, the applicant is not eligible for MA-BC:
n Group health plans, unless the plan does not cover the needed cancer treatment.
n Individual health insurance coverage, unless the plan does not cover the needed cancer treatment.
n Medicare.
n MA.
n Armed forces insurance (TRICARE, CHAMPVA).
n Minnesota Comprehensive Health Association (MCHA).
Note: Do not require verification if the applicant states her insurance does not cover her cancer treatment.
l If the coverage does not meet the definition of creditable coverage, enter insurance information in MMIS and determine if the premium is cost-effective.
Household Composition (standard guidelines)
Follow standard MA guidelines.
Not applicable - there is no income or asset test, so no evaluation method is needed.
Asset Guidelines (standard guidelines)
There is no asset limit.
There is no income limit.
Deductions/Disregards (standard guidelines)
There is no income limit.
There is no income limit.
Covered Services (standard guidelines)
MA-BC enrollees are eligible for all MA-covered services for as long as they need treatment.
Women eligible under this basis are excluded from managed care enrollment.
A woman who was diagnosed with breast or cervical cancer by a participating Sage Screening Program provider, but not using Sage funds, may be screened retroactively for possible MA-BC eligibility with Sage funds.
Note: Each Sage clinic decides if they will perform retroactive screenings to be covered under Sage program funds.
Redetermine MA under another basis for MA-BC enrollees who report they are no longer in need of treatment for breast or cervical cancer, including precancerous conditions and early stage cancer.
If women are eligible for MA without a spenddown under another basis (other than the mandatory bases listed at the beginning of this section), they may choose between that basis and MA-BC. If they choose the other basis, then become ineligible for MA at a later date, redetermine eligibility for MA-BC.
Note: Require verification of the continuing need for treatment if the Sage Screening Program form is more than 12 months old.
Not applicable.