Breast and Cervical Cancer Treatment Program (BCCTP)

The BCCTP was implemented on January 1, 2002. BCCTP is both federal and state-funded. Eligibility determination and ongoing case maintenance is done by the Department of Health Care Services (DCHS). This program provides full-scope or restricted, no share-of-cost MC to uninsured or under insured individuals who are screened through the Centers for Disease Control and Prevention (CDC) or by the National Breast and Cervical Cancer Early Detection Program; and are found to be in need of treatment including some precancerous conditions. In California, the authorized screening providers are those participating in either the Cancer Detection Programs: Every Woman Counts (EWC), or Family Planning, Access, Care and Treatment (FPACT) program.

 

BCCTP must be considered by the EW prior to denying or discontinuing MC benefits. At the time of application, redetermination or any time a change is reported that results in ineligibility, and the EW is aware or the applicant or recipient declares he/she has breast cancer or she has cervical cancer, the EW must send a referral to BCCTP and not take any action on the MC benefits until a determination is received from BCCTP.

 

In order to make individuals aware that the BCCTP is available, a flyer, “Breast and Cervical Cancer Treatment Program (BCCTP)” (MC 372) must be included in all intake and redetermination packets.

 

The BCCTP provides an online, internet-based application process specifically designed to enable breast and/or cervical cancer patients to apply for BCCTP coverage right in an EWC or FPACT provider’s office. Upon application, the enrolling provider gives the applicant the Confirmation Document (CD) and message text document. The CD tells the applicant whether they received Accelerated Enrollment (AE) or not and the message text document provides additional information about the BCCTP. Those determined eligible are sent a MC BIC, if they do not already have one. If the applicant receives AE and does not have a BIC, the CD may be used until the BIC is received in the mail.

Federal BCCTP 

The federally-funded BCCTP provides full scope, no share of cost (SOC) MC benefits to uninsured individuals under age 65 who are US citizens or lawful immigrants, have no health insurance coverage and are found to be in need of treatment for breast and/or cervical cancer. Individuals who meet all federal BCCTP requirements remain eligible for the duration of the treatment period.

 

Ineligibility for federal BCCTP

An individual becomes ineligible for federal BCCTP when any of the following occurs:

• Has turned 65 years of age
• Has obtained creditable insurance coverage, Medi-Cal with a SOC, Medicare, employer provided insurance, or a Covered California Plan, etc.
• No longer needs treatment for breast and/or cervical cancer as determined by her treating physician.

Note: The Federal BCCTP allows eligibility for beneficiaries who have MC with a SOC, if they meet all other federal BCCTP eligibility criteria. State-funded BCCTP provides coverage to individuals who meet all non-federal BCCTP requirements, including those who are concurrently eligible for restricted MC (i.e., undocumented aliens, pregnant individuals, etc.)

Federal BCCTP Health Insurance Coverage Limitations

Individuals who have the following types of health insurance coverage are ineligible for BCCTP:

• Medicare
• Group health plan
• MC (full-scope, no SOC)
• Armed Forces insurance
• State health risk pool
• Health insurance coverage - benefits consisting of medical care provided through:
  • Insurance or reimbursement, or otherwise and including items and services paid for as medical care) under any hospital or medical service policy or certificate, or
  • Hospital or medical service plan contract, or
  • Health maintenance organization (HMO) contract offered by a health insurance company.

State-Funded BCCTP

California BCCTP was created to address coverage beyond the limitations of the federal law. The State-funded BCCTP program covers breast and/or cervical cancer patients needing treatment who have been determined ineligible for the federal BCCTP, such as:

• Women age 65 and over, regardless of immigration status;

• Women under 65 without satisfactory immigration status (SIS); or • Men (breast cancer only) of any age or immigration status.

 

On January 2019, AB1810 eliminated the time limit and provides continued coverage through the duration of the treatment if an individual with a diagnosis of breast and/or cervical cancer meets all BCCTP eligibility requirements. It also applies to individuals diagnosed with a reoccurence of breast and/or cervical cancer.

