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Issue Alert - 02-05-02

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Date:

May 10, 2002

Issue Summary:

New Medicaid category - The Breast and Cervical Cancer Prevention and Treatment Program

Persons Affected:

Women between 18 and 64 who have been screened for breast or cervical cancer at a participating health department and have been diagnosed with cervical or breast cancer or a precancerous condition and are without health care coverage.

For More Information:

Center for Civil Justice320 S. Washington, 2nd Floor Saginaw, MI 48607 (989) 755-3120, (800)724-7441 Fax: (989) 755-3558E-mail: info@ccj-mi.org


Background

Medicaid

What's Happening?

There is a new Medicaid category called the Breast and Cervical Cancer Prevention program. DCH – not FIA - is responsible for determining eligibility and maintaining the benefits for this program.Who is Eligible?In order to be quality for this program you need to be:- female- be age 18 through 64- have been screened for breast or cervical cancer as part of a health department program called “Breast and Cervical Cancer Control Program”- have been diagnosed with breast or cervical cancer or a precancerous condition through this health department program- not have “credible health insurance” coverage that covers breast or cervical cancer or precancerous conditions (see below)- the patient’s income cannot exceed 250% of the federal poverty level. (This is a health department requirement not a Medicaid requirement.)- the patient must also be a Michigan resident, have a social security number or a good reason for not having one; be a citizen or eligible non-resident; report all other resources and comply with FIA’s institutional status policy (PEM 265).Who is not eligible because they already have health insurance?“Credible Health Insurance” includes Medicare, Armed Forces insurance, group health plan, state health risk pool, medical care under a hospital or medical services policy or certificate, hospital or medical service plan or contract, and health maintenance organization contract.Persons with full Medicaid coverage or emergency medical coverage are not eligible for this program. Persons under the State Medical Program (SMP) or the Medicaid spend-down program will be reassigned from the old program to this Medicaid program. Advocates should note that the diagnosis must come from a site that is participating in the program in order to trigger the coverage. A diagnosis by the woman’s doctor is not sufficient. You can find more information on the program by clicking on http://www.michigan.gov/mdch , then click on the links for “Physical Health and Prevention, “ then the link for “Prevention” , then “cancer” and finally cancer to find a link for the program. Click on BCCCP Referral List for a list of participating agencies. Some of the sites are public health agencies and others are private providers. How does a woman access this program?A woman must be screened through participating site. A finding by her own doctor is not enough. Not all counties have sites. In some cases, a woman must travel to sites in another county. A woman may request screening from a participating site if her local health agency is not participating. If a women is eligible, an application form will be completed by the health department coordinator or casemanager. The Department of Community Health will determine eligibility and conduct all redeterminations. FIA is not involved at all.

Finding Help

Most legal aid and legal services office handle these type of cases, and they do not charge a fee. You can locate the "free" legal services or legal aid office that serves your county on the Michigan Legal Assistance Network website (http://www.mlan.net/locate.html) or look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738

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