5101:1-41-04 Breast and cervical cancer project (BCCP) medicaid: eligibility period.

(A) Ohio shall not provide eligibility or coverage for BCCP medicaid, including retroactive eligibility and coverage, for any reason, prior to July 1, 2002.

(B) Eligibility for BCCP medicaid is effective the month that the Ohio department of job and family services (ODJFS) receives an application for this medicaid category and the applicant meets all relevant eligibility requirements described in rule 5101:1-41-03 of the Administrative Code. The first day of eligibility is the earliest day of the month in which ODJFS receives the application that the applicant meets all relevant eligibility requirements described in rule 5101:1-41-03 of the Administrative Code.

(1) ODJFS shall not provide BCCP medicaid coverage, including retroactive coverage, for any period of time preceding the applicant's fortieth birthday or following the applicant's sixty-fifth birthday.

(2) ODJFS shall 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. "Date of diagnosis" is defined in rule 5101:1-41-02 of the Administrative Code.

(3) The first month of BCCP medicaid coverage may be a partial month of coverage.

(C) ODJFS may extend eligibility for BCCP medicaid retroactively to the third month prior to the month of application if the applicant satisfies the following conditions:

(1) The individual met all relevant eligibility requirements described in rule 5101:1-41-03 of the Administrative Code for each of the three months in which retroactive coverage is sought.

(2) ODJFS shall not provide BCCP medicaid coverage, including retroactive coverage, for any period of time preceding the applicant's fortieth birthday or following the applicant's sixty-fifth birthday.

(3) ODJFS shall 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. "Date of diagnosis" is defined in rule 5101:1-41-02 of the Administrative Code.

(4) The first month of BCCP medicaid retroactive coverage may be a partial month of coverage.

(5) BCCP medicaid will not cover an expense for a medical service which is incurred outside an eligible timeframe.

(D) BCCP medicaid shall be terminated in accordance with pre-termination review requirements outlined in rule 5101:1-38-011 of the Administrative Code under the following circumstances:

(1) If the individual no longer meets one or more of the eligibility criteria for BCCP medicaid identified in rule 5101:1-41-03 of the Administrative Code.

(2) If a finding is made that the individual was determined eligible for ODH BCCP when such determination was made in error and ODH BCCP eligibility did not exist.

(3) If a finding is made that the individual was not screened for breast or cervical cancer under the centers for disease control and prevention's (CDC) "National Breast and Cervical Cancer Early Detection Program (NBCCEDP)".

(4) If the individual no longer receives treatment for breast or cervical cancer, pre-cancerous conditions, or early stage cancer. "Treatment" and "no longer receives treatment of breast or cervical cancer" are defined in rule 5101:1-41-02 of the Administrative Code.

(5) If the treatment period has ended and required redetermination documents with verification of continued need for treatment has not been received by ODJFS.

(a) ODJFS may presume that an individual is receiving treatment for the duration of the treatment period.

(b) A treatment period lasting more than twelve months from the beginning month of BCCP eligibility requires the ODJFS to perform a review of the individual's continuing medicaid eligibility, in accordance with rule 5101:1-41-05 of the Administrative Code.

(6) If the individual obtains creditable health coverage as defined in rule 5101:1-41-02 of the Administrative Code.

(7) If the individual reaches sixty-five years of age.

(8) If the individual meets eligibility criteria of any other category of medicaid, except as described in rule 5101:1-41-02(H)(2) of the Administrative Code. 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.

(9) If the individual fails to cooperate in the eligibility determination process, including the determination of eligibility for other categories of medicaid.

(a) To facilitate immediate access to services for women who are in need of treatment for breast or cervical cancer, BCCP medicaid coverage will be allowed for a period of time while an eligibility determination for other categories of medicaid is conducted.

(b) If the individual fails to cooperate in the determination of eligibility for other categories of medicaid as required, the last day of BCCP medicaid coverage will be the last day of the month following the month in which eligibility was approved.

(10) If the individual no longer meets other general non-financial and non-resource eligibility requirements applicable to medicaid recipients (e.g., citizenship/immigration status, Ohio residency, etc.) as delineated in rule 5101:1-41-03(G) of the Administrative Code.

Eff 7-1-02
Rule promulgated under: RC 111.15
Rule authorized by: RC 5111.0110
Rule amplifies: RC 5111.0110
R.C. 119.032 review dates: 07/01/2007