This rule establishes eligibility criteria for medical assistance based on an individual's need of treatment for breast or cervical cancer, including pre-cancerous conditions (treatment). The Authority administers the Oregon Breast and Cervical Cancer Treatment Program (BCCTP) by entering into agreements with qualified entities as approved by the Authority to provide screening services for BCCTP funded by the Centers for Disease Control in support of the National Breast and Cervical Cancer Early Detection Program.

1. (1) To be eligible for BCCTP, an individual must:

   1. (a) Be found to need treatment following screening services provided by a qualified entity;
   2. (b) Be under the age of 65;
   3. (c) Not be covered for treatment by minimum essential coverage; and
   4. (d) Not be receiving Medicaid through a Medicaid program listed in 42 U.S.C. §1396a(a)(10)(A)(i) (mandatory Medicaid eligibility groups).

2. (2) An individual is presumptively eligible for BCCTP beginning the day a qualified entity determines, on the basis of preliminary information, that they are likely to meet the requirements of section (1). A qualified entity that determines an individual presumptively eligible for BCCTP shall:

   1. (a) Notify the Authority of the determination within five working days; and
   2. (b) Explain to the individual at the time the determination is made the circumstances under which an application for medical assistance shall be submitted to the Authority and the deadline for the application (see section (3)).

3. (3) To remain eligible for benefits, an individual determined by a qualified entity to be presumptively eligible for BCCTP shall apply for medical assistance no later than the last day of the month following the month in which the determination of presumptive eligibility is made. Presumptive eligibility for BCCTP ends on:

   1. (a) The last day of the month following the month in which presumptive eligibility begins, if the individual does not file an application by that date;
   2. (b) The day on which a determination is made for other Medicaid/CHIP program benefits.

4. (4) An individual found eligible for the BCCTP by the Authority becomes ineligible at the point at which any of the following occur:

   1. (a) The treating health professional determines the course of treatment is complete;
   2. (b) Upon reaching age 65;
   3. (c) When the individual becomes covered for treatment by minimum essential coverage;
   4. (d) Upon becoming a resident of another state;
   5. (e) When the Authority determines they do not meet the requirements for eligibility.

Statutory/Other Authority

ORS 411.402, 411.404, 413.042 & 414.534

Statutes/Other Implemented

ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.447, 414.534, 414.536, 414.540 & 414.706

History

DMAP 63-2025, amend filed 08/28/2025, effective 09/01/2025
DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020
DMAP 3-2015, f. & cert. ef. 1-30-15
DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15
DMAP 20-2014, f. & cert. ef. 3-28-14
DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14
DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14