Medicaid Cancer Treatment Program (MCTP): Breast, Cervical, Colorectal and Prostate Cancer

The Medicaid Cancer Treatment Program (MCTP) is a Medicaid program for eligible persons who are found to be in need of treatment for breast, cervical, colorectal or prostate cancer (and in some cases, pre-cancerous conditions of these cancers).

To be enrolled in the MCTP, an individual must complete an application with a New York State Department of Health Cancer Services Program (CSP) trained designee, referred to as a Designated Qualified Entity (DQE). A DQE is a person designated and trained by the New York State Department of Health as a "Qualified" entity, for the purpose of assisting individuals to complete the MCTP application.

Once an individual is enrolled in the MCTP, full Medicaid coverage is provided for an initial period of enrollment as determined by the type of cancer or pre-cancerous condition being treated. Recertification is required yearly, if the individual is still in need of treatment, at which time eligibility is reassessed. Enrollees must receive services from a Medicaid enrolled provider in order to have their services covered. MCTP coverage is limited to the individual enrollee and cannot be extended to family members or dependents.

Eligibility for the MCTP:

Breast Cancer: To be eligible for Medicaid coverage for the treatment of breast cancer or pre-cancerous breast conditions under the MCTP, applicants must be:

  • Screened for and diagnosed with breast cancer or a pre-cancerous breast condition by a New York State licensed health care provider, OR, if diagnosed with such in another state, were screened and/or diagnosed by that state's National Breast and Cervical Cancer Early Detection Program;
  • Not covered under any creditable insurance at the time of MCTP application;
  • In need of treatment for breast cancer or a pre-cancerous breast condition;
  • A resident of New York State; and
  • A United States (U.S.) citizen or an alien with satisfactory immigration status.

If an individual who meets the above requirements appears to be eligible for Medicaid in any of the mandatory categories, the individual will be given Medicaid coverage under the MCTP for a limited time pending a Medicaid eligibility determination.

Cervical Cancer: To be eligible for Medicaid coverage for the treatment of cervical cancer or pre-cancerous cervical conditions under the MCTP, applicants must be:

  • Screened for and diagnosed with cervical cancer or a pre-cancerous cervical condition by a New York State licensed health care provider, OR, if diagnosed with such in another state, were screened and/or diagnosed by that state's National Breast and Cervical Cancer Early Detection Program;
  • Not covered under any creditable insurance at the time of MCTP application;
  • In need of treatment for cervical cancer or a pre-cancerous cervical condition;
  • A resident of New York State; and
  • A United States (U.S.) citizen or an alien with satisfactory immigration status.

If an individual who meets the above requirements appears to be eligible for Medicaid in any of the mandatory categories, the individual will be given Medicaid coverage under the MCTP for a limited time pending a Medicaid eligibility determination.

Colorectal Cancer: To be eligible for Medicaid coverage for the treatment of colorectal cancer or pre-cancerous colorectal conditions under the MCTP, applicants must be:

  • Cancer Services Program eligible at the time of screening or diagnosis;
  • Screened and/or diagnosed with colorectal cancer by a current CSP credentialed provider;
  • Under 65 years of age;
  • Income eligible (income at or below 250% Federal Poverty Level (FPL) at the time of MCTP application);
  • Not covered under any creditable insurance at the time of MCTP application;
  • In need of treatment for colorectal cancer or pre-cancerous colorectal condition;
  • A resident of New York State; and
  • A United States (U.S.) citizen or an alien with satisfactory immigration status.

If an individual who meets the above requirements appears to be eligible for Medicaid in any of the mandatory categories, the individual will be given Medicaid coverage under the MCTP for a limited time pending a Medicaid eligibility determination.

Prostate Cancer: To be eligible for Medicaid coverage for the treatment of prostate cancer or pre-cancerous prostate conditions under the MCTP, applicants must be:

  • Screened and/or diagnosed with prostate cancer by a current CSP credentialed provider;
  • Under 65 years of age;
  • Income eligible (Income at or below 250% Federal Poverty Level (FPL) at the time of MCTP application);
  • Not covered under any creditable insurance at the time of MCTP application;
  • In need of treatment for prostate cancer or pre-cancerous prostate condition;
  • A resident of New York State; and
  • A United States (U.S.) citizen or an alien with satisfactory immigration status.

If an individual who meets the above requirements appears to be eligible for Medicaid in any of the mandatory categories, the individual will be given Medicaid coverage under the MCTP for a limited time pending a Medicaid eligibility determination.

Enrollment:

Unlike most Medicaid programs, where enrollment occurs at the local department of social services, the point of entry for this program is the Cancer Services Program (CSP), where designated qualified entities are located to assist individuals in completing the MCTP enrollment process. Enrollments for MCTP are processed centrally by State staff in the Office of Health Insurance Programs (OHIP). Individuals who are determined eligible will receive Medicaid coverage for as long as they need cancer treatment.

If you think this program will benefit you or someone you know, you should contact your local CSP.

Check the Department of Health website at:
http://www.health.ny.gov/diseases/cancer/ or
Public Health Program List or
Call The Cancer Services Program at 1-866-442-2262.

For additional information call the Medicaid Help Line at: 1-800-541-2831; or
E-mail your questions to:canserv@health.state.ny.us