Medicaid for Breast and Cervical Cancer

Women with a low income who do not have access to coverage for breast and cervical cancer treatment services may be able to get help through Medicaid for Breast and Cervical Cancer. Administered by the Texas Department of State Health Services (DSHS), women who are screened and diagnosed through the Breast and Cervical Cancer Services (BCCS) program automatically qualify for full Medicaid upon diagnosis.

MEDICAID FOR BREAST & CERVICAL CANCER

Formed by a combination of the Breast and Cervical Cancer Prevention and Treatment Act of 2000, and the Centers for Disease Control’s Breast and Cervical Cancer Early Detection Program (NBCCEDP), women nationwide have access to free screenings and diagnostic testing for these conditions if their insurance does not cover them. After being screened by your state’s respective NBCCEDP and receiving an abnormal test result or diagnosis of cancer or a precancerous condition, you are eligible for continued treatment – paid for by Medicaid. Women will also have access to the full array of Medicaid services unrelated to cancer treatment while members. Of course, there are income guidelines in order to qualify, set at 200 percent of FPL. Once treatment is complete or your income exceeds the limits, you will no longer qualify for benefits. Only those who are diagnosed through Texas Breast and Cervical Cancer Services will qualify for Medicaid coverage.

MBCC Eligibility

In order to qualify for MBCC and screenings through BCCS, you must be between ages 40 and 65, a resident of Texas, a U.S. citizen or national, and have income less than or equal to 200 percent of federal poverty. To gain Medicaid benefits, you must be diagnosed with and in need of treatment for one of a number of biopsy-confirmed definitive breast or cervical diagnoses, including CIN III, severe cervical dysplasia, cervical carcinoma in-situ, invasive cervical cancer, ductal carcinoma in situ or invasive breast cancer, as defined by BCCS policy. Insurance requirements for the program are either no coverage at all, or a health plan with limited benefits that explicitly does not cover these services.

Income Guidelines

Family of 1: $1,862 monthly, $22,340 yearly

Family of 2: $2,522 monthly, $30,260 yearly

Family of 3: $3,182 monthly, $38,180 yearly

Family of 4: $3,842 monthly, $46,100 yearly

Family of 5: $4,501 monthly, $54,020 yearly

Family of 6: $5,162 monthly, $61,940 yearly

Family of 7: $5,822 monthly, $69,860 yearly

Family of 8: $6,482 monthly, $77,780 yearly

Add $660 for each additional member in households over 8 persons.

Covered Benefits

After diagnosis and successful enrollment into MBCC, members have a full range of services covered by Medicaid available to them. In addition to cancer treatment, they can receive any medically necessary type of care provided through Medicaid, including hospital services, emergency care, physician services, and prevention. As mentioned, these benefits last for the entire duration of the woman’s cancer treatment. If a woman has recurrent breast or cervical cancer, the BCCS contractor must reapply in order to continue Medicaid benefits.

Referral from BCCS to MBCC

To guarantee a smooth, quick transfer of information and enrollment into MBCC from BCCS, medical providers are required to provide a clear referral and proper diagnosis. They must identify the correct BCCS contractor, and make sure the test results are biopsy-confirmed and meet the criteria for enrollment. As the patient, the provider will do all the work for you, communicating with the BCCS program to ensure your test results get to the agency’s case manager, and include in the referral what information is needed from you. This may include proof of income, residency, and other documents to complete the application process

How to Apply

First, get screened by a certified BCCS provider near you. To locate a clinic or doctor, call 2-1-1 or search the BCCS Clinic Locator. There, your eligibility for Medicaid will be assessed, and if you qualify due to diagnosis, you may fill out the Medicaid Medical Assistance Application (form 1034). All required documents and information will be recorded and collected by the BCCS contractor. BCCS will send your form to the DSHS, where your eligibility will be checked, and application sent to the HHSC, who will ultimately decide if you qualify for Medicaid. For further details on the program, application and eligibility, contact the Health and Human Services Commission by calling 2-1-1, or visit www.cms.gov .