 

Note: The individual must meet all other State-Funded BCCTP requirements to be eligible for the additional treatment period.

The state-funded BCCTP covers individuals who are:

BCCTP Individuals

Who are...	Including...
Uninsured	Individuals who do not have no-cost MC, Medicare or private health insurance
Under Insured	Individuals with share-of-cost MC, Advanced Premium Tax Credits (APTC), and/or a Qualified Health Plan (QHP) through Covered California. Individuals with existing comprehensive health insurance coverage (i.e., Medicare or private health insurance) that is inaccessible due to high premium, deductible and/or copayment costs (exceeding $750 in the 12-month period.)
Meet Residency Requirements	• Are residents of California
Meet Income Guidelines	• Are at or below 200% Federal Poverty Level (based on family Size)
Require treatment	• In need of breast and/or cervical cancer treatment

Referrals to BCCTP

When making a BCCTP referral, the EW must:

1. Initiate the referral on the first day of contact by the beneficiary or applicant. Do not delay in sending any referrals to BCCTP.
2. Complete the BCCTP referral form “County Referral to the Breast and Cervical Cancer Treatment Program” (MC 373). Include the following information:  Name and contact information (including phone extension) of the EW making the referral.

            • Provide current and available information at the time of the referral that would assist in  determining BCCTP eligibility.

            • If available, any pertinent documents must be sent with the MC373 referral, e.g., pathology report, front and back of identification card, LPR card, and income verification, etc. Send via secure, encrypted email to: BCCTP@dhcs.gov or via fax at (916) 440-4593 Note: Do not include any Personally Identifiably Information (PII) in the Subject Line of an email as the subject lines are not encrypted in the same manner as the body of the email.

3. Notify the applicant/recipient that a referral was sent to BCCTP for an eligibility determination.
4. Document in the Journal page that BCCTP and DDSD referrals were sent or only a BCCTP referral sent. Document the reason the applicant would have been denied or discontinued from MC.
5. Document that a BCCTP and DDSD referrals were sent or only a BCCTP referral sent. Document the reason the applicant would have been denied or discontinued from MC.
6. Transfer an intake case to continuing pending BCCTP/DDSD decisions.

Referring BCCTP Applicants to DDSD

At application, if the individual will be denied and the EW is aware or the applicant declares to have breast or cervical cancer, the EW must:

1. Determine if the applicant meets all the criteria for a disability evaluation.
2. If the applicant meets the DDSD criteria, simultaneously refer the applicant to DDSD for a disability determination and to BCCTP for an eligibility determination. Make a notation on Box 10 of the DDSD referral form (MC 221) that the individual has been referred to BCCTP.

Note: If the MC 221 does not indicate in Box 10 that the EW has made a referral to BCCTP, the DDSD analyst will fax the MC 221 to the EW indicating a BCCTP referral appears necessary. The EW must check the case file and verify if a referral has been made to BCCTP. If one has not been made, the EW must make the referral and inform DDSD.

3. If the applicant does not meet the DDSD criteria, and there is no linkage to MC, refer the individual to BCCTP without a disability packet. Keep MC pending.
4. If the applicant is a male or a woman 65 years or older, not eligible for MC, deny MC and also send a referral for State-funded BCCTP.

Simultaneously referring an individual to BCCTP and DDSD will allow the federally BCCTP eligible individuals to receive MC benefits, including Accelerated Eligibility if eligible, while their disability determination is being reviewed. BCCTP will contact the applicant to determine if the individuals meets federal BCCTP requirements. The State will make a BCCTP eligibility determination and if found eligible will issue an approval Notice of Action (NOA) to the applicant and copy the EW who made the referral.

Referring Individuals

If an MC recipient is no longer eligible for his/her existing MC program either at the annual redetermination or when the recipient reports a change in circumstances, and they declare to have breast and/or cervical cancer, the EW must follow the SB 87 process to determine whether the individual is eligible for any other MC program, including federal BCCTP.

