Eligible North Carolinians may be covered through the Cancer Assistance Program (CAP) 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.

Stated briefly, for a patient to qualify for the Cancer Assistance Program, he/she must:

• Be a resident of North Carolina,
• Meet financial eligibility criteria (refer to current income guidelines),
• 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.
• Be ineligible for other medical assistance programs (e.g., Medicaid), or have limited health insurance or none at all.

Residency

North Carolina residency is determined by meeting one of the following conditions:

The applicant, or a parent of a minor applicant, is a United States citizen who now lives in North Carolina and intends to make North Carolina his/her permanent home.

The applicant, or a parent of a minor applicant, is not a United State 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 State 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). 

Financial Eligibility

The Cancer Assistance 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.  A current or updated copy can be obtained from the Cancer Prevention and Control Branch or Purchase of Medical Care Services.

The patient must have a Financial Eligibility Application (DHHS 3014) completed annually by a financial interviewer and it remains in effect up to one year from the date of signature unless the financial information changes before then.

Medical Eligibility

To be medically eligible for diagnostic services, a patient must have a condition strongly suspicious of cancer.  The Cancer Assistance 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 Assistant 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.  Copies of the rates may be obtained from the Cancer Prevention and Control Branch or on the Internet under "Publications" at the following site provided by the National Cancer Institute:  http://www-seer.ims.nci.nih.gov.

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).

Covered Services and Eligibility Providers