There are no MA income or resource computation for determining eligibility under BCCPT. 55 Pa. Code § 140. 731 55 Pa. Code § 140.732
The CAO determines eligibility for retroactive MA under BCCPT as follows:
Benefits can begin as early as the first day of the third month preceding the month of application. The period of eligibility for retroactive BCCPT benefits begins the first day of the month in which the first medical service was incurred.
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. 55 Pa. Code § 140.771
The CAO determines eligibility for continuing MA under BCCPT as follows:
When a woman first applies, the CAO does not make the eligibility determination. 55 Pa. Code § 133.84
A woman may visit a Healthy Woman Provider (HWP) (see Appendix B,) for screening and referral to the HWP Case Management Team. She may also choose Direct Access to visit a non-HWP provider if that is more convenient.
If she chooses Direct Access to a non- HWP provider:
The PA600B application is available and may be downloaded by the woman or her doctor at: www.pahealthywoman.org. Clink on "Patient" at the bottom to access the link to the form (PA600B).
The individual will complete the PA600B, Part A in the provider's office.
The provider who diagnosed the cancer will complete the PA600B, Part B.
The provider or the individual will fax the form to the (HWP) Case Management team at Adagio Health for review, fax: (412) 201-4702.
The HWP Case Management Team will screen the completed forms and fax them to the CAO MA Outreach Liaison in the county where the woman resides.
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, or in a MAGI category, the income of the BCCPT member is counted for that decision. The BCCPT member remains eligible in the BCCPT category if not eligible in a category higher on the cascade.
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 May 21, 2014, Replacing January 16, 2014