1310.000.00 MEDICAID COVERAGE

IM-111, November 26, 2007

MO HealthNet coverage under BCCT begins on the 1st day of the month of application, if the woman meets all eligibility requirements. Prior quarter coverage can also be approved, if the woman was eligible. Coverage cannot begin prior to the month the SMHW provider's diagnosis occurred. No coverage can begin prior to August 28, 2001 (although the qualifying screening may have occurred prior to August 28, 2001). For eligible women, regular BCCT MO HealthNet coverage begins on the latest of the following dates:

The BCCT program provides full MO HealthNet benefits. Coverage for BCCT participants is provided on a fee-for-service basis. BCCT MO HealthNet coverage is date-specific.

1310.005.00  MO HEALTHNET PRIOR QUARTER COVERAGE

IM-111, November 26, 2007

Eligibility determination for prior quarter MO HealthNet coverage under BCCT may be separate from the eligibility determination of current coverage under BCCT. A woman DOES NOT have to be currently eligible for MO HealthNet coverage under BCCT to be eligible for prior quarter coverage and vice versa. The effective dates of prior quarter coverage are no earlier than the first day of the third month prior to the month of application (as long as all eligibility requirements are met) and can extend to but not include the first day of the month of application.

EXAMPLE: Ms. Brown is diagnosed with cervical cancer by a SMHW provider on June 10. She applies for BCCT at the local county office on August 15. Information provided on the BCC-2 shows the date of diagnosis, with the need for treatment ending July 31. As Ms. Brown meets all other eligibility requirements, approve her for prior quarter only, coverage dates May 1 through July 31.

1310.010.00  MO HEALTHNET END DATES ON CLOSINGS

IM-111, November 26, 2007

MO HealthNet coverage is date-specific for BCCT cases at the time of the closing. A date-specific closing can take effect in the future, up to the last day of the month following the month the closing action is entered in the IMU5 system. If the date of ineligibility is in the future, that date must be entered in field 43 of IMU5. If the date of ineligibility entered in field 43 is the current date or earlier, the system will end MO HealthNet coverage on the date of the closing. If no date is entered in field 43, MO HealthNet coverage will end on the date of the closing.