Patient Eligibility


Program Enrollment

Clients must enroll through program staff at either the regional office level or the state level. At that time, EDW staff determine the client’s eligibility for services and give the client an enrollment number. The client must communicate this number to the provider when requesting an appointment for EDW services. The enrollment number is to be recorded on billing forms submitted in order to verify that the client is currently enrolled in EDW.

All Clients:

  • Must meet the income guidelines (see below). Income is self-reported by the client
  • Must not have health insurance or have major medical hospitalization insurance only with a $2500, unmet deductible; this must be verified prior to enrollment in the program.
  • Women under age 40 are not eligible if they have any health insurance.

A. Eligibility Criteria for Specific Services:

Services Reimbursed
By Early Detection Works

Woman's Age

Clinical Breast Exam

Mammogram

Pap Test

Diagnostics

Pre-approved required?

50-64

Yes

Yes

Yes

Yes

No

40-49

Yes

Yes - if symptomatic or with close family history of breast cancer*

Yes

Yes

No

*Family history includes a personal history of breast, GYN or colorectal cancer or a mother, daughter or sister with a history of breast cancer.

Providers with access to Susan G. Komen Breast Cancer Foundation or other local funds should utilize this source of funding when possible. EDW will serve as the payer of last resort. Basic income guidelines apply to all women.


*A limited number of services are available for uninsured women under age 40; call 1-877-277-1368 for additional information.

B. How to enroll

Prior to the client's first appointment, she must call the staff for her region at the regional office number or the state toll free line at 1-877-277-1368 to answer questions which will determine her eligibility for the program. Upon qualifying, the client will be given an enrollment number, which the client will give to the provider when making her appointment.

Clients will provide demographic information by filling out the top portion of the Intake & Visit Summary form on each visit. Clients will also answer questions to determine high risk status for breast and cervical screening and sign a consent form for the program.

C. Effective dates:

  • Begin date: The day the client signs her medical release is considered the client's enrollment date.
  • End date: Clients remain eligible for the life of the program or as long as they meet age, income and insurance eligibility requirements.

D. Income guidelines:

Income eligibility guidelines are tied to Federal poverty guidelines. Program eligibility rules require women to have an income at or below this level to qualify for Early Detection Works services.

Income Eligibility Guidelines

Income Eligibility Guidelines

Family
Size*

Annual
Maximum

Monthly
Maximum

1

$23,925

$1,994

2

$32,075

$2,673

3

$40,225

$3,352

4

$48,375

$4,031

5

$56,525

$4,710

6

$64,675

$5,390

7

$72,825

$6,069

8

$80,975

$6,748

Add an additional $8,150 for each person