PMC19284317 Men and Eligibility for Breast and Cervical Cancer Prevention and Treatment (BCCPT) - February 14, 2019
PMC17977317 Evaluating Eligibility for BCCPT (PH 20) - April 21, 2016
The Breast and Cervical Cancer Prevention and Treatment (BCCPT) category, PH20, provides full Medical Assistance (MA) benefits to individuals with breast and cervical cancer, including precancerous conditions of the breast or cervix.
NOTE: Individuals with a diagnosis of ovarian or uterine cancer are NOT eligible for BCCPT.
Public Law 106-354
55 Pa. Code § 140.721
55 Pa. Code § 140.751
The Individual must:
Be screened and diagnosed with breast cancer, cervical cancer, or a precancerous condition of the breast or cervix. If an individual has any other cancer diagnosis, they are not eligible for BCCPT.
Be uninsured or have no creditable health insurance that covers the condition; Family Planning Services (PSF) is not considered creditable coverage when determining eligibility for BCCPT.
Be under age 65.
Be a U.S. citizen or qualified lawfully present non-citizen; An undocumented non-citizen may be eligible for BCCPT to cover an emergency medical condition if they meet all other eligibility criteria.
Be a Pennsylvania resident.
Provide or apply for a social security number (if applicable).
NOTE: There are no MA income or resource limits for the BCCPT category.
55 Pa. Code § 140.731
55 Pa. Code § 140.732
The CAO must determine eligibility for BCCPT using the rules in this chapter and the following chapters:
55 Pa. Code § 140.721
55 Pa. Code § 140.781
Medical Assistance Eligibility Handbook
Application - Chapter 304
Identity - Chapter 320
Citizen/Alien - Chapter 322
NOTE: The CAO must not delay approval of MA under BCCPT while waiting for proof of citizenship and identity.
Residence - Chapter 323
Reporting Changes - Chapter 370
Renewal - Chapter 376
Notices - Chapter 377
Verification - Chapter 378
Appeal and Fair Hearing - Chapter 870
Restitution and Disqualification - Chapter 910
Reimbursement - Chapter 915
Enumeration - Chapter 950
Voter Registration - Chapter 980
Individuals enrolled in MA under BCCPT receive the following:
A Pennsylvania ACCESS card, which is shown to enrolled medical providers.
Full MA benefits in a Health Choices managed care plan (mandatory).
Full MA benefits through the fee-for-service delivery system if the individual cannot enroll in a managed care plan. (See Chapter 386)
Healthcare Benefits Package (HCBP) coverage:
Children under 21 are enrolled in the Children's HCBP.
Individuals 21 and older are enrolled in the Adult HCBP.
Individuals who are eligible under BCCPT (PH20) receive full MA coverage. MA coverage is not limited to breast and cervical cancer related expenses.
The following eligibility requirements must be verified:
A lack of creditable coverage. Creditable coverage is defined under section 2701(c) of the Public Health Service Act (42 U.S.C. 300gg(c)). All healthcare coverage must be reviewed to determine if there is enough insurance to cover all the medical services for breast and cervical cancer, including precancerous conditions of the breast or cervix. Staff members from the regional HIPP offices review creditable coverage within five days of getting a referral from the CAO. (See Appendix D for the HIPP BCCPT Template and Appendix E for instructions on HIPP referrals and HIPP regional office listings.)
NOTE: An individual with healthcare coverage that doesn’t pay for prescriptions is ineligible for MA under the BCCPT program, because they are still considered to have creditable coverage.
The need for continued treatment at partial and complete renewals.
Citizenship.
Identity.
NOTE: The CAO will not delay approval of MA under BCCPT while waiting for proof of citizenship and identity.
Updated April, 2, 2019, Replacing February, 28, 2017