Medical Assistance for Women with Breast or Cervical Cancer

1. Medical Assistance for Women with Breast or Cervical Cancer Became effective July 1, 2002 Updated 5/7/13

2. 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.

3. Medical Assistance“MA-BC” • Coverage will begin where Sage’s ends • 12-month eligibility • Full MA benefits

4. 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

5. Eligibility CriteriaMA-BC (cont’d) • To be eligible for MA-BC an individual must: • be under age 65 • not be otherwise eligible for MA

6. Eligibility CriteriaMA-BC (cont’d) • 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

7. 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

8. Forms Needed to Determine MA-BC Eligibility : • Sage Enrollment Form (Copy)

9. Forms Needed to Determine MA-BC Eligibility (cont’d) : • General Consent for Release of Information • If provider is sending the Sage Enrollment form to the county agency(Keep on file)

10. Forms Needed to Determine MA-BC Eligibility (cont’d) : • MA-BC Application/Renewal Form (click to open form) • (Original)

11. 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

12. 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 patient’s citizenship or immigration status.

13. Presumptive Eligibility (cont’d) • 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

14. Presumptive Eligibility (cont’d) • 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

15. Presumptive EligibilityQualified Providers • Sage Screening Program Participating Provider • Enrolled MA Provider • Must be verified as having been trained • Today you are trained!

16. 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

17. How to Determine Presumptive Eligibility for MA-BC (same process as regular) • Sage Enrollment Form

18. 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)

19. 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

20. Presumptive Eligibility Temporary Medical Assistance Authorization Temporary MA Authorization form(click to open form)

21. 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)

22. 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)

23. 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

24. Registering to Participate in 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 or fax to 651-431-7446 attention Tamara Smith (phone 651-431-2283

25. Questions or Comments?Contact your Regional Coordinator (RC)