IM-05 January 18, 2013; IM-111 November 26, 2007
The application form for BCCT is the IM-1BC. The IM-1BC requests the applicant to provide identification, citizenship/alien status and insurance information.
The IM-1BC may be submitted to Family Support Division (FSD) in one of two ways:
- If the woman received screening services through a Show Me Healthy Women (SMHW) provider and was determined eligible for BCCT Presumptive Eligibility (BCCT PE), the SMHW provider will:
- Instruct the claimant to fill out the IM-1BC application, and
- The SMHW provider will return it to the Customer Relations Unit based in St. Joseph.
If referred by the SMHW provider, the provider’s name, phone number and date of diagnosis should be on the form.
- Women who have been screened and diagnosed with breast or cervical cancer by a SMHW or a MO HealthNet provider may apply at their local county FSD office.
If the woman was not determined eligible for BCCT PE by a SMHW provider, send an Authorization for Disclosure of Consumer Medical/Health Information (MO 650-2616) form and the Certification of Need for Treatment – Breast/Cervical Cancer (BCC-2) form to verify she has been screened and is in need of breast or cervical cancer treatment.
The BCCT application must be registered in IAPP on the day received by FSD. Failure to register the regular BCCT application (or MHABD, MHF, MHK application if requested) when received can result in the BCCT PE period ending incorrectly rather than extending until the BCCT (or MHABD, MHF, MHK application) eligibility determination is made.
The BCCT category of assistance is available on IAPP under MO HealthNet for the Aged, Blind, and Disabled (MHABD). An application registered for BCCT may be approved under the MHABD program if eligible under the MHABD program requirements or under the BCCT program. A BCCT application (M1) may be registered even if there is an active M2 (BCCT PE) case active.