Family and Children's Medicaid MA-3250 Breast and Cervical Cancer Medicaid
v. county dss procedures
REVISED 11/01/09 – CHANGE NO. 14-09
Common Name Database. BCCM applications are included in the county’s Application Management Report and the Report Card.
The county keys the DSS-8124 using the date of application as the date a “complete” application was received in the county dss, whether faxed or mailed.
3. DSS determines if the applicant is eligible for BCCM or another Medicaid aid program/category. If the woman is a qualified alien, DSS must verify the alien document and date of admission into the U.S. by accessing SAVE. The date of Medicaid eligibility can be no earlier than the first day of the month of her diagnosis, as stated on the DMA-5081. Retroactive coverage of three months is allowed. (Refer to V.B. for determining eligibility under another aid program/category.)
4. DSS faxes the DMA-5081 to the MEU of DMA. DMA faxes the DMA-5081 to the North Carolina Division of Public Health. DPH reviews the DMA-5081 to determine the Medicaid certification period for the woman. DPH then faxes the DMA-5081 determination to DMA. The DMA-5081 determination is faxed to DSS no later than one working day after receipt. If more than 12 months is given for her length of treatment, then only a 12 month certification period is given. At the end of the certification period, DSS completes a review to determine her ongoing eligibility.
5. Complete the DSS-8125 ‘authorized representative’ field on page 2 with the name and address of the BCCCP Coordinator. This generates a copy of the approval notice to the BCCCP Coordinator. This assists the BCCCP Coordinator in ensuring treatment occurs or other funding is identified.
Withdrawal/denial notices must be manual as denials are completed on the DSS-8124 Application and the ‘authorized representative’ field is not available for the application screen. Send a copy of the notice to the BCCCP Coordinator.
Once the case is approved in EIS, a gray Medicaid ID card will be mailed to the recipient.
B. Eligible Under Another Medicaid Aid Program/Category
1. When Section III of the DMA-5079 is completed by the screening provider, the woman may be eligible for another Medicaid program. If a woman is eligible for another Medicaid program she is ineligible for Breast and Cervical Cancer Medicaid. Review the application to see under which aid program/category she may be eligible.
REISSUED 11/01/09 – CHANGE NO. 14-09
a. Determine if more verification is needed to determine eligibility in another aid program/category. If more information is needed to determine eligibility for another Medicaid program, send a DMA-5097/5097S, Request for Information. The BCCCP Coordinator remains a resource for any requested information.
b. Calculate earned and unearned income and resources. Document the verification on the application. Determine in which Medicaid program she is eligible according to her verified income and resources. If verification is not received and it appears a/r has a deductible, then authorize Medicaid under BCCM.
2. If the woman is potentially eligible for Medicaid with a deductible, authorize her for MAF-M if her medical expenses meeting her deductible have been incurred as of the date of the BCCM application.
3. If the woman is a qualified alien, verify the authenticity of the alien document, and the date of admission using SAVE, Systematic Alien Verification for Entitlement Program.
4. If the woman states she is disabled but not receiving disability, process the application for BCCM. Advise the applicant to apply for MAD-90. Once she is approved for Medicaid for the Disabled, close the Breast and Cervical Cancer Medicaid. Ensure there are no gaps in eligibility coverage.
C. Redetermination Process
1. The monthly Case Management Report, DHREJ CASE MANAGEMENT REPORT, displayed in XPTR contains BCCM cases whose certification period is expiring. The message displays on the report three months prior to the last month of the certification period. There is also a special review message that displays two months prior to the month of the 65th birthday.
2. Appointment notices will not be generated.
3. Before the end of the certification period, initiate the review process by mailing the DMA-5079, Breast and Cervical Cancer Medicaid Application, to the recipient and the DMA-5081R, Recertification for Continuing BCCM Eligibility, to the BCCCP screening provider. The BCCCP screening provider will assist you in getting the physician to complete the form if ongoing treatment is still needed.
REISSUED 01/01/11 – CHANGE 19-10
4. If the DMA-5081R indicates a need for additional treatment, fax the form to MEU (919-715-0801) to send to DPH. DPH will determine if treatment meets criteria and establish needed months for eligibility. MEU will fax the form to the county. Upon receipt of the DMA-5079, Breast and Cervical Cancer Medicaid Application and completed DMA-5081R, Recertification for Continuing BCCM Eligibility, complete the review. If she is still receiving treatment for cancer, key the new certification period into EIS. Key the BCCCP Coordinator name and address into the ‘authorized representative’ field on the DSS-8125 to ensure a copy of the approval notice is sent to the BCCCP coordinator.
5. If she is no longer receiving treatment for cancer, terminate case in EIS after evaluating for any other Medicaid aid program/category based on information in record. Send a timely notice of termination. This notice can be automated. To notify the BCCCP Coordinator use the ‘authorized representative’ field for terminations.
D. Changes in Situation
The recipient is to report any changes in her situation within 10 calendar days to the county department of social services.
1. Attained Age 65
If a woman turns 65 during her period of Medicaid coverage, her eligibility terminates at the end of the month of her 65th birthday. A message will display on the Case Management Report in XPTR two months prior to the month of her 65th birthday. Before terminating, explore other categories of Medicaid coverage. The IMC is to assist the individual in getting coverage under Medicare. A timely notice is to be sent to terminate her assistance if she is ineligible for any other Medicaid program.
2. No Longer Needs Treatment for Cancer
A woman determined eligible under this option remains eligible as long as she receives treatment for breast or cervical cancer. Presume that a woman is receiving such treatment during the duration of the period established by her physician and DPH. If it is reported that the woman is no longer in need of treatment for cancer, she is no longer eligible for BCCM.
REVISED 01/01/11 – CHANGE NO. 19-10
Evaluate eligibility for other Medicaid programs. If she is eligible for another Medicaid aid program/category, process the case. If she is ineligible for other coverage, terminate the case after the timely notice.
3. Becomes Pregnant
If a woman becomes pregnant, evaluate the case for Medicaid for Pregnant Women. Transfer the MAF-W to MPW if the recipient is eligible for MPW. If treatment for cancer has been terminated and the recipient is not eligible for MPW or any other Medicaid aid program/category, terminate the Medicaid coverage for Breast and Cervical Cancer. Send a timely notice.
4. Eligible for Other Medicaid Programs
a. If a woman begins to receive Social Security Disability, she may become eligible for another Medicaid aid program/category. Terminate BCCM and give adequate notice unless the woman has a deductible. If she has a deductible, send a timely notice. Approve the Medicaid for the Disabled by entering an administrative application. Refer to the EIS Manual for procedures in completing the DSS-8125.
b. If a woman has children, she may become eligible for another Medicaid aid program/category as a caretaker relative. Refer to MA-3235, Caretaker Relative Eligibility. At the end of the adequate notice, transfer the BCCM case to another MAF category. Refer to the EIS Manual for allowable transfer codes.
c. If a woman is no longer able to work or her income is terminated and she has children, she may be eligible for another Medicaid aid program/category. Transfer the BCCM case at the end of the adequate notice to MAF-C. Refer to the EIS Manual for allowable transfer codes.
5. Obtains Health Insurance
If a woman obtains or it is discovered that she has creditable medical health insurance, she is no longer eligible for Breast or Cervical Cancer Medicaid. Ensure the insurance coverage will cover breast or cervical cancer treatments. Refer to II. B. above for definition of creditable coverage. Evaluate for all other Medicaid programs. If ineligible for all other Medicaid programs, start the process to terminate coverage. Follow procedures in MA-3510, Third Party Recovery for entering insurance information.
6. Moves to a Different County
Refer to MA-3340, County Residence, for transfer procedures.
REISSUED 11/01/11 – CHANGE NO. 15-11
7. Moves Out of State
If the recipient moves out of North Carolina, terminate the Medicaid coverage for this program. Send an adequate notice or a timely notice. Refer to MA-3430, Notice and Hearings Process, to determine which is correct in this situation.
8. Enters a Long Term Care Facility
Refer to MA-3325, Long-Term Care Budgeting, if the woman enters a long-term care facility. Compute a patient monthly liability, and enter into EIS. Advise the woman to apply for Medicaid for the Disabled.
Advise the applicant to apply for Medicaid for the Disabled if she alleges she has a disability but has not been determined disabled by Social Security Disability. Work with the BCCCP Coordinator to get her to apply for SSA disability.
1. Approve the woman for Breast and Cervical Cancer Medicaid if she is eligible while she is waiting on the approval of the disability.
2. If the disability is approved, close the BCCM with the appropriate notice.
F. Children in the Home
If the woman applying for BCCM indicates she has young children in the home under the age of 19 and it appears they may be eligible for NCHC or Medicaid, mail a DMA-5063, N.C. Health Check/Health Choice for Children Application, to the woman.
If the BCCM recipient is the caretaker of children receiving Medicaid, a referral to Child Support Enforcement is required.
G. Terminated From Another Program
If a woman is being terminated from Medicaid in any program and was previously enrolled, screened and determined to need treatment by a BCCCP screening provider, the county dss is to do the following.
1. Determine if the woman continues to be eligible for BCCM during the certification period established for BCCM.
REVISED 11/01/11 – CHANGE NO. 15-11
H. Non-U.S. Citizens and Emergency Medical Services
1. Women who do not meet the citizenship/alienage eligibility criteria may still be able to receive Medicaid coverage related to an "emergency condition."
2. When the county receives an application for emergency medical services, review the application to see if she is potentially eligible under BCCM. If the applicant has breast or cervical cancer and currently receives treatment for cancer, the county DSS must contact the local health department to see if the woman was screened through BCCCP. If so, indicate this on the DMA-5135, Date (s) of Emergency Services Requested for An Alien, sent to DMA.
3. If a non-qualified alien has been screened by the BCCCP and determined to need treatment for cancer, she may be eligible under BCCM for certain dates of coverage if it is determined she has a medical emergency. Medicaid may not be authorized until after the emergency service has occurred.