Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 05 - Community Medicaid › Part 1 - Medicaid for Elders and Adults with Disabilities: Community Medicaid › Section 210-RICR-40-05-1.7 - Special Coverage Groups

Current through June 14, 2024
1.7.1
Overview
There are certain IHCC groups that are exempt from various
					 income and/or resource requirements because they provide coverage to people
					 with unique characteristics and/or health needs.
1.7.2
Breast and Cervical Cancer
A. The Breast and Cervical Cancer Prevention
				  and Treatment Act of 2000 (Pub. Law
				  106-354), amended Title XIX to
				  include an optional Medicaid coverage group for uninsured women who are
				  screened and need treatment for breast or cervical cancer or for precancerous
				  conditions of the breast or cervix. The Rhode Island Department of Health
				  (DOH), Women's Cancer Screening Program, is responsible for administering the
				  screening required for Medicaid eligibility through this pathway.
1. Eligibility Criteria - To qualify, an
				  applicant must be under age sixty-five (65) and receive screening for breast or
				  cervical cancer under the CDC Breast and Cervical Cancer Early Detection
				  Program administered by DOH and found to need treatment for either breast or
				  cervical cancer, or a precancerous condition of the breast or cervix. In
				  addition, an applicant must not be Medicaid eligible in another coverage group
				  or have access to or be enrolled in a health insurance plan that provides
				  essential benefits, as defined in Federal Regulations at
				   42 C.F.R. §
													447.56. All general requirements for Medicaid
				  must also be met. There is no resource limit. Retroactive eligibility is
				  available for eligible members of this coverage group and no disability
				  determination is required.
2.
				  Determination process - Members of this coverage group are not required to meet
				  EAD income and resource limits or those established for other Medicaid
				  eligibility pathways. Under the State's §1115 waiver, income
				  eligibility for members of this coverage group is set at two hundred fifty
				  percent (250%) of the FPL. In addition, presumptive eligibility is also
				  available to women who meet the screening requirements, prior to a full
				  determination of Medicaid eligibility, if the woman is a resident of the
				  State.
3. Continuing eligibility -
				  A redetermination of Medicaid eligibility must be made periodically to
				  determine whether the beneficiary continues to meet all eligibility
				  requirements. Eligibility ends when the beneficiary:
a. Attains age sixty-five (65);
b. Acquires qualified health
				  insurance/creditable coverage;
c.
				  No longer requires treatment for breast or cervical cancer;
d. Fails to complete a scheduled
				  redetermination;
e. Is no longer a
				  Rhode Island resident; OR
f.
				  Otherwise does not meet the eligibility requirements for the
				  program.
4. Agency
				  responsibilities - The DOH administers the screening and application segments
				  of the program. EOHHS conducts redeterminations and renewals and is responsible
				  for providing timely notice and the right to appeal when any change in
				  eligibility occurs.
5.
				  Applicant/beneficiary responsibilities - Beneficiaries are responsible for
				  providing timely and accurate information about the status of their
				  condition/treatment prior to the date of redetermination or at intervals
				  specified.