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STAR+PLUS Medicaid for Breast and Cervical Cancer Program

Date: 04/05/21

Effective September 1, 2017, women in the Medicaid for Breast and Cervical Cancer (MBCC) program began receiving all Medicaid services, including cancer treatment, through a Managed Care Organization (MCO) that offers STAR+PLUS. Superior HealthPlan’s MBCC team was created to serve this population. The Superior MBCC team includes Registered Nurses (RNs) trained to assist members in identifying service needs and coordinating their benefits. Members enrolled in the program will receive all Medicaid services, including cancer treatment and reconstruction, through STAR+PLUS.

Providers can assist by:

  • Facilitating early detection through routine breast and cervical cancer screenings.
  • Providing education about the MBCC program and how to apply.
  • Completing renewal forms every six months for those with ongoing active treatment needs.

Member Eligibility

The STAR+PLUS MBCC program is available to women 18-64 years of age who:

  • Have been diagnosed with breast or cervical cancer (including pre-cancerous conditions).
  • Need treatment for breast and/or cervical cancer (including pre-cancerous conditions).
  • Live in Texas.
  • Are a U.S. citizen or eligible immigrant.
  • Do not have health insurance.
  • Have an income at or below 200 percent of the Federal Poverty Level.

Applying for Eligibility

If a member has been diagnosed with breast or cervical cancer and does not have health insurance that will pay for treatment, they may be eligible to receive full Medicaid benefits by applying for MBCC. To see if they qualify for this Medicaid program, they should contact a Breast and Cervical Cancer Services Clinic by visiting the Healthy Texas Women homepage and clicking “Learn More Now” under “Breast & Cervical Cancer Services.”

Active Treatment

At reapplication and at each redetermination, the MBCC applicant or recipient must provide Form H1551, Treatment Verification. This form must be completed by their treating health professional, verifying that they need active treatment services for breast or cervical cancer. Active cancer treatment includes services related to the individual's condition as documented in their plan of care, such as:

  • Surgery.
  • Chemotherapy.
  • Radiation.
  • Reconstructive surgery.
  • Medication (ongoing hormonal treatment).

These services may also include diagnostic services that are necessary to determine the extent and proper course of treatment and active disease surveillance for triple negative receptor breast cancer.

Women who are determined to require only routine health screening services for a breast or cervical condition (for example, annual clinical breast examinations, mammograms and pap tests as recommended by the American Cancer Society and the U.S. Preventative Services Task Force) are not considered to need treatment and are not eligible for MBCC. A woman may reapply for MBCC if she is later diagnosed with a new breast or cervical cancer, pre-cancerous condition or a metastatic or recurrent breast or cervical cancer.

In addition to STAR+PLUS services, members in the MBCC program will receive:

  • Service coordination with an assigned RN Care Manager, which includes:
    • Assessing, identifying and addressing member needs.
    • Working with members and their families, community supports and provider(s) to develop a plan of care.
    • Educating members and their families on how to manage their own care and services.
    • Assisting in locating community resources for services not covered by the STAR+PLUS program.
  • Unlimited prescriptions.
  • Emergency care.
  • A Primary Care Provider (PCP) to ensure their needs are addressed.
  • Access to Superior’s network of specialty providers
  • Durable Medical Equipment (DME), and items specific to their diagnosis such as bras, prostheses and lymphedema sleeves.
  • Value-added services, such as respite care, extra vision services and health and wellness services.

*Please note: Women in the MBCC program will continue to receive full Medicaid benefits as long as they remain eligible, and every 6 months submit proof of active treatment for breast and/or cervical cancer from their treating physician (Form H1551), as well as MBCC renewal (Form H2340). These forms are provided to members by Texas Health and Human Services (HHS).

Additional Information

To identify a member’s Service Coordinator, or for additional information, please contact Superior’s Member Services department at 1-877-277-9772.