MaineCare Member  
Handbook 
 
 
June 2023 
 
 
 
 
 
 
  Welcome MaineCare Member! 
 
Letmebethe first to welcomeyou to MaineCare, Maines health insurance program forlower
income adults, children, pregnant women, older adults, and people with disabilities. MaineCare 
is Maines version of Medicaid. MaineCare helps you get the healthcare you need to take care of 
yourself or your family so that you can go to work, school, or be an active part of your 
community.   
There are different types of MaineCare coverage for different people. Sometimes the range of 
benefits and resources can be confusing. The MaineCare MemberHandbook is here to help you 
better understand your coverage, so you can make the right health care decisions for you and 
your family.   
This handbook has information about the various types of MaineCare coverage, and about what 
services are available to you with the type of MaineCare you have. It also includes details on 
where to go if you have additional questions, and other helpful resources. In short, the 
MaineCare Member Handbook contains a lot of information. Not every section will apply to you, 
but if you have MaineCare, there is information in here that may help you.   
If you need further assistance, you can always call MaineCare Member Services at                     
1-800-977-6740. If you are deaf or hard of hearing and have a TTY machine, call 711. We are 
here to help you get the answers you need.  
Thank you, and again, welcome to MaineCare. 
 
 
 
Michelle Probert 
MaineCare Director  
   
  This handbook explains the MaineCare program. It is not a legal policy or contract. This handbook is 
updated often and printed versions may include old information. The most current version of the 
handbook can be found on the MaineCareMember Resources webpage at: 
https://www.maine.gov/dhhs/oms/member-resources.  
 
 
 
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 1 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Table of Contents   
Table of Contents .............................................................................................................................2
Chapter 1: Basic Information about MaineCare ..............................................................................5
MaineCare Members ........................................................................................................................5
Applying for MaineCare ..................................................................................................................5
Medical and Financial Reviews and Changes .................................................................................6
MaineCare Card ...............................................................................................................................7
Covered Services .............................................................................................................................7
Cost to You ......................................................................................................................................8
Interpreter Services ........................................................................................................................10
Chapter 2: Getting Services ...........................................................................................................12
COVID-19......................................................................................................................................12
Hospital Emergency Department (ED) ..........................................................................................13
Urgent Care ....................................................................................................................................13
Preventive Services ........................................................................................................................14
Prior Authorization (PA)................................................................................................................14
Out-of-State Services .....................................................................................................................16
Restriction Policy or Lock-In.........................................................................................................16
Chapter 3: Programs Explained .....................................................................................................17
Accountable Communities (AC) Program .....................................................................................17
Adult Dental Coverage ..................................................................................................................17
Private Health Insurance Premium (PHIP) ....................................................................................17
Telehealth .......................................................................................................................................19
Quitting Tobacco ...........................................................................................................................20
Transitional MaineCare .................................................................................................................21
Transportation ................................................................................................................................21
Chapter 4: Pharmacy Services .......................................................................................................24
Preferred Drug List ........................................................................................................................24
Mail Order Pharmacies ..................................................................................................................24
Discount Drug Programs................................................................................................................24
Drugs for the Elderly and Disabled (DEL) ....................................................................................25
Maine Rx Plus ................................................................................................................................26
Chapter 5: Services for Children ....................................................................................................27
MaineCare Coverage Options ........................................................................................................28
Childrens Coverage ......................................................................................................................28
Coverage for Children without Citizenship ...................................................................................28
Newborn Coverage ........................................................................................................................28
Katie Beckett ..................................................................................................................................28
Purchasing MaineCare through Health Insurance Purchase Option (HIPO) .................................28
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 2 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Services for Children .....................................................................................................................28
Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT) ................................28
School Health Related Services .....................................................................................................29
Chapter 6: Services for Older Adults and Adults with Disabilities ...............................................31
Home and Community-Based Waiver Recipients .........................................................................31
Deductibles for the Medically Needy ............................................................................................31
Medicare ........................................................................................................................................31
Medicare Savings Programs  Also called Buy-In ........................................................................32
Long-Term Care Coverage ............................................................................................................33
Electronic Visit Verification ..........................................................................................................33
Chapter 7: Primary Care Provider ..................................................................................................35
Choose a PCP .................................................................................................................................35
Appointments with your PCP ........................................................................................................35
Losing your PCP ............................................................................................................................36
Referrals .........................................................................................................................................36
Chapter 8: Your Rights as a MaineCare Member ..........................................................................37
Advance Health Care Directive or Living Will .............................................................................37
Estate Recovery .............................................................................................................................37
Fair Hearings ..................................................................................................................................39
Medical Records ............................................................................................................................40
Medical Support from the Other Parent .........................................................................................41
Other Health Insurance and MaineCare .........................................................................................41
Protected Health Information .........................................................................................................42
Chapter 9: Benefit Packages ..........................................................................................................46
Services that May Be Covered .......................................................................................................46
Benefit Packages Explained ...........................................................................................................46
Full Benefit Packages ....................................................................................................................46
Home and Community Based Services Waivers ...........................................................................48
Inmates or Prison Coverage, Exception to Full Benefit Package ..................................................55
Limited Benefit Packages ..............................................................................................................55
Special Benefit Waiver or HIV Waiver .........................................................................................56
Pregnant People Who Are Presumptively Eligible ........................................................................57
Limited Family Planning Benefit...................................................................................................57
Coverage for Individuals who are not Citizens or have no Documents from the U.S. Department 
of Homeland Security ....................................................................................................................58
Federally Non-Qualified Children under 21 and People who are Pregnant ..................................58
Emergency Services (also called Emergency MaineCare) ............................................................58
Residents of Nursing Facilities ......................................................................................................60
Residents of Residential Care Facilities ........................................................................................61
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 3 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Information about your MaineCare Benefits .................................................................................62
Chapter 10: Helpful Addresses, Telephone Numbers, and Websites ............................................63
DHHS Eligibility, Office for Family Independence (OFI) ............................................................63
MaineCare Member Services .........................................................................................................67
Pharmacy Help Desk......................................................................................................................67
Transportation Brokers ..................................................................................................................68
Maine Center for DiseaseControl and Prevention ........................................................................70
Maine Breast and Cervical Health Program ..................................................................................70
The Women, Infants, and Children Program .................................................................................71
Community Resources ...................................................................................................................71
Chapter 11: Terms and Definitions ................................................................................................82
 
