Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 477 - MEDICAID ELIGIBILITY
Chapter 27 - ELIGIBILITY FOR THE AGED, BLIND, AND DISABLED; MEDICALLY NEEDY; QUALIFIED DISABLED WORKING INDIVIDUALS; MEDICAID INSURANCE FOR THE WORKERS WITH DISABILITIES; BREAST AND CERVICAL CANCER; EMERGENCY MEDICAL SERVICES ASSISTANCE; AND KATIE BECKETT
Section 477-27-006 - BREAST AND CERVICAL CANCER PROGRAM

Universal Citation: 477 NE Admin Rules and Regs ch 27 ยง 006

Current through September 17, 2024

Under the Breast and Cervical Cancer Prevention and Treatment Act of 2000, certain individuals who need treatment for breast or cervical cancer may be eligible for Medicaid. Neb. Rev. Stat. section § 68-1020 authorizes this coverage in Nebraska.

006.01 ELIGIBILITY REQUIREMENTS. In order to receive Medicaid, the individual must:

(A) Be screened for breast and cervical cancer by Every Woman Matters;

(B) Be found to need treatment for breast or cervical cancer, including a precancerous condition or early stage cancer;

(C) Be 64 years old or younger;

(D) Not be otherwise eligible for any category of Medicaid;

(E) Not be covered by creditable health insurance;

(F) Be a Nebraska resident; and

(G) Be a United States citizen or a qualified non-citizen.

006.02 CREDITABLE HEALTH INSURANCE. For purposes of this program, creditable health insurance includes any health insurance coverage except a plan that:

(A) Provides limited scope coverage such as plans that only cover dental, vision, or longterm care;

(B) Provides coverage for only a specified disease or illness;

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

(D) Has exhausted the individual's lifetime limit on all benefits under the plan or coverage, including treatment for breast or cervical cancer.

006.03 ELIGIBILITY PERIOD. Eligibility begins the first of the month in which the individual signs the application for the Breast and Cervical Cancer Program. Eligibility continues as long as the treatment for breast or cervical cancer is required, as determined by a physician, unless the individual becomes ineligible for some other reason. Eligibility automatically ends the last day of the month of the client's 65th birthday.

006.03(A) PRE-CANCEROUS CONDITIONS. For pre-cancerous cervical conditions, eligibility automatically ends the last day of the month following the month treatment begins unless the physician provides the Department with a monthly statement indicating continued treatment is required. Continued treatment does not include continued surveillance, testing, or screening.

006.03(B) BREAST AND CERVICAL CANCER. For breast and cervical cancer, a physician's statement verifying the need for treatment must be provided to the Department every six months for the individual to remain eligible for Medicaid coverage.

006.03(C) PRESUMPTIVE ELIGIBILITY. Eligibility may be presumptively determined by a qualified Medicaid provider. See 477 NAC 19 for presumptive eligibility requirements.

Disclaimer: These regulations may not be the most recent version. Nebraska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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