477 Neb. Admin. Code, ch. 24, § 004

Current through September 17, 2024

Section 477-24-004 - WOMEN'S CANCER PROGRAM

004.01 Women's Cancer Program

The Breast and Cervical Cancer Prevention and Treatment Act of 2000 allows Medicaid for women who need treatment for breast or cervical cancer. Section 68-1020, Neb. Rev. Stat. authorizes this coverage in Nebraska.

004.02 Eligibility Requirements

In order to receive Medicaid, the woman must:

1. Be screened for breast and cervical cancer by Every Woman Matters;

2. Be found to need treatment for breast and/or cervical cancer, including a precancerous condition or early stage cancer;

3. Be age 64 or younger;

4. Not be otherwise eligible for Medicaid;

5. Not be covered by creditable health insurance;

6. Be a Nebraska resident; and

7. Be a U.S. citizen or a qualified alien.

004.03 Creditable Health Insurance

For purposes of this program, creditable health insurance includes any health insurance coverage except a plan that:

1. Is limited scope coverage such as those which only cover dental, vision, or long term care;

2. Is coverage for only a specified disease or illness;

3. Does not include treatment for breast or cervical cancer (such as a period of exclusion); or

4. Has exhausted the woman's lifetime limit on all benefits under the plan or coverage, including treatment for breast or cervical cancer.

004.04 Eligibility Period

Eligibility begins with the first of the month that the client signs the application for the Women's Cancer Program on the prescribed application see Appendix 477-000-061. Eligibility continues as long as the client requires treatment for breast or cervical cancer, as determined by her physician, unless she becomes ineligible for some other reason. Eligibility automatically ends the last day of the month of the client's 65th birthday.

For pre-cancerous cervical conditions, eligibility automatically ends the last day of the month following the month treatment begins unless the physician provides the agency with a monthly statement that continued treatment is required.

Continued treatment does not include continued surveillance, testing, or screening.

For breast and cervical cancer, a physician's statement verifying the need for treatment must be provided to the agency every six months for the woman to remain eligible for Medicaid coverage.

004.05 Presumptive Eligibility

The client may be determined presumptively eligible by a qualified Medicaid provider. Presumptive eligibility begins on the date that the qualified provider determines that the client appears to meet eligibility criteria.

477 Neb. Admin. Code, ch. 24, § 004