There are no MA income or resources computations for determining eligibility under BCCPT.
The CAO determines eligibility for retroactive MA under BCCPT as follows:
Benefits can begin up to 90 days before the approval date.
All eligibility requirements under BCCPT must be met during the retroactive period, including screening and diagnosis of breast or cervical cancer or a precancerous condition of the breast or cervix.
The CAO determines eligibility for continuing MA under BCCPT as follows:
When a woman first applies, the CAO does not make an eligibility determination.
When a completed PA 600B is received from the Community Health Coordinator, the CAO authorizes MA eligibility under BCCPT within five work days.
If the woman has creditable coverage, a referral must be made to the HIPP staff to confirm that
NOTE: When a referral to HIPP is needed to confirm creditable coverage, the five-day work requirement begins from the date the CAO gets a response.
NOTE: Medicare Part A and Medicare Part B are considered creditable coverage. Select Plan is not considered creditable coverage.
At the partial renewal, the need for continued treatment must be proven before the eligibility period can be extended.
The Office of Medical Assistance Programs (OMAP) will review all medical records presented during the partial review to make sure all steps taken and services given were medically necessary under the rules of the Office of the Medical Director (OMD).
The CAO will be notified that:
There is a continued need for a specific length of treatment.
Treatment can be decreased.
Treatment is stopping because it is no longer needed or because the client has failed to provide proof of the need for treatment.
NOTE: Notice must be sent to the client whenever a client is approved for a shorter period of treatment or is no longer eligible for BCCPT.
At the complete renewal, the continued need for treatment must be proven. If the renewal form shows that the woman has creditable coverage, that must be proven, too.
The CAO should either continue or end eligibility under BCCPT based upon the recommendation from OMAP, even if it’s different from what the provider states on the document.
A referral to HIPP is necessary for all clients who report having health insurance.
If BCCPT eligibility ends, the CAO worker will review for other categories of MA.
All applications for MA eligibility under BCCPT must be reviewed for other MA categories. If information provided on the BCCPT application indicates that the woman or her household appears eligible for MA in another category, the family may need to be contacted to get more information.
The correct application for the MA category being evaluated will be given to the woman and her household.
The income and resources of a person in the BCCPT program are treated as follows when deciding on eligibility for other household members:
If the entire household including the BCCPT member is found eligible for NMP, all household income must be counted. The BCCPT member is converted to the NMP category, unless the NMP category is GA-related. In that case, the BCCPT member stays in the BCCPT category, and the other household members are GA-related NMP
If the entire household including the BCCPT member is found eligible for MNO, all household income must be counted. The BCCPT member remains in the BCCPT category, and the other household members are MNO.
If members of the household are eligible for the Healthy Beginnings program, the income of the BCCPT member is counted for that decision. The BCCPT member remains eligible in the BCCPT category.
Reminder: Resources are excluded for households with children under the age of 21 when determining MA eligibility.
A woman eligible for MA under BCCPT must not be authorized in a category of MA that provides fewer health care benefits, even if her household qualifies for that category.
Example: A woman is authorized for MA under BCCPT. The CAO review finds that the household is eligible for MNO. The woman remains eligible under BCCPT category, while remaining household members are authorized under MNO category.
Updated February 14, 2012, Replacing October 8, 2003