Family and Children's Medicaid MA-3250 Breast and Cervical Cancer Medicaid

II. eLIGIBiLITY REQUIREMENTS FOR Breast and Cervical Cancer Medicaid (BCCM)

The applicant must meet all the following requirements to be eligible for Breast and Cervical Cancer Medicaid.

A. The woman must be enrolled and screened for breast or cervical cancer through the BCCCP. BCCCP must determine that she needs treatment for either breast or cervical cancer including pre-cancerous conditions and early stage cancer.

Women who have moved to N.C. from another state and were enrolled in the BCCCP screening program in another state and women who are referred from a private physician must be enrolled, screened and found to need treatment for either breast or cervical cancer by BCCCP.

B. The woman must not have any creditable medical insurance coverage, including Medicare and/or Medicaid.

Do not authorize the woman for BCCM if she is eligible for another Medicaid benefit. If the woman is potentially eligible for MAF-M (medically needy), authorize her for MAF-M if her medical expenses to meet the deductible have been incurred as of the date of the BCCM application.

The following types of coverage are creditable medical insurance coverage:

1. A group medical plan,

2. Medical insurance coverage, which is benefits consisting of medical care under any hospital or medical service policy or certificate, hospital or medical services plan contract, or HMO organization contract offered by a medical insurance issuer,

3. Medicare A and/or B,

4. Medicaid,

5. Armed forces insurance,

6. A state medical risk pool.

A woman with creditable medical insurance coverage is ineligible for BCCM. However, if the insurance coverage consists solely of limited benefits such as accidents or limited-scope dental, vision, or long term-care she may be eligible for BCCM. There may also be limited circumstances where a woman has major medical insurance, but she is not actually covered for treatment of breast or cervical cancer.

REVISED 08/01/13 - CHANGE NO. 04-13

(II.B.)

In this situation, she would meet the requirement for having no creditable medical insurance coverage.

C. The woman must be age 18 through 64.

D. The woman must meet other general eligibility requirements for Medicaid.

1. Be a citizen of the U.S. or be an alien who meets the criteria contained in MA-3332, US Citizenship Requirements and/or MA-3330, Alien Requirements.

NOTE: If the woman is an alien limited to emergency medical care only, she may still be able to receive Medicaid coverage related to an "emergency condition," other than services related to an organ transplant. Breast or cervical cancers may be identified at various stages.

2. Be a resident of North Carolina as defined in MA-3335, State Residence.

3. Not be an inmate of a public institution. Note that individuals incarcerated in a NC Department of Public Safety, Division of Prisons (DOP) facility have their eligibility placed in suspension. Refer to MA-3360, Living Arrangement.

4. Not be authorized for Medicaid in another assistance category, county, or state. Refer to MA-3230, Eligibility of Individuals under 21, MA-3335, State Residence, and MA-3340, County Residence. Refer to V.B.

5. Furnish a Social Security number or apply for a number. Refer to MA-3355, Enumeration Procedures.

6. Cooperate with the local child support enforcement agency in establishing paternity and securing medical and child support for any child who is currently receiving Medicaid. Refer to MA-3365, Child Support.

NOTE: There is no income or asset test for this Medicaid coverage group. The a/r meets the Medicaid income and asset test based on eligibility for BCCCP.

REISSUED 08/01/13 - CHANGE NO. 04-13