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 Notice of Privacy Practices

 

 

 

 

 

 

 

 

 

 

 

DID YOU JUST DIAGNOSE A WOMAN WITH BREAST OR CERVICAL CANCER WHO IS LOW INCOME AND UNINSURED/UNDERINSURED?

 

Form PA600B

Spanish Version of Form PA600B

 

Here’s how you can assist your patient in obtaining free breast and cervical cancer treatment if she’s eligible!

The Pennsylvania Department of Health’s HealthyWoman Program (HWP) provides free breast and cervical cancer screening and diagnostic testing to eligible women. The Department of Public Welfare provides free treatment for women diagnosed through the HWP.


Even if you are not a HWP provider, you can refer women to the Breast and Cervical Cancer Prevention and Treatment (BCCPT) Program.  The woman must meet the eligibility requirements of the HWP and the BCCPT Program to receive cancer treatment.

IT IS A BRIEF, THREE-STEP PROCESS TO ASSIST YOUR PATIENT.

If you have any questions, please contact the Pennsylvania Department of Health’s HWP Case Management Team at Adagio Health 1-800-215-7494.

PROCESS to enroll your patient into the Commonwealth’s free Treatment Program:

      

      1. Print out form PA600B .

2. Have the woman complete the HealthyWoman Enrollment form (PA600B), Part A HWP. The health care provider should fill out PA600B , Part B – Medicaid Eligibility

    application.

3. Fax both forms to the Pennsylvania Department of Health’s HWP Case Management Team at Adagio Health at 412-201-4702.


HWP
Eligibility Guidelines

 

Age:  The general age is 40 through 64 (unless a woman under age 40 is symptomatic or 65 or older and is not covered by Medicare).

Income:  The woman’s gross household income must be at or below 250 percent of the federal poverty annual guideline.

 

2013 Federal Poverty Annual Income Guidelines at 250% of Poverty

 

Family Size

Gross Monthly Income

Annual Income

1

$2,394

$28,725

2

$3,231

$38,775

3

$4,069

$48,825

4

$4,906

$58,875

5

$5,744

$68,925

6

$6,581

$78.975

7

$7,419

$89,025

8

$8,256

$99,075

 Each Additional Person

$   838

$10,050

 
 

Insurance Status:   The woman must be uninsured or underinsured.  Underinsured means that the woman has health insurance, but it does not cover breast or cervical screening offered by the HWP or she is financially unable to pay any required deductible or co-payment.

Women enrolled in Medicare Part B, Medicaid, or HMOs are not eligible for the HWP.


BCCPT Program Eligibility Guidelines

  • Be under age 65
  • Be diagnosed with breast or cervical cancer or a pre-cancerous condition of the breast or cervix
  • Be uninsured or have limited health care coverage
  • Be a resident of PA with a social security number

For additional information about the HWP and the BCCPT Program, please visit the Department of Public Welfare at www.dpw.state.pa.us/omap and search for the BCCPT Program for information on this program.

For additional information on other social services that may be available, please visit this web site:

COMPASS: Provides information and an application for your patient to determine what health and social services she may be eligible for through various state agencies.

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