X-920, Medicaid Coverage | Texas Health and Human Services

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Revision 22-3; Effective July 1, 2022

Women who are eligible for MBCC-Presumptive or MBCC receive full regular Medicaid benefits.

Before certifying a woman for MBCC-Presumptive or MBCC, Centralized Benefit Services (CBS) staff complete inquiry into the Texas Integrated Eligibility Redesign System (TIERS) to determine if the applicant currently receives Medicaid or Children's Health Insurance Program (CHIP) benefits. Deny the MBCC application if the woman receives other Medicaid coverage.

Exceptions: Do not deny the application if the woman’s Medicaid coverage is ending.

Note: If a woman certified for Healthy Texas Women (HTW) becomes eligible for MBCC, there may be an overlap in coverage for the month in which she applies for MBCC. MBCC eligibility begins the date an applicant meets all eligibility criteria and cannot precede the day after the diagnosis date. After the woman is determined eligible for MBCC, terminate HTW prospectively.

X—921 Medical Effective Date (MED)

Revision 12-3; Effective July 1, 2012

Medicaid eligibility begins the date an applicant meets all eligibility criteria. The MED cannot precede the day after the diagnosis date.

For MBCC-Presumptive, the MED is the date the BCCS contractor determines the woman is presumptively eligible for MBCC, but no earlier than the date after the woman was diagnosed with breast or cervical cancer. If the woman provides information needed for MBCC eligibility, provide MBCC coverage for dates that precede the MBCC-Presumptive MED.

Related Policy

Prior Coverage, X-922

X—922 Prior Coverage

Revision 15-4; Effective October 1, 2015

A woman may be eligible for up to three months of prior coverage under MBCC if all other eligibility requirements are met. MBCC only covers unpaid medical bills for services received after the individual's breast and cervical cancer diagnosis date. If a woman indicates on Form H1034, Medicaid for Breast and Cervical Cancer, that she has unpaid medical bills that occurred during the three months before she applied for MBCC, assign an MED of the day after her diagnosis date. Do not require the woman to provide proof of the unpaid medical bills or a completed Form H1113, Application for Prior Medicaid Coverage.

For medical expenses incurred before or on her date of diagnosis, the client must apply for prior Medicaid coverage using Form H1010, Texas Works Application for Assistance — Your Texas Benefits; Form H1205, Texas Streamlined Application; or online at YourTexasBenefits.com. Refer the client to an HHSC eligibility office for the appropriate application or have the client call 2-1-1 to locate the nearest HHSC eligibility office.

Example One: The applicant was diagnosed on August 15 and applied for MBCC on November 21 indicating that she has unpaid medical bills for August, September, October and November. Assign an MED of August 16.

Example Two: The applicant was diagnosed on July 7 and applied for MBCC on July 21 indicating that she has unpaid medical bills for May and June. The individual is not eligible for prior coverage under MBCC since the unpaid medical bills were before her diagnosis date. Assign an MED of July 8.

Example Three: The applicant was diagnosed on January 31 and applied for MBCC on June 4 indicating she has unpaid bills for February. The woman is not eligible for prior coverage since her unpaid medical bills occurred prior to the three-month period before she applied for MBCC.

Note: If the applicant had creditable coverage before applying for MBCC and indicates she has unpaid medical bills for the months she was covered by insurance, the client is not eligible for prior coverage under MBCC. The client must apply for prior Medicaid coverage using Form H1010, Form H1205, or online at YourTexasBenefits.com to determine whether she meets all eligibility requirements for prior Medicaid. See A-831, Three Months Prior Coverage.

X—923 Medicaid Termination

Revision 20-4; Effective October 1, 2020

MBCC eligibility ends when the recipient first meets any of the following conditions. The recipient:

becomes 65;
obtains creditable coverage;
is no longer receiving active treatment for breast or cervical cancer;
no longer resides in Texas;
is confined in a public institution; or
dies.

X—924 Types of Coverage

Revision 18-1; Effective January 1, 2018

People certified for MBCC-Presumptive receive their medical care via fee-for-service.

People certified for MBCC are enrolled in the STAR+PLUS managed care program.