Description

Breast and Cervical Cancer Treatment Program (BCCTP)

Questions & Answers

 1.    What is the Breast and Cervical Cancer Treatment Program (BCCTP)?

The BCCTP provides cancer treatment and services for eligible low-income California residents who are screened by Cancer Detection Program: Every Woman Counts (CDP:EWC) or Family Planning, Access, Care and Treatment (Family PACT) program and found to be in need of treatment for breast and/or cervical cancer.

Enrollment is performed only through providers in CDP:EWC and Family PACT programs.  The BCCTP provides on line, real-time enrollment in the provider’s office.

• For information about the CDP:EWC screenings and who is eligible, visit the CDP:EWC website.
• For information about locating a Family PACT provider near you, visit the Family PACT website.  Enter your zip code in the prompt on the left hand side of the page.
• In most cases, temporary Medi-Cal benefits are available right away while a final eligibility determination is completed by State Eligibility Specialists.

3.    Who is eligible for BCCTP?

An individual may receive coverage through BCCTP if all of the following requirements are met:

• Have been screened and found to be in need of treatment for breast (women and men) and/or cervical cancer (women only), follow-up care for cancer or precancerous cervical lesions/conditions by an CDP:EWC or Family PACT provider
• Women under age 65 who has satisfactory immigration status or is a citizen or national of the United States
• California resident
• Have monthly gross family income at the time of screening and diagnosis, which is at or below 200 percent of the federal poverty level for the family size.
• Have no other health insurance including full-scope no share-of-cost Medi-Cal or Medicare.

If not eligible for full-scope Medi-Cal coverage under federal BCCTP, an individual may still be eligible for State-funded BCCTP limited or restricted scope Medi-Cal coverage if the following requirements are met:

• Have been screened and found in need of treatment for breast (men and women) and/or cervical cancer (women only), follow-up care for cancer or precancerous cervical lesions/conditions by an EWC or Family PACT provider
• California resident
• Have monthly gross family income at the time of screening and diagnosis, which is at or below 200 percent of the federal poverty level for the family size
• Male of any age or any immigration status
• Female under 65 years of age with  unsatisfactory immigration status
• Female 65 years of age or older; and/or
• Have health insurance, including share-of-cost Medi-Cal and/or Medicare

After you apply at the provider’s office, your application is submitted to the State and reviewed by State Eligibility Specialists.

• If you are determined eligible for presumptive eligibility benefits (temporary); and you do not already have a Medi-Cal card, you will receive a white plastic Benefits Identification Card (BIC).
• BCCTP and Medi-Cal do not provide lists of doctors that accept Medi-Cal.
• BCCTP is a special Medi-Cal program.  Therefore, a provider must have an agreement with Medi-Cal to receive payment from the State.

 

For eligibility determination, the State Eligibility Specialist may also ask you for more information, including the following:

• Proof of identity
• Proof of citizenship/immigration status
• Social Security Number (SSN) or a letter from the Social Security Administration showing you were issued a SSN
• Information about other health coverage (if any)

 

• BCCTP provides coverage for breast and cervical cancer treatment and services related to your cancer diagnosis.  If approved for federal BCCTP, you may receive full scope Medi-Cal coverage which is not limited to breast and cervical cancer treatment and services.
• State-funded BCCTP provides no-cost services limited to breast and/or cervical cancer treatment, related services, and reimbursment of insurance premiums under certain circumstances. 
• Prosthetic bras are covered if a prescription is written by a doctor and taken to a Durable Medical Equipment (DME) supply facility that accepts Medi-Cal.

 

• Federal BCCTP provides full-scope Medi-Cal benefits for the duration of cancer treatment, as long as the individual continues to meet all other BCCTP eligibility criteria.
• State BCCTP provides limited-scope Medi-Cal benefits for breast cancer treatment services for up to 18 continuous months and cervical cancer treatment services for up to 24 continuous months.
• An additional 18-month or 24-month period of coverage with a recurring breast or cervical cancer diagnosis, regardless of cancer location, to State-funded BCCTP recipients whose original period of coverage has expired. Individuals with a recurrence must meet all applicable eligibility requirements to receive an additional period of coverage. Individuals with a break in services may have to reapply.