 
 
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 4 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Chapter 1: Basic Information about MaineCare 
 
MaineCareprovides health care coveragefor Maines children and adults who are elderly,
disabled, or with low incomes. MaineCare, Maines Medicaid program, is jointly funded by the 
federal governments Centers forMedicare & Medicaid Services (CMS) and the State of Maine.  
 
MaineCare Members 
  A MaineCare member is an individual who receives health care coverage through 
MaineCare because they meet the income guidelines and are eligible based on age, family 
situations, and health care needs. 
  MaineCare is for individuals who have low income or are medically needy. 
  Some programs, such as nursing home care and in-home services, require both financial 
and medical eligibility. 
 
Applying for MaineCare 
The Office for Family Independence (OFI) determines MaineCare eligibility. OFI is an office of 
the Department of Health and Human Services (DHHS), just like the Office of MaineCare 
Services. 
See the MaineCareEligibility Guidelines document for the income limits for MaineCare on the 
Health Care Assistance webpage at: https://www.maine.gov/dhhs/ofi/programs-services/health-
care-assistance. You and your family may be eligible for MaineCare if your monthly income, 
before you pay taxes, is up to your household size listed. If you are close to the income limits, 
you should go to My Maine Connection or contact the Office for Family Independence (OFI) to 
apply because some of your income may not count toward this limit. 
To apply for MaineCare, you can do one of the following: 
  Go to My Maine Connection to see if you are eligible or to apply online for MaineCare. 
The web address is: https://www.mymaineconnection.gov/.  
  Print an application by going to this web address: 
https://www.maine.gov/dhhs/ofi/applications-forms. You can then mail it to:                
114 Corn Shop Lane, Farmington, ME 04938. 
  Call 1-855-797-4357; TTY users, dial 711. 
  Visit a local DHHS - Office for Family Independence (OFI). Go to the following web 
address to see the list of district office addresses: 
https://www.maine.gov/dhhs/about/contact/offices. DHHS offices are located throughout 
the state. To see what office your town is assigned to, go to the Office Finder webpage at: 
http://gateway.maine.gov/dhhs-apps/office_finder/index.asp.  
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 5 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Call the OFI eligibility office if you: 
  Need a MaineCare card  
  Have questions about your eligibility 
  Move or change phone numbers 
  Become pregnant or have a baby 
  Have a change in household members 
  Get or lose other health insurance 
  Get or lose a job 
  Want an administrative hearing when your MaineCare coverage ends 
 
You can call the eligibility office at 1-855-797-4357. See Chapter 10 of this handbook for a list 
of addresses and phone numbers of the local DHHS offices. 
 
Medical and Financial Reviews and Changes  
The eligibility office sends you a renewal form to complete annually. To make sure you dont 
miss it, be on the lookout forthe envelope with a blue block. This will have the renewal 
information and instructions. When you get your renewal form, be sure to complete and return it 
on time. If you dont, you could lose MaineCare coverage.    
 
Its important to update your contact information with OFI any time it changes to ensure you 
dont lose coveragebecausethey cant reach you. Stay connected to stay covered by updating
your contact information today at MyMaineConnection.gov, or by calling the eligibility office at 
1-855-797-4357 to update your information through an automated system.  
 
If you have changes that may affect your MaineCare, call the eligibility office at 1-855-797-
4357. You should report changes within 10 days.  
 
Report changes such as: 
 
  Address 
  Income 
  Assets 
  Other health insurance, including Medicare 
  Someone moving in or out of your home 
  Marital status  
 
You can call the eligibility office at 1-855-797-4357. See Chapter 10 of this handbook for a list 
of addresses and phone numbers of the local DHHS offices. 
 
 
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 6 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  MaineCare Card 
 
 
 
All members get a plastic MaineCare card. Please bring this card with you to your health 
appointments. Your card can only be used for you. It is against the law to let anyone else use it 
for anything but your care.  
 
Keep your MaineCarecard even if your coverage ends. You may get MaineCare again. If that 
happens, you can use the same card. If you lose your card or need a new one, contact your local 
DHHS eligibility office. See Chapter 10 of this handbook for your local DHHS contact 
information.  
 
Covered Services 
MaineCare pays for medically necessary services based on your coverage group, which is 
determined by your income, age, medical needs, and if you need help with Activities of Daily 
Living (ADLs). MaineCare may not cover all services listed below. Not all coverage groups 
have coverage for the same slate of services. Make sure MaineCare covers the service you need 
before you get care. There are limits or special rules for most covered services. 
 
What services arecovered? 
Some examples of services that may be covered include: 
  Doctor visits 
  Prescription medications 
  Behavioral health services 
  Gender affirming care services, such as hormone therapy or surgery   
  X-rays and labs 
  Emergency and hospital visits 
 
What services arenot covered? 
Some examples of services that are not covered include: 
  Acupuncture 
  Cosmetic surgery 
  Experimental