There are no MA income or resource computation for determining eligibility under BCCPT.
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.
The CAO determines eligibility for continuing MA under BCCPT as follows:
When an individual first applies, the CAO does not make the eligibility determination.
An individual may visit a Pennsylvania Breast & Cervical Cancer Early Detection Program (PA-BCCEDP) provider for screening and referral to the PA-BCCEDP Case Management Team. The individual may also choose Direct Access to visit a non-PA-BCCEDP provider if that is more convenient.
If the individual chooses Direct Access to a non-PA-BCCEDP provider:
The PA600B application is available and may be downloaded by the individual or their doctor at: http://www.dhs.pa.gov/bccpt. Access to the form (PA600B) is available on the website.
The individual will complete the PA600B, Part I in the provider's office.
The provider who diagnosed the cancer will complete the PA600B, Part II.
The CAO, individual, provider or physician will fax the form to the PA-BCCEDP Case Management team at Adagio Health for review, fax: (412) 201-4702, or email to bccpt@adagiohealth.org (preferred method of contact is email).
The PA-BCCEDP Case Management Team will screen the completed forms and fax them to the CAO MA Outreach Liaison in the county where the individual 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 individual or their 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 individual and their 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 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.
An individual eligible for MA under BCCPT must not be authorized in a category of MA that provides fewer health care benefits, even if their household qualifies for that category.
Example: An individual is authorized for MA under BCCPT. The CAO review finds that the household is eligible for MNO. The individual remains eligible under BCCPT category, while remaining household members are authorized under MNO category.
Updated July 22, 2022, Replacing September 9, 2019