Cancer Control Program Eligibility Requirements

Eligible North Carolinians may be covered through the Cancer Control Program (CCP) for inpatient and/or outpatient diagnostic services of cancer or suspected malignancies and for the treatment of cancer. To qualify, one must meet three eligibility requirements:

	Be a permanent resident of North Carolina.
	Meet financial eligibility criteria (refer to current income guidelines) and be ineligible for other medical assistance programs (e.g., Medicaid) or have limited or no health insurance (see guidelines on coordination with other insurers).
	Meet medical eligibility criteria (have symptoms or clinical findings suspicious of cancer or be diagnosed as having cancer and have an estimated 25 percent or better chance of five-year survival rate at the time each treatment is requested).

	The applicant, or a parent of a minor applicant, is a United States citizen.
	The applicant, or a parent of a minor applicant, is not a United States citizen, but has applied for United States citizenship. Immigration and Naturalization Service (INS) documentation must accompany the application.
	The applicant, or a parent of a minor applicant, is not a United States citizen, but has a permanent resident visa or has applied for one. INS documentation must accompany the application.
	The applicant is a migrant farm worker or a dependent of one. A Migrant Farmworker Health Program Eligibility Application (DHHS 3753) ) must be submitted with the Financial Eligibility Application (DHHS 3014). Migrant farmworker status qualifies the applicant as a North Carolina resident for all POMCS programs.

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Financial Eligibility

The Cancer Control Program uses the patient's gross family income and does not allow for deductions from income in determining financial eligibility which is based on 115 percent of the Federal Poverty Guidelines. The income scale is updated each July 1.

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Medical Eligibility

To be medically eligible for diagnostic services, a patient must have a condition strongly suspicious of cancer. The Cancer Control Program will authorize only those services determined by the Program to be medically necessary to rule out or confirm a preliminary diagnosis. Request for inpatient diagnostic services must include justification as to why the services cannot be done on an outpatient basis. Diagnostic services for suspected cervical intraepithelial neoplasia (CIN) will be covered if there is cytologic evidence of CIN.

To be medically eligible for treatment services, the attending physician must certify that there is a 25 percent or better chance of five-year survival at the time of treatment authorization request. The Cancer Control Program will use the current five-year relative survival rates published by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program as a guide for evaluating requests for treatment. To access the five-year survival rate, select a specific cancer site in the SEER Cancer Statistics Review.

An Authorization Request (DHHS 3056) must be completed by the patient's physician for each type of service. All Authorization Requests for treatment services must be accompanied by a pathology report. All Authorization Requests for chemotherapy must be accompanied by a treatment regimen describing the treatment being requested (drugs to be used, the dosage and frequency of administration).

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