In order to follow the SB 87 process, the EW must:

1. Determine if the recipient meets the DDSD criteria to send a referral.
2. Refer the recipient to DDSD for a disability determination, if applicable, AND send a referral to BCCTP. Make a notation on Box 10 of the MC 221 that a BCCTP referral has been made

Note: If the MC 221 does not indicate in Box 10 that the EW has made a referral to BCCTP, the DDSD analyst will fax the MC 221 to the EW indicating a BCCTP referral appears necessary. The EW must check the case file and verify if a referral has been made to BCCTP. If one has not been made, the EW must make the referral and inform DDSD.

3. Place the recipient in one of the SB 87 pending disability Aid Codes (6J, 6R, 5J, or 5R) while a disability determination is pending.
4. If the individual does not meet the DDSD criteria, send a BCCTP referral without a DDSD packet.
5. Do not discontinue MC benefits for an individual under 65 years of age until BCCTP determination is received. If a DDSD referral was made, also wait for the DDSD decision.

Note: A male or a 65 year-old or older female are not eligible for federal BCCTP, but EWs must still follow the SB 87 process to determine whether the individual is eligible for any other MC program.
Do not discontinue MC benefits for a woman under 65 years of age until BCCTP determination is received. If a DDSD referral was made, also wait for the DDSD decision.

BCCTP Categories

Seven aid codes are assigned to BCCTP and are viewable on MEDS secondary screens: INQ1, INQ2 or INQ3. There are an additional four interim aid codes.

Aid Codes for Individuals (only) Who Are Less Than 65 Years of Age

Aid Code	Funding	Description
0U	Federal/ State Funded	Restricted MC Services and State-Funded Cancer Treatment and Related Services for  Women Without SIS This category provides restricted services for females (only) under 65 years old, who do not have SIS, and who do not have other health insurance. The period of eligibility for this category is up to 18 months for breast cancer and up to 24 months for cervical cancer. Individuals must have income below 200% of the Federal Poverty Level (FPL). These individuals may receive subsequent periods of eligibility if diagnosed with recurring breast/cervical cancer and still meet all other eligibility requirements. NOTE: This aid code does not provide Minimum Essential Coverage (MEC). This aid coded includes: MC emergency services, State-Funded BCCTP services Pregnancy or postpartum Services, and LTC MC Services.
0P	Federal	Federal BCCTP Eligibility Determined The period of eligibility for this aid code is the duration of treatment as long as all other federal BCCTP eligibility criteria continue to be met. This is a full-scope, no-SOC MC for females (only) who have SIS and have no creditable health insurance coverage.
0V	Federal	Continuing Restricted Services for 0U Eligibles The 0U eligibles must have exhausted their period of state-funded cancer treatment services, but still need treatment and still meet all federal BCCTP requirements except for immigration status. This category provides continuing MC emergency services and state-only MC pregnancy-related/LTC services without a SOC, for 0U beneficiaries whose 18 or 24 month period of state-funded cancer treatment coverage has ended but continue to need treatment and meet all other federal BCCT eligibility requirements except for immigration status.
0M	State	Accelerated Eligibility (AE) - Two-Month Limit This category provides temporary, full-scope, no-SOC MC limited to two months only (the month of application and the month after) because the individual did not request ongoing MC.
0N	State	Presumptive Eligibility (PE) - Two-Month Limit This is a temporary, full-scope, no-SOC MC coverage for women with no health insurance coverage. BCCTP applicants are granted for two months of PE with a termination date populated in MEDS. When a BCCTP beneficiary applies for Medi-Cal and MEDS shows a Medi-Cal application registration has been completed, the termination date will automatically be removed. Once the final Medi-Cal determination is completed, then Aid Code 0N will be automatically terminated.

