In order to qualify for early detection services, a woman must meet age, income and insurance status guidelines. In addition, a woman must not participate in any program that provides these same services, such as Family Planning in a parish health unit. The screening provider determines a patient's eligibility for participation in LBCHP.
Early Detection Services
The following breast and cervical screening services are provided to eligible participants:
• Clinical Breast Exam
• Mammogram
• Pelvic Examination
• Pap Test
Priority Population
Although LBCHP begins screening services at 40, priority is given to women 50-64 years of age, at or below 250% of the Federal Poverty Guidelines and who are un- or under-insured. Within this population, priority is given to never or rarely screened women. Rarely screened is defined as not having been screened within the last five years.
Eligibility Guidelines
Age
Eligible Early Detection Services by Age Group
AGE |
EARLY DETECTION SERVICES |
40-49 years |
Pelvic Examination, Pap Test, Clinical Breast Exam |
50-64 years |
Pelvic Examination, Pap Test, Clinical Breast Exam, Mammogram |
A woman who by virtue of symptoms or physical findings, regardless of age, is considered to have a substantial likelihood of having breast disease is to be referred for a diagnostic mammogram. She must be screened through the LBCHP to be eligible.
Income
The participant's household income must be at or below 250% of the Federal Poverty Level. The Federal Poverty Level and the LBCHP's maximum allowable income are adjusted annually. LBCHP does not require proof of income for program participants. However, some providers may require proof of income according to their institution's policies. If a participant is diagnosed with cancer Medicaid may require proof of income.
Maximum Allowable Income (at or below 250% of Federal Poverty Level)
FAMILY SIZE |
ANNUAL* |
MONTHLY |
1 |
26,000 |
2,166 |
2 |
35,000 |
2,916 |
3 |
44,000 |
3,666 |
4 |
53,000 |
4,416 |
5 |
62,000 |
5,166 |
6 |
71,000 |
5,916 |
7 |
80,000 |
6,666 |
8 |
89,000 |
7,416 |
*For family units of more than 8 members, add $3,600 for each additional member. Effective January 23, 2008.
Insurance Status
Under-insured women are entitled to the same LBCHP services as eligible uninsured women.
Women under Medicare Part B and/or Medicaid are not eligible for LBCHP services. LBCHP cannot pay the co-payment for Medicare. A woman who meets the income requirements of LBCHP is considered under-insured and eligible for services under the following conditions:
• Her medical insurance does not cover LBCHP services or
• The deductible or co-payment required by her insurance deters her from receiving breast and cervical cancer early detection screening services.
Treatment
Most women screened or diagnosed through the Louisiana Breast and Cervical Health Program providers will qualify for Louisiana Breast and Cervical Medicaid Program (BCC Medicaid) to cover the cost of treatment. BCC Medicaid applications are coordinated at each provider site.
Women needing treatment for a breast cancer or a cervical pre-cancer or cancer who have not been screened or diagnosed by an LBCHP provider are not eligible for BCC Medicaid. The eligibility criteria for BCC Medicaid are set by the state of Louisiana. If you do not qualify for BCC Medicaid and need help arranging treatment, please call us at 1.888.599.1073 for assistance. Our patient navigator or our services coordinator will assist you with accessing services in the public hospital system. You also may contact the Louisiana Medicaid Program directly at 1.888.544.7996 to see if you qualify for Medicaid coverage under another eligibility category.