Revision 17-3; Effective July 1, 2017

 

 

 

X—110 Medicaid for Breast and Cervical Cancer (MBCC)

Revision 15-4; Effective October 1, 2015  

 

The Breast and Cervical Cancer Control Program and Treatment Act of 2000 gives states the authority to provide Medicaid to low-income women previously not eligible under the Medicaid program. The Centers for Medicare and Medicaid Services approved a state plan amendment to allow Texas to provide full Medicaid benefits to uninsured women under age 65 who are identified through the Texas Department of State Health Services (DSHS) Breast and Cervical Cancer Services (BCCS) programs and who are in need of treatment for breast or cervical cancer, including pre-cancerous conditions. The program was implemented September 1, 2002.

The 80th Texas Legislature, Regular Session, 2007, provided funding to expand the pool of providers who provide screening and diagnostic services to women. As of September 1, 2007, any provider can diagnose a woman for breast or cervical cancer so that she may be eligible for Medicaid through MBCC.

MBCC is displayed in the Texas Integrated Eligibility and Redesign System (TIERS) as TA 67, MA-MBCC.

 

X—111 MBCC-Presumptive

Revision 12-3; Effective July 1, 2012  

 

Presumptive eligibility is a Medicaid option that allows states to enroll women in Medicaid for a limited period of time based on a determination by a Medicaid provider of likely Medicaid eligibility. Texas chose the presumptive eligibility option offered in the Breast and Cervical Cancer Control Program and Treatment Act of 2000. The option facilitates prompt Medicaid enrollment and immediate access to services for women who are in need of treatment for breast or cervical cancer.

BCCS contractors determine a woman’s presumptive eligibility for MBCC and indicates this on Form H1034, Medicaid for Breast and Cervical Cancer. Specialized staff at Centralized Benefit Services (CBS) certify the woman for MBCC-Presumptive if additional information or verification is needed to determine eligibility for another type of Medicaid or ongoing MBCC.

MBCC-Presumptive is displayed in TIERS as TA 66, MA – MBCC-Presumptive.

 

X—120 General Overview

Revision 17-1; Effective January 1, 2017 

 

To qualify for MBCC, an applicant must:

  • be a woman under age 65;
  • have been screened for breast or cervical cancer and found to need treatment for either breast or cervical cancer;
  • not be insured, that is, she must not otherwise have creditable coverage (creditable coverage refers to a health plan that covers treatment for breast and cervical cancer as well as current enrollment in Medicaid, Medicare or the Children's Health Insurance Program [CHIP]);
  • meet Medical Programs citizenship and identity requirements;
  • not be eligible for another type of medical assistance; and
  • be a resident of Texas.

Only specified staff at CBS determines eligibility for MBCC-Presumptive and MBCC.

If a woman returns the requested information or verification and meets Medicaid eligibility requirements for another type of Medicaid or MBCC, her MBCC-Presumptive Eligibility Determination Group (EDG) is denied prospectively and she is certified for the other type of Medicaid or MBCC. If the woman fails to return the requested information or if based on the information provided, she does not meet Medicaid eligibility requirements, her MBCC-Presumptive EDG is denied effective the date she is found ineligible for ongoing Medicaid.

Once determined eligible for MBCC, a woman remains eligible for Medicaid through the duration of her cancer treatment or until she no longer meets the eligibility criteria, whichever is earlier.

If field staff receives inquiries regarding this program, refer the woman to 2-1-1. Staff at 2-1-1 can assist the woman in locating a Breast and Cervical Cancer Services (BCCS) contractor near their residence who can determine if they have a qualifying diagnosis for MBCC and, if so, assist the woman in applying for MBCC.

 

X—130 Application Processing

Revision 12-3; Effective July 1, 2012

 

 

X—131 Application Procedures

Revision 17-3; Effective July 1, 2017

 

New applicants apply for MBCC using Form H1034, Medicaid for Breast and Cervical Cancer. New applicants cannot apply for MBCC using any other application.

Form H1034 can only be obtained through a contracted BCCS provider.

A woman can locate a contracted BCCS provider in her area at https://www.healthytexaswomen.org/find-a-doctor.

The BCCS provider assists the individual in completing the application.

A former MBCC recipient can reapply for MBCC, without going through a BCCS provider to be screened, using Form H2340, Medicaid for Breast and Cervical Cancer Renewal, and Form H1551, Treatment Verification, if it has been 12 months or less since the diagnosis date for breast or cervical cancer or the date her active treatment was last verified, whichever is later. 

 

X—132 MBCC Forms

Revision 15-4; Effective October 1, 2015  

 

Medicaid for Breast and Cervical Cancer uses the following specialized forms:

  • Form H1034, Medicaid for Breast and Cervical Cancer
  • Form H2340, Medicaid for Breast and Cervical Cancer Renewal
  • Form H2340-OS, Medicaid for Breast and Cervical Cancer
  • Form H1550, Out of State NBCCEDP Verification
  • Form H1551, Treatment Verification

 

X—133 Women's Health Services (WHS) Procedures

Revision 16-3; Effective July 1, 2016

 

Form H1034, Medicaid for Breast and Cervical Cancer, is faxed by a contracted provider to HHSC's WHS unit. The WHS contact validates Form H1034 as having been received and completed by a contracted BCCS provider and indicates if the individual has a qualifying medical diagnosis. Once validated, WHS faxes the application to the vendor. Providers are not allowed to fax Form H1034 directly to the vendor or the HHSC eligibility staff.

Note: Do not process an application if it is not received from WHS without contacting WHS to determine if it is a valid MBCC application.

 

X—134 File Date

Revision 15-4; Effective October 1, 2015  

 

The file date is the date the BCCS contractor determines the woman is presumptively eligible for MBCC. The contractor enters this date in Section 3 of the BCCS Contractor Certification page on Form H1034, Medicaid for Breast and Cervical Cancer. If the application is not forwarded to the HHSC vendor within five business days from the presumptive eligibility date, the file date is the date HHSC receives the application.

Document why a certain file date was used to determine eligibility when:

  • the file date used differs from the received date on Form H1034; or
  • Form H1034 has two received dates.

 

X—135 Interviews

Revision 10-2; Effective April 1, 2010  

 

An interview is not required when applying for or renewing an application for the MBCC. Schedule a phone interview only if the individual requests an interview.

Note: Do not deny the application if the applicant misses her interview; continue determining eligibility.

 

X—136 Authorized Representatives (AR)

Revision 15-4; Effective October 1, 2015  

 

An individual may designate an individual or organization as an AR, following the policy explained in A-170, Authorized Representatives (AR).