Covered Services and Eligibility Guidelines


All women must meet eligibility criteria and have an EDW enrollment number prior to receiving services

Statement of Eligibility

  • Women between the ages of 40 and 64
  • No insurance or, with pre-approval, catastrophic hospitalization only insurance, with $2,500 unmet deductible.
  • Women who have government sponsored insurance (Medicare/Medicaid/MediKan) are not eligible.
  • With pre-approval, women under 40 with a personal history of cancer and meeting other eligibility guidelines.
  • Meet current income guidelines (See table below)

Breast Cancer Screening

  • Women age 50-64 are eligible for an annual screening or diagnostic mammogram.
  • Women age 40-49 are eligible for an annual clinical breast exam (CBE) and self breast exam education.
  • Women age 40-49 are eligible for an annual screening mammogram if they are symptomatic, have a personal history of cancer, or have a mother, daughter, or sister with history of breast cancer.
  • Repeat mammograms at 6 month intervals will be covered as clinically indicated for short-term follow-up.
  • Women with abnormal breast screening results are eligible for diagnostic tests shown in Attachment C.

Cervical Cancer Screening

  • Starting at age 21, women should get a Pap test every 3 years.
  • Between ages 30 and 65, a Pap test with human papillomavirus (HPV) co-testing is recommended every 5 years. This is the preferred approach, but it is acceptable to have a Pap test alone every 3 years.
  • Women over age 65 who have had regular screening with normal results should not be screened for cervical cancer. Women over age 65 who have been diagnosed with cervical pre-cancer should continue to be screened.
  • Women who have had their uterus and cervix removed in a hysterectomy and have no history of cervical cancer or pre-cancer should not be screened.
  • Women should discuss their risk factors with their physician.

Payment Policy

  • Program guidelines require that this program be the payor of last resort.
  • Program funds cannot be used to supplant other federal programs. For example, if a client receives Medicaid or Medicare, she would not be eligible for the EDW program. If a woman is eligible for either Medicare or Medicaid, and she is not enrolled in those programs, she should be encouraged to apply for coverage.
  • For women with pre-approval, catastrophic hospitalization only insurance, proof of type of insurance and deductible must be attached to the program forms.  

To receive treatment for cancer, all
clients must be diagnosed through EDW

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