5.17.2 NON-FINANCIAL REQUIREMENTS

5.17.2.1 Disqualifying Insurance Coverage

5.17.2.2 Non-Disqualifying Insurance Coverage

5.17.2.3 Family Planning Waiver participants

The following are Wisconsin Well Woman Medicaid specific non-financial requirements:

1. Meet general MA non-financial requirements (1.1.2).
    

2. Be at least 35 years old but under age 65.
    

3. Have been screened for breast or cervical cancer by WWWP
    

4. Be diagnosed for breast or cervical cancer, or certain pre-cancerous conditions of the cervix, as identified by the screener.
    

5. Require treatment for the breast or cervical cancer, or certain pre-cancerous conditions of the cervix, as identified by the screener.
    

6. Not be eligible for any other subprogram of MA, including BadgerCare.
    

7. Meet the insurance coverage requirements listed below in 5.17.2.1.

5.17.2.1 Disqualifying Insurance Coverage

A woman is ineligible for Wisconsin Well Woman Medicaid if she is covered by any one of the following:

1. Group health plans.

2. Full benefit health insurance.

3. Medicare Parts A or B.

4. Any other category of full benefit MA.

5. Veteran’s benefits/CHAMPUS.

6. HIRSP.

7. Federal employee health plans.

8. Peace Corps health plans.

9. Other full benefit private or public health care plans that provide cancer treatment.

5.17.2.2 Non-Disqualifying Insurance Coverage

1. The following health care benefits do not disqualify a client from Wisconsin Well Woman Medicaid:

1. 1. Coverage only for accident, or disability income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter. insurance, or any combination thereof.
       

   2. Liability insurance, including general liability insurance and automobile liability insurance.
       

   3. Workers’ compensation or similar insurance, credit-only insurance.
       

   4. Coverage for on-site medical clinics.
       

   5. Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
       

   6. Indian Health Services.

g. Non-coverage of cancer treatment due to waiting period.

8. Non-coverage of breast or cervical cancer treatment due to exclusion (max out) of cancer treatment benefit in the policy.

2. Separate health insurance benefits that are not considered health insurance if offered separately are:

1. 1. Limited scope dental or vision benefits.
       

2. 2. Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.
       

3. Independent uncoordinated benefits are not considered health care insurance if offered as independent and/or uncoordinated benefits (e.g., coverage only for specified disease or illness, hospital indemnity or other fixed indemnity insurance.
    

4. Separate insurance policies are not considered health insurance if offered as a separate insurance policy:

1. 1. Medicare supplemental health insurance.

   2. Coverage supplemental to the coverage provided under Chapter 55 of Title 10.

   3. Similar supplemental coverage under a group health plan.  

However, Medicare Parts A or B disqualify a client from Wisconsin Well Woman Medicaid eligibility.

5.17.2.3 Family Planning Waiver participants

Women enrolled in Family Planning Waiver who meet the following criteria, (regardless of age) will be eligible for Wisconsin Well Woman Medicaid.  These are woman who:
 

• Are screened for, and diagnosed with, cervical cancer or a precancerous condition of the cervix,
  
  OR
   

• Receive a clinical breast exam through FPW and through follow up medical testing independent of the FPW are diagnosed with breast cancer.
  
  AND  
   

• Are found to be in need of treatment for breast or cervical cancer or precancerous cervical condition and do not have other insurance that would cover the cancer treatment.

This page last updated in Release Number: 08-01

Release Date: 01/07/08

Effective Date: 01/07/08