The woman is authorized in the MAF aid program/category with one of the following classifications:
This coverage group (BCCM) does not require the woman to have an eligible child for her to be eligible for Medicaid.
The date of application is the date that a "complete" application is received from a BCCCP screening provider in the agency. This may be by fax or mail.
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The certification period for this coverage group is based on the woman's course of treatment for cancer as established by a physician and approved by the Division of Public Health (DPH). A DMA-5081, Verification of Screening and Diagnosis for Breast and Cervical Cancer Medicaid, must be completed by a physician giving an estimated length of treatment.
The certification period may be up to 12 months. Even if the course of treatment is estimated by the physician to be more than 12 months, the certification period for Medicaid coverage can be no longer than 12 months.
If the course of treatment is estimated to be less than 12 months, the certification period must be the actual number of months the DPH states on the DMA-5081.
A review is completed at the end of the certification period to determine if she continues to be eligible for BCCM. Refer to V.C. for redetermination procedures.
For example, the woman turned 65 years old or has obtained major medical insurance coverage. Terminate the woman's BCCM case after she has been evaluated for any other Medicaid program and timely notice has been given. See V.
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The applicant may request up to 3 months of retroactive coverage under BCCM. Retroactive coverage only applies if as of the earlier date, the woman met eligibility requirements. This includes having been screened and found to need treatment for breast or cervical cancer in the retroactive month.
The retroactive months are separate from the ongoing certification period.
Referral to Child Support Enforcement is not required unless the woman is a caretaker of children receiving Medicaid. If a woman is approved for MAF-W who has children receiving Medicaid, complete a referral on the child's case and send to Child Support Enforcement.
If a child of the MAF-W recipient is approved for Medicaid, complete a referral on the child's case and send to Child Support Enforcement.
A referral screen is displayed only when the woman is between 18 and 21 years of age for the BCCM case. Do not send a referral on this case to Child Support since there are no children in the MAF-W case.
Breast and Cervical Cancer Medicaid recipients are eligible for Medicaid funded transportation services.
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Copayments are the same as other Medicaid programs. There is no co-payment for women under age 21. For women age 21 and over, refer to MA-3540, Medicaid Covered Services.
These recipients are ineligible for managed care.
Medical care programs of the Indian Health Service (IHS) or of a tribal organization are sometimes considered creditable coverage under the Public Health Act. However, not all women are covered under such programs. In North Carolina, Medicaid is considered the primary payer when Indian Health Services is involved. Therefore, even if the woman can use IHS, she is eligible for BCCM.
Reaction to the BENDEX, BEER, FRR, and ESC/UI and other reports are not required unless the woman goes into another Medicaid program.
This coverage group is excluded from COLA since there is no income or asset test for BCCM.
BCCM applicants/recipients have the same right to request a hearing as other Medicaid a/r’s. Refer to MA-3430, Notice and Hearings Process, for procedures on appeals.
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.