10.14.04.04

.04 Eligibility — Breast and Cervical Cancer Program.

A. To be eligible to receive breast cancer services under this chapter through the Breast and Cervical Cancer Program, an applicant shall:

(1) Be a resident of Maryland;

(2) Be 40 years old or older;

(3) Meet the financial eligibility criteria specified in §B of this regulation;

(4) Meet the health insurance criteria specified in §C of this regulation; and

(5) Be determined to be eligible to receive covered services by a:

(a) Local health department or an agency or organization designated by the local health department; or

(b) Private entity that contracts with the Department to render services in Baltimore City or Calvert County.

B. Financial Eligibility Criteria.

(1) Financial eligibility under this chapter is based on annual gross income and family size.

(2) To be financially eligible to receive breast cancer services under this chapter through the Breast and Cervical Cancer Program, an applicant may not have an annual gross income that exceeds 250 percent of the most recent federal poverty guidelines updated annually in the Federal Register by the United States Department of Health and Human Services in accordance with 42 U.S.C. §9902(2).

(3) For the purposes of determining family size under the federal poverty guidelines set forth at §B(2) of this regulation, the following individuals are family members of the applicant:

(a) The applicant;

(b) The applicant's spouse;

(c) The applicant's financially dependent children; and

(d) The applicant's financially dependent relatives.

C. To be eligible to receive breast cancer services under this chapter through the Breast and Cervical Cancer Program, an applicant shall meet one of the following health insurance criteria:

(1) The applicant is not currently covered by health insurance; or

(2) The applicant is currently covered by health insurance that:

(a) Does not provide reimbursement for a service covered under this chapter; or

(b) Requires the applicant to pay a co-pay, co-insurance, or a deductible that has not been met for a service covered under this chapter.

D. An applicant may not receive breast cancer services under this chapter through the Breast and Cervical Cancer Program if:

(1) The applicant is enrolled in Medical Assistance; or

(2) The applicant is enrolled in a health maintenance organization.