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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 4: Client Eligibility : 4.10 Medicaid for Breast and Cervical Cancer (MBCC) : 4.10.3 Continued MBCC Program Eligibility

4.10.3
After a woman is enrolled in the MBCC program, eligibility may continue if she meets one of the following criteria:
A woman may continue to receive Medicaid benefits as long as she meets the eligibility criteria and provides proof that she is receiving active treatment for breast or cervical cancer. Women who are no longer in MBCC may reapply if they are diagnosed with a new breast or cervical cancer or a metastatic or recurrent breast or cervical cancer.
Note:
Active disease surveillance (for the purposes of determining eligibility for MBCC) is periodically monitoring disease progression in order quickly to treat cancerous and precancerous conditions that arise from the presence of a previously diagnosed TNRBC.
If the client’s cancer is in remission and the physician determines that the client requires only routine health screening for a breast or cervical condition (e.g. annual breast examinations, mammograms, and Pap tests as recommended by the American Cancer Society and the U.S. Preventative Services Task Force), the client is not considered to be receiving treatment; and MBCC coverage will not be renewed. A client who is subsequently diagnosed with a new, metastatic, or recurrent breast or cervical cancer may reapply for MBCC benefits.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.