575           BREAST AND CERVICAL CANCER MEDICAID (LADIES FIRST)

The Center for Disease Control ( CDC ) and Prevention conducts the National Breast and Cervical Cancer Early Detection Program, which provides funding for breast and cervical cancer screening in all 50 states. To encourage women to seek treatment, Congress passed the Breast and Cervical Cancer Prevention and Treatment Act of 2000.  This act authorizes states to provide Medicaid coverage to women who are diagnosed with cancer through participation in a CDCCenter for Disease Control and Prevention screening program.  Alaska began using this optional Medicaid eligibility category on July 1, 2001.  Alaska changed the program name to Ladies First in 2018.

575 A.       BCHC SCREENING

The Division of Public Health ( DPH ) operates and determines eligibility for the Breast and Cervical Health Check ( BCHC ) program to screen individuals in accordance with the national CDCCenter for Disease Control and Prevention criteria. This program uses 25 different health care providers in 15 communities throughout the state. There are also three tribal grantees that provide screening services:

• Southcentral Foundation;
   
• Southeast Alaska Regional Health Corporation; and
   
• Arctic Slope Regional Health Corporation; 

To be eligible for the BCHCBreast and Cervical Health Check program, a woman must:

1. Be age 18-64;
    
2. Be uninsured or have insurance that does not cover preventative screening services; and
    
3. Have income below 250% of the Federal Poverty Guideline for Alaska.  DPHDivision of Public Health determines income eligibility for this program.
    

575 B.      APPLICATION

After a woman has been screened by the BCHCBreast and Cervical Health Check , she may apply for Medicaid by using the Gen 50C application form.  Screened recipients may get the GEN 50C application from a public health center, the BCHCBreast and Cervical Health Check Program screener, a public assistance office, or fee agent.  Medicaid applications for this eligibility category must be sent to:

 Division of Public Assistance

 Attention: Long Term Care Unit

 3901 Old Seward Highway, Suite 131

 Anchorage, AK 99503

575 C.      ELIGIBILITY

To be eligible for this Medicaid category, an applicant must:

1. Have been screened under the Alaska BCHCBreast and Cervical Health Check , or CDCCenter for Disease Control and Prevention National Breast and Cervical Cancer Early Detection program from another state, and determined to need treatment for breast or cervical cancer;
    
2. Meet general Medicaid eligibility requirements of residency and assignment of rights;
    
3. Be a U.S.United States citizen or qualified alien;
    
4. Not be eligible for any other Medicaid category; and
    
5. Does not have credible coverage that covers her breast and cervical cancer treatment.

Credible coverage is any of the following:

1. A group health plan;
2. Health insurance coverage;
3. Medicare Part A or part B;
4. Medicaid;
5. Uniform Services coverage;
6. A medical care program of the Indian Health Service or of a tribal organization;
7. A public health plan; and
8. A Peace Corps health benefit plan.

The Breast and Cervical Cancer Medicaid category does not have a separate financial eligibility test beyond what was already required for eligibility under the BCHCBreast and Cervical Health Check screening program.

Although men may also get breast cancer, they are not included in the CDCCenter for Disease Control and Prevention screening program and, therefore, are not eligible for this Medicaid category.

575 D.      COVERAGE

If eligible, BCCMBreast and Cervical Cancer Medicaid should be certified for 12 months.  Coverage may end during the certification period for the following reasons:

• Other insurance is obtained that covers breast and cervical cancer;
• Eligible for another Medicaid category;
• No longer an Alaska resident;
• Turns 65;
• Refuses treatment or does not start treatment; or
• Completes active treatment.

When the office receives the form titled: Breast and Cervical Cancer Program Closing Form, close the case with 10 day adverse action and send the M420 notice.  In the free-form section of the notice explain to the client that a physician review of the case determined that treatment ended and that the woman should contact her original screening provider to re-enroll in the Breast and Cervical Health check program so she can receive coverage for her surveillance appointments.  Send an email to Paola Smith and the appropriate program manager to advise them of the closure.

NOTE:  

In the notice DO NOT say "Your case manage Jane Doe determined your treatment ended" keep it generic by simply saying "A physician review of your case."

Coverage may include home and community-based services if the recipient meets the requirements of the Adults with Physical Disabilities waiver.  See Section 560.  For recipients who appear financially eligible for APAAdult Public Assistance-related or LTCLong Term Care Medicaid, the caseworker should recommend, but cannot require that she pursue a disability determination so that when treatment ends and eligibility has ended under the BCCBreast and Cervical Cancer category, the woman can be transitioned to those Medicaid eligibility categories.   

575 E.      RENEWALS

At least once each calendar year a recipient must complete a renewal application.  The proper form for an annual review application is DPADivision of Public Assistance form GEN 72.

In addition to the completed renewal application, the recipient must also provide any additional DPADivision of Public Assistance forms and any other information/verification that is necessary to correctly redetermine the recipient's eligibility.  

575 F.       NOTICES

Refer to section 520 H for the policy on notices.

575 G.       QUESTIONS

For general questions about screening for breast or cervical cancer or help with finding a screening provider, call the Division of Public Health at 269-8069 (Anchorage) or 1-800-410-6266 (outside Anchorage).

For questions about how to apply for Breast and Cervical Cancer Medicaid or about how this Medicaid category works, please contact the Long Term Care Unit in the Division of Public Assistance toll free at 1-800-478-7778.