Prescription:

• The pharmacy states that Medi-Cal will not authorize my prescription: 
  • The pharmacy or your medical provider must request a treatment authorization request.  Your pharmacy or provider may also call:
    • (800) 541-5555 (outside of California, please call 916-636-1980) or (916) 552-9500

 

 Billing:

• I received a bill from a medical provider, pharmacy or laboratory: 
  • Make sure that Medi-Cal or your managed care health plan has been billed for these services.  Medical providers and pharmacies that accept Medi-Cal are responsible for billing Medi-Cal directly.  If a medical provider states that they are waiting for authorization from Medi-Cal, they must contact their regional Medi-Cal Treatment Authorization Request liaison.  BCCTP does not authorize any medical treatment, diagnostic exams, or prescriptions.
    

 Out-of-Pocket payment:

• I paid for services that should have been covered by BCCTP:
  • If you already paid for services that are covered by Medi-Cal, you should call the Conlan Unit (916) 403-2007 for assistance.

Enrollment into a Medi-Cal health plan:

• If I have a problem with my Medi-Cal health plan, who do I call?
  • You can call the Medi-Cal Managed Care Ombudsman office at (888) 452-8609
• If I want to change plans or enroll in a managed care plan, who do I call?
  • You can call Health Care Options at (800) 430-4263 for assistance.

 

Repayment to the State for Medi-Cal Services received:

• I received information about Estate Recovery and have specific questions:
  • You may contact the Estate Recovery office (916) 650-0590 or ER@dhcs.ca.gov  

 

Premium Assistance:

• It has been over 90 days and I have not received my insurance premium reimbursement:
  • You can contact the Third Party Liability office Department of Health Care Services via FAX (916) 440-5676 or write to: 

Department of Health Care Services
Third Party Liability and Recovery Division
HIPP Program – MS 4719
Post Office Box 997422
Sacramento, CA  94899-7422

You must submit an application to request retroactive Medi-Cal and if you are determined eligible for federal BCCTP benefits.  It is possible that Medi-Cal can pay for the services you received for up to three months prior to your application.

Federal BCCTP (Medi-Cal) requires that each beneficiary must have a redetermination once every 12 months.  This is called the annual redetermination.  The annual redetermination requires that your medical doctor provides verification that you are still in need of treatment for breast and or cervical cancer.  It is very important that you return the necessary paperwork with the required signatures by the deadlines.

• • • Example 1: It is possible for the spouse of a BCCTP beneficiary to submit an application with Covered CA for affordable health coverage and not include the BCCTP beneficiary.  The spouse would have to include the BCCTP beneficiary on the application because the BCCTP beneficiary is part of the spouse’s household for eligibility determination (family size income, etc.).  However, the spouse can mark on the application that the BCCTP beneficiary is not requesting health insurance coverage.  In this situation, the spouse would be properly evaluated for coverage and the BCCTP beneficiary would not be evaluated for health insurance coverage because he or she did not apply.  This would have no effect on the BCCTP beneficiary’s current eligibility. 
    • Example 2:  A parent enrolled in BCCTP submits an application on behalf of their minor children without requesting coverage for themselves.  The children would be properly evaluated for coverage and the parent that is enrolled in BCCTP would not be evaluated for coverage because they did not apply.  This would have no effect on the parent’s current BCCTP eligibility.

If you are not eligible for BCCTP, you can apply for insurance affordability programs through the CoveredCA website. Covered CA’s toll-free number is:

• 1-800-300-1506 (TTY: 1-888-889-4500).  You can call Monday through Friday, 8 a.m. to 6 p.m. and Saturday, 8 a.m. to 5 p.m.  The call is free!
• Other resources not affiliated with Medi-Cal are: The American Cancer Society, Susan G. Komen, Cancer Care Inc., or the Breast Cancer Network of Strength.
• For more information about BCCTP or to find a BCCTP enrolling provider, please call toll free 1-800-824-0088.  

 

 

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