IM-5, January 18, 2013, IM-111, November 26, 2007

The application form for BCCT is the IM-1BC. The IM-1BC requests the applicant to provide identification, citizenship/alien status and insurance information.

The IM-1BC may be submitted to Family Support Division (FSD) in one of two ways:

  1. If the woman received screening services through a Show Me Healthy Women (SMHW) provider and was determined eligible for BCCT Presumptive Eligibility (BCCT PE), the SMHW provider will:
    1. Instruct the claimant to fill out the IM-1BC application, and
    2. The SMHW provider will return it to the Customer Relations Unit based in St. Joseph.

    If referred by the SMHW provider, the provider's name, phone number and date of diagnosis should be on the form.

  2. Women who have been screened and diagnosed with breast or cervical cancer by a SMHW or a MO HealthNet provider may apply at their local county FSD office.

If the woman was not determined eligible for BCCT PE by a SMHW provider, send an Authorization for Disclosure of Consumer Medical/Health Information (MO 650-2616) form and the Certification of Need for Treatment – Breast/Cervical Cancer (BCC-2) form to verify she has been screened and is in need of breast or cervical cancer treatment.

The BCCT application must be registered in IAPP on the day received by the FSD.  Failure to register the regular BCCT application (or MHABD, MHF, MHK application if requested) when received can result in the BCCT PE period ending incorrectly rather than extending until the BCCT (or MHABD, MHF, MHK application) eligibility determination is made.

The BCCT category of assistance is available on IAPP under MO HealthNet for the Aged, Blind, and Disabled (MHABD). An application registered for BCCT may be approved under the MHABD program if eligible under the MHABD program requirements or under the BCCT program. A BCCT application (M1) may be registered even if there is an active M2 (BCCT PE) case active.


IM-111, November 26, 2007

The IM-1BC has four screening questions to determine if the woman may be eligible for MO HealthNet benefits in other categories. If the IM-1BC indicates the woman may be eligible for another category, send her the appropriate application form (IM-1UA or IM-1MA). Request the woman complete and return the application. Do not delay approval of BCCT while waiting on the other application. If the woman is determined eligible for another MO HealthNet program (other than MHABD Spenddown) after the BCCT approval, change the BCCT eligibility to the other category on the same day.


IM-111, November 26, 2007

All BCCT applications are to be processed within 30 days. The approval notice for BCCT is the IM-32. The letter should state the woman has been approved for MO HealthNet coverage and in Section 4, state “Your eligibility for MO HealthNet coverage is based on the results of your diagnosis of breast or cervical cancer and need for treatment.


IM-111, November 26, 2007

To approve an individual for BCCT, enter the following:

Case Action: 02 Open MO HealthNet/Title XIX Only

Reason Open: 01 Illness, injury or impairment

Field 23: “W” BCCT Identifier

Field 13E: Beginning date of eligibility

Field 13G: “T” Title XIX only

Field 13g2: “W” - Reason for LOC “T” - BCCT

Field H: Enter appropriate citizenship code

Income and budget information is not required.

Error 284 - MA, SSI NOT A, E, F, OR W will appear if an entry of “W” is not in both fields 13g2 and 23.