Current through all regulations passed and filed through September 16, 2024
(A) This rule describes the eligibility
criteria for BCCP medicaid.
(B) An
individual shall meet all of the following criteria to be eligible for BCCP
medicaid:
(1) Be screened for breast or
cervical cancer under the national breast and cervical cancer early detection
program (NBCCEDP).
(a) An individual is not
required to obtain screening for both breast and cervical cancer as a condition
of eligibility for participation in the NBCCEDCP.
(b) Individuals screened for breast or
cervical cancer under the NBCCEDP in a state other than Ohio must be determined
eligible for the Ohio department of health (ODH) BCCP and must utilize
the ODH BCCP case management services and Ohio 's BCCP medicaid application
process as outlined in rule 5160:1-5-02.4 of the Administrative Code.
(2) Be in need of treatment for
breast or cervical cancer, precancerous conditions, or early stage cancer, as
indicated by a treating health professional, based on the
centers for
disease control and prevention (CDC) NBCCEDP funded screening.
(3) Be uninsured as defined in rule
5160:1-5-02.1 of the Administrative Code.
(4) Must not meet the eligibility criteria of
any other medicaid program described in Chapters 5160:1-3, 5160:1-4, 5160:1-5,
and 5160:1-6 of the Administrative Code.
(5) Be under sixty-five years of
age.
(6) Meet all other
nonfinancial eligibility requirements applicable to medicaid applicants
described in Chapters 5160:1-1 and 5160:1-2 of the Administrative
Code.
(C) Effective date
of BCCP medicaid.
As defined in rule
5160:1-2-01
of the Administrative Code, the effective date is
the first day of the month that the Ohio department of medicaid (ODM) receives
an application for BCCP medicaid and the individual meets all eligibility
requirements described in this rule.
(1)
Retroactive eligibilty shall be explored as described in rule
5160:1-2-01
of the Administrative Code.
(2) The
first month of BCCP medicaid coverage may be a partial month of coverage based
on the date of diagnosis of breast or cervical cancer, pre-cancerous
conditions, or early stage cancer. "Date of diagnosis" is defined in rule
5160:1-5-02.1 of the Administrative Code.
(D) BCCP medicaid shall be
discontinued when the individual meets the eligibility
criteria of any other category of medicaid. If the individual is determined
eligible for any other category of medicaid, the last day of BCCP medicaid
coverage will be the last day of the month prior to the month the new category
of medicaid begins.
(E) The Ohio department of health
(ODH) or its designated local agencies or subgrantees shall:
(1) Determine the individual eligible for the
ODH BCCP.
(2) Screen for all other
medicaid programs before determining the individual eligible for ODH
BCCP.
(F) The Ohio
department of medicaid (ODM) shall:
(1) Screen
all BCCP medicaid applicants for potential eligibility in other medicaid
programs as described in rule 5160:1-5-02.4 of the Administrative
Code.
(2) Require BCCP medicaid
applicants to provide information regarding income and/or resources to screen
the applicant for potential eligibility for other medicaid programs.
(3) Not provide BCCP medicaid coverage,
including retroactive coverage, for any period of time preceding the date of
diagnosis of breast or cervical cancer, pre-cancerous conditions, or early
stage cancer.
(G)
Individuals not meeting citizenship or immigration status eligibility
requirements may be eligible for coverage for an emergency medical condition as
described in rule
5160:1-5-06
of the Administrative Code.
