Section 477-27-006 - BREAST AND CERVICAL CANCER PROGRAMUnder the Breast and Cervical Cancer Prevention and Treatment Act of 2000, certain individuals who need treatment for breast or cervical cancer may be eligible for Medicaid. Neb. Rev. Stat. section § 68-1020 authorizes this coverage in Nebraska.
006.01ELIGIBILITY REQUIREMENTS. In order to receive Medicaid, the individual must: (A) Be screened for breast and cervical cancer by Every Woman Matters;(B) Be found to need treatment for breast or cervical cancer, including a precancerous condition or early stage cancer;(C) Be 64 years old or younger;(D) Not be otherwise eligible for any category of Medicaid;(E) Not be covered by creditable health insurance;(F) Be a Nebraska resident; and(G) Be a United States citizen or a qualified non-citizen.006.02CREDITABLE HEALTH INSURANCE. For purposes of this program, creditable health insurance includes any health insurance coverage except a plan that: (A) Provides limited scope coverage such as plans that only cover dental, vision, or longterm care;(B) Provides coverage for only a specified disease or illness;(C) Does not include treatment for breast or cervical cancer, such as a period of exclusion; or(D) Has exhausted the individual's lifetime limit on all benefits under the plan or coverage, including treatment for breast or cervical cancer.006.03ELIGIBILITY PERIOD. Eligibility begins the first of the month in which the individual signs the application for the Breast and Cervical Cancer Program. Eligibility continues as long as the treatment for breast or cervical cancer is required, as determined by a physician, unless the individual becomes ineligible for some other reason. Eligibility automatically ends the last day of the month of the client's 65th birthday. 006.03(A)PRE-CANCEROUS CONDITIONS. For pre-cancerous cervical conditions, eligibility automatically ends the last day of the month following the month treatment begins unless the physician provides the Department with a monthly statement indicating continued treatment is required. Continued treatment does not include continued surveillance, testing, or screening.006.03(B)BREAST AND CERVICAL CANCER. For breast and cervical cancer, a physician's statement verifying the need for treatment must be provided to the Department every six months for the individual to remain eligible for Medicaid coverage.006.03(C)PRESUMPTIVE ELIGIBILITY. Eligibility may be presumptively determined by a qualified Medicaid provider. See 477 NAC 19 for presumptive eligibility requirements.477 Neb. Admin. Code, ch. 27, § 006
Amended effective 9/28/2021