Aid Codes for Males or Females

Aid Code	Funding	Description
0T	State	Coverage Limited to Cancer Treatment and Related Services Only The period of eligibility for this aid code is up to 18 months for breast cancer or up to 24 months for cervical cancer. Provides coverage limited to breast and/or cervical cancer treatment and relates services to females 65 years old or older, regardless of immigration status, who do not have health insurance coverage Provides coverage limited to breast cancer treatment and related services for males of any age or immigration status (regardless of age or immigration status) and who do not have health insurance coverage. Individuals must have income below 200% of the Federal Poverty Level (FPL). These individuals may receive subsequent periods of eligibility if diagnosed with recurring breast/cervical cancer and still meet all other eligibility requirements. This aid code does not provide Minimum Essential Coverage (MEC).
0R	State	High-Cost Other Health Coverage-Coverage Limited to Cancer Treatment and Related  Services Only Both males and females (regardless of age or immigration status) may qualify. This category provides payment of premiums, co-payments, deductibles, as well as coverage for breast and/or cervical cancer treatment and related services that are not covered by insurance. The insurance costs as determined by BCCTP Eligibility Specialist (ES), exceeds $750 in the 12-month period beginning on the date of eligibility determination for BCCTP. If the insurance costs during this 12-month period are determined by the ES to be $750 or less, the individual is not eligible for state-funded BCCTP coverage. The period of eligibility for this aid code is up to 18 months for breast cancer or up to 24 months for cervical cancer. Individuals must have income below 200% of the Federal Poverty Level (FPL).
OW	Federal	Transitional full-scope MC coverage with no SOC to BCCTP beneficiaries terminated from aid code 0P because they have obtained age 65, acquired creditable health coverage, or are no longer in need of treatment for breast and/or cervical cancer.
0X	State	Transitional restricted MC and State-funded cancer treatment and related services to BCCTP beneficiaries terminated from aid code 0U because they have obtained creditable health coverage, but their out-of-pocket expenses for the health coverage will exceed $750 in the next 12-month period and have not exhausted the 18 or 24 months of State-funded eligibility. Note: If the EW does not make a determination before the end of the beneficiary’s 18 months (for breast cancer) or 24 months (for cervical cancer) of State-funded eligibility, when State-funded BCCTP ends, the beneficiary will be placed into aid code OL until the EW makes a determination.
0Y	State	Transitional restricted MC and State-funded cancer treatment and related services to beneficiaries terminated from aid code 0U because they have turned 65 years of age, have no creditable health coverage, and have not exhausted the 18 or 24 months of state-funded eligibility. Note: If the EW does not make a determination before the end of the 18 or 24 months of State-funded BCCTP, when State-funded BCCTP ends, the beneficiary will be placed in aid code 0L until the EW makes a determination.
0L	State	Transitional restricted MC for beneficiaries who: Terminated from aid code 0U because they are no longer in need of treatment for breast and/or cervical cancer; Terminated from aid code 0U because they acquired creditable health coverage, but their out-of-pocket expenses will not exceed $750 in the next 12-month period. Terminated from aid code 0V because they have obtained age 65, acquired creditable health coverage, or are no longer in need of treatment for breast and/or cervical cancer, Have exhausted their 18 or 24 months of State-funded BCCTP coverage pending a determination while in interim aid code 0X or 0Y.

Processing BCCTP Determinations

In most cases, prior to denying or discontinuing MC benefits, the EW must have both a BCCTP determination and a DDSD decision if a referral was made.

Applicants with a DDSD Referral

If the applicant is found not eligible for federal BCCTP or found eligible only for State BCCTP, the EW must wait for the disability determination from DDSD before making a final MC eligibility determination for any other MC program. Send the appropriate MC denial NOA. The NOA must include the BCCTP denial paragraph, if appropriate. BCCTP will send a letter to the applicant, copy the EW, regarding the determination of state-funded BCCTP.

When the EW receives the DDSD determination that the individual does not meet MC disability criteria, but a determination by BCCTP has not been received, the EW is not to deny or discontinue MC until the BCCTP decision is received.

Applicants without a DDSD Referral

If a DDSD referral was not made, BCCTP will determine eligibility for both federal and State BCCTP. Once that determination is made, BCCTP will notify the EW if the individual is not eligible for federal BCCTP. The EW will send the denial NOA of both the MC and BCCTP programs. BCCTP will notify the
 
individual, copy the EW, if the individual is not eligible for State BCCTP. BCCTP will only send an eligibility letter (not NOA) regarding the State BCCTP since the State BCCTP is not a MC benefit.

Denial NOA

If the applicant is not eligible for federal BCCTP or eligible only for State BCCTP, the EW must send the final denial NOA for all MC programs, including the federal BCCTP. The NOA must include the following BCCTP denial paragraph:

Your application for MC has been denied, including for the Breast and Cervical Cancer Treatment Program (BCCTP). However, BCCTP will now review your case to determine if you are eligible for State-funded BCCTP. State-funded BCCTP is not a MC Program. You will receive a separate letter from the BCCTP letting you know if you are eligible for State-funded BCCTP.

The State will send a letter to the applicant regarding the eligibility determination for State-funded BCCTP as these benefits are not considered MC benefits.

Processing Chart

The following is a chart to clarify the steps in processing an applicant for BCCTP prior to denial:

 

Question	If. . .		Then. . .
1. Is the applicant eligible for federal BCCTP?	YES		BCCTP sends the approval NOA to the client with a copy to the EW. The EW waits for the DDSD decision if a referral was made and a decision has not been received. Deny MC if no DDSD referral was made. (No specific BCCTP language required on the NOA.)
	NO		EW waits for the DDSD decision. Once the DDSD decision is received, follow steps in # 3 below. EW sends a MC denial, including BCCTP denial if a DDSD referral was not sent.
2. Is the applicant eligible for State BCCTP?	YES		BCCTP sends a letter to the applicant. The EW follows step # 1 above. (The applicant is not eligible for federal BCCTP.)
	NO		BCCTP will send a letter to the applicant. The EW follows steps 1 and 3.
3.  Is the applicant considered disabled?		YES	The EW must take the following actions: Approve disability-based MC if otherwise eligible. Calls or faxes approval NOA to BCCTP. Check MEDS for correct Aid Code.
		NO	EW sends MC denial NOA including federal BCCTP denial if the applicant is not eligible for federal BCCTP, or only eligible for State BCCTP.

MC Recipient Eligible for Federal BCCTP and NOA

If the MC recipient is found eligible for federal BCCTP, the State will issue a NOA to the recipient and copy the EW who made the referral. If BCCTP makes a favorable BCCTP determination prior to DDSD, the EW must discontinue the alleged disability Aid Code (6J) effective the end of the current month. Do not send a discontinuance NOA so not to confuse the recipient and delay treatments.

Full Scope with a Disability Packet

If an individual is not eligible for the federal BCCTP, the State will notify the EW. The individual must remain active in a pending disability Aid Code while a disability determination is pending. Upon receipt of the DDSD decision, the EW will take appropriate action. If the individual is found not to have a disability, the EW must inform BCCTP as soon as possible and send a discontinuance NOA including denial for BCCTP.

Note: BCCTP cannot determine eligibility for the State BCCTP until all eligibility determinations for MC have been completed.

Restricted MC with a Disability Packet

If an individual on restricted MC is determined not eligible for federal BCCTP, BCCTP will notify the EW. The individual must remain active in a pending disability aid codes (5J or 5R) while a disability determination is pending. BCCTP will proceed to make a determination for the State BCCTP. If the individual is found eligible for the State BCCTP, the State will notify the individual immediately.

If the individual is found not to have a disability, the worker must inform BCCTP and send a final discontinuance NOA for all MC programs, including the federal BCCTP.

Disability Determination for Applicant or Recipient Approved Federal BCCTP

When an individual is approved for federal BCCTP and the EW later receives a DDSD decision of disability, the EW must check MEDS to determine if the individual is still active in BCCTP (aid code 0N, 0P, 0W). If the individual is still federally active in BCCTP but is now also eligible for MC based upon disability, the worker must

• Make the individual eligible for MC under the correct disability Aid Code effective the first of the following month and send the approval NOA.
• Fax a copy of the approval NOA to BCCTP to indicate that the individual is eligible for MC and under which program.

BCCTP will evaluate if the individual must be terminated from BCCTP or if she may continue under BCCTP.

Note: In the MC hierarchy of programs, BCCTP is the last program. In most cases, if an individual is eligible for disability-based MC and federal BCCTP, the EW would set up disability based MC and BCCTP will discontinue the program.

BCCTP Processing Chart for MC Beneficiaries

For MC recipients, BCCTP cannot make a determination of eligibility for State BCCTP until all eligibility determinations for MC have been made.

Below is a chart to clarify the BCCTP processing for a MC beneficiary:

BCCTP Processing for a MC Recipient

Question	If. . .	Then. . .
1. Is the recipient eligible for federal BCCTP?	YES	BCCTP sends the approval NOA with a copy to the EW. If DDSD has not made a decision, discontinue MC effective the end of the current month. Do not send an NOA. If no DDSD referral was made, discontinue MC.
2. Is the recipient determined disabled by DDSD? Note: Recipient is federally eligible for BCCTP.	NO	The recipient remains active until a decision is received from DDSD. If no DDSD referral was sent, send a MC discontinuance NOA including BCCTP denial.
	NO	Discontinue MC. Do not send an NOA. Note: The recipient is already receiving MC through BCCTP.
3. Is the recipient determined disabled by DDSD? Note: The recipient is not eligible for federal BCCTP.	YES	Approve disability-based MC, if otherwise eligible.
	NO	Send a MC discontinuance NOA, including federal BCCTP denial. Fax copy of NOA to BCCTP Note: BCCTP will proceed to process state BCCTP.

MC Discontinuance NOA

The discontinuance NOA must be issued once the BCCTP and or the DDSD determinations are received by the EW if the recipient is ineligible for MC and/or federal BCCTP. The EW must add specific language to the discontinuance NOA prior to mailing it to the MC recipient who claims to have breast or cervical cancer. The language is as follows:

“Your application for MC has been denied, including for the Breast and Cervical Cancer Treatment Program (BCCTP). However, BCCTP will now review your case to determine if you are eligible for State-funded BCCTP. State-funded BCCTP is not a MC program. You will receive a separate letter from the BCCTP letting you know if you are eligible for State-funded BCCTP.”

MC 351 and MC 239 A

Notices of Action MC 351 and MC 239 A have been revised to include the specific BCCTP required language. If another MC notice is issued for an individual who is denied federal BCCTP, the EW must include the specific required BCCTP denial paragraph as written above.

Retroactive Benefits

If the original application to the county included a request for retroactive benefits and MEDS does not show coverage for the requested months, the EW must fax a copy of the MC approval NOA to BCCTP to indicate that the individual is eligible for MC and under which program.

Annual Redetermination (RD) for BCCTP Eligibility

Annual RDs are performed by State Eligibility Specialists (ES) for those individuals receiving full or restricted federal BCCTP benefits (in Aid Code 0P, 0U and 0V) to determine if there have been any changes in the individual’s circumstance (i.e., obtained health insurance coverage, no longer California resident, etc.) that may affect ongoing BCCTP eligibility and determine if the recipient is still in need of treatment. Currently, annual RDs are not required for state-funded BCCTP; however, the individuals are required to report within ten calendar days any changes which may affect their eligibility.

State Hearings and Appeals

BCCTP recipients have the same hearing and appeal rights as any other MC recipient. When an MC applicant or recipient appeals a denial of MC eligibility and that appeal is based on her having, or declaring to have, breast and/or cervical cancer, Administrative Law Judges (ALJs) have been instructed that the case must be referred to BCCTP.

 

The case must be referred to BCCTP by the county if the ALJ renders a decision to the county and the county has previously not referred the case to BCCTP. If the decision is rendered to the DDSD and the MC 221 does not show that a referral to BCCTP has been made, the DDSD staff will fax the MC 221 to the county indicating a BCCTP referral appears necessary. The county must check the case file and verify if a referral has been made to the BCCTP. If one has not been made, the county must make the referral.

 

The ALJ cannot make a ruling on the individual’s MC eligibility or otherwise uphold a NOA denying an applicant or terminating a female recipient from MC until the federal BCCTP assessment is completed. If the case was not previously referred to BCCTP, the ALJ must pend the decision until the BCCTP determination is made. If BCCTP determines that the woman is federal BCCTP eligible, the ALJ will dismiss the case based on federal BCCTP eligibility. If BCCTP determines that the woman is not eligible for federal BCCTP, and the woman does not qualify for MC disability, the ALJ will deny the appeal.

 

When the county receives a fair hearing request from a woman who was determined not eligible for MC, including federal BCCTP, the county is to write a position statement for the hearing. As part of the position statement, the county must contact the BCCTP and receive a statement from BCCTP as to the details of why the applicant or beneficiary was not eligible for the federal BCCTP.

Managed Care for BCCTP Beneficiaries

Only the full-scope BCCTP beneficiaries (Aid Code 0P) may voluntarily enroll in managed care plans.

Recipients Ineligible for BCCTP

When a recipient is no longer eligible for federal, the BCCTP recipient will continue to receive the same level of benefits. BCCTP staff will place the recipient in an interim aid code in MEDS until an SB 87 process is completed and reported to MEDS by county staff.

BCCTP referrals are emailed to the MC Program Coordinators and forwarded to the MC Benefits Assistance (MBA) for processing. The county must complete the eligibility review within 60 days from the date the BCCTP staff sends the referral.

Recipients Ineligible for federal or state BCCTP

Individuals who are no longer eligible for federal or state BCCTP will continue to receive full-scope MC or restricted MC benefits until a redetermination of MC eligibility can be performed by county staff. On a monthly basis, these ineligible BCCTP individuals will come over in the “Exception Eligibles” (EE) tracking report.

The chart below outlines the process when a BCCTP beneficiary appears on the Exception Eligibles report.

Recipients Ineligible for BCCTP

1. BCCTP Staff    
   1. Terminates the recipient from the BCCTP aid code and places the correct interim aid code in MEDS.
   2. Sends an Informational Notice to inform the recipient that he/she will continue to receive full-scope, no SOC or restricted MC until the county makes a determination of his/her eligibility for any other MC program.
   3. Sends BCCTP County Notification form when a BCCTP case requires a county redetermination under another MC Program.
   4. Determines if beneficiary is eligible for State-funded BCCTP.
   5. Sends a timely Notice of Action.

      1. Note: If the county determines the recipient is eligible for full-scope, no-cost MC, the recipient will be terminated from the BCCTP and will not be placed into state-funded BCCTP.

2. Medical Program Coordinator    
   1. Forwards the referral packet to MBA Intake for processing.
3. CCS Application Support    
   1. Completes the application registration and case assignment following the current business process.
4. EW    
   1. Mails MC l Informing Notices including MC 007, MC 219, DHCS 7007, DHCS 7007A to the client.Completes SB 87 process.
   2. Contacts the BCCTP staff (as indicated on the BCCTP County Notification form) to obtain clarification or additional information regarding the referral packet, as needed.
   3. Approves or denies MC benefits.

      1. Note: No special MEDS transaction is required to change a BCCTP interim aid code to another MC program aid code. The MC approval transaction will automatically terminate the recipient’s interim aid code.

Related Topics

Every Woman Counts (EWC) Program

Accelerated Enrollment (AE)