Medical Assistance for Women with Breast or Cervical Cancer

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Medical Assistance for Women with Breast or
Cervical Cancer
Became effective July 1, 2002

• Updated 10/20/2009

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Breast and Cervical Cancer Prevention and
Treatment Act of 2000

• Gave states matching funds to provide Medicaid
  eligibility to a new group of individuals
  previously not eligible.
• Full Medical Assistance benefits to women
  diagnosed through the Sage Screening Program and
  needing treatment.

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Medical AssistanceMA-BC

• Coverage will begin where Sages ends
• 12-month eligibility
• Full MA benefits

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Eligibility CriteriaMA-BC

• To be eligible for MA-BC an individual must
• have been screened under the Sage Screening
  Program and program funds were used to pay (all
  or in part) for the screening or follow-up
• need treatment, including diagnostic services to
  determine the extent and course of treatment for
  breast or cervical cancer, including
  pre-cancerous conditions and early stage cancer

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Eligibility CriteriaMA-BC (contd)

• To be eligible for MA-BC an individual must
• be under age 65
• not be otherwise eligible for MA

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Eligibility CriteriaMA-BC (contd)

• To be eligible for MA-BC an individual must
• not be covered by other creditable health
  insurance coverage
• have an immigration status that qualifies her for
  MA
• have proof of citizenship
• have a Social Security Number

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AdministrationMA-BC

• County Human Service Agencies will administer
  MA-BC
• There is a specific MA-BC contact at each county
  agency
• Contact your Sage RC for the contact info.
• Website list of contacts

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Forms Needed to Determine MA-BC Eligibility

• Sage Enrollment Form (Copy)

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Forms Needed to Determine MA-BC Eligibility
(contd)

• General Consent for Release of Information
• If provider is sending the Sage Enrollment form
  to the county agency (Keep on file)

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Forms Needed to Determine MA-BC Eligibility
(contd)

• MA-BC Application/Renewal Form
• (Original)

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SummaryForms Sent to County Agency for MA-BC
Determination

• Sage Enrollment Form (Copy)
• MA-BC Application/Renewal Form (Original)
• Note Provider keeps Consent to Release on file

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Presumptive Eligibility

• MA-BC includes a temporary immediate coverage
  option for women who appear to meet the basic
  eligibility criteria for the program.
• Presumptive eligibility is useful in providing
  more immediate coverage (than the full
  eligibility process) for women who need to begin
  treatment immediately.
• Since the determination of presumptive
  eligibility does not consider citizenship or
  immigration status, women whose citizenship or
  immigration status is unknown or uncertain may be
  eligible. Providers do not need to ask about a
  patients citizenship or immigration status.

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Presumptive Eligibility (contd)

• The clinic where patient is screened can grant
  Presumptive Eligibility
• Provides automatic coverage for 30 days while
  application is pending
• Application should also be completed and sent
  along with a copy of the Sage form just as it
  would for the regular process

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Presumptive Eligibility (contd)

• Once presumptive eligibility has been granted, it
  cannot be taken away, even if the women is found
  ineligible for ongoing coverage or she does not
  pursue ongoing coverage.
• Coverage ends when the county agency determines
  the individual is eligible/ineligible for ongoing
  MA-BC
  OR
• After 30 days individual does not file a
  complete MA-BC application with the county agency

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Presumptive EligibilityQualified Providers

• Sage Screening Program Participating Provider
• Enrolled MA Provider
• Must be verified as having been trained
• Today you are trained!

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How to Determine Presumptive Eligibility for
MA-BC

• Criteria for Presumptive Eligibility is same
• Screened and found to need treatment
• Under age 65
• Other health insurance Yes/No

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How to Determine Presumptive Eligibility for
MA-BC (same process as regular)

• Sage Enrollment Form

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How to Determine Presumptive Eligibility for
MA-BC (same process as regular)

• Presumptive Eligibility Criteria Found on the
  Sage Enrollment Form
• Screened and found to need treatment
• Under age 65 (Question 1 - Birthdate)
• Other health insurance (Question 4)

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Forms to Grant Presumptive Eligibility (same
forms as regular)

• Temporary Medical Assistance Authorization
• Shows that the woman is eligible for Medical
  Assistance
• Carbon form - Copies to patient, county agency
  and keep copy for file

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Presumptive Eligibility Temporary Medical
Assistance Authorization
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Forms to Grant Presumptive Eligibility (same
forms as regular)

• General Consent for Release of Information
  (DHS-2243a)
• Patient consents release of the Sage Enrollment
  Form to the county agency (Keep on file)

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During Presumptive Eligibility

• MA-BC Application/Renewal
• 30 days to complete and return to the county
  agency
• Can be forwarded to the county agency by provider
• Eligibility ends if not received by county agency
  in 30 days (Original)

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SummaryForms Sent to County Agency for
Presumptively Eligible Individuals

• Sage Enrollment Form (Copy)
• Temporary Medical Assistance Authorization (Copy)
• MA-BC Application/Renewal (Original) May be sent
  by provider or patient
• Note provider keeps Consent for Release on file

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Registering to Participate in Presumptive
Eligibility

• Send email to DHS stating that you have completed
  the on-line training for MABC Presumptive
  Eligibility
• Download AGREEMENT FOR PROVISION OF BREAST AND
  CERVICAL CANCER SCREENING, PREVENTION, AND
  TREATMENT SERVICES
• Complete and send to address on bottom of form
  
• You must do both of the above to be certified to
  grant Presumptive Eligibility
  

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Questions or Comments?Contact your Regional
Coordinator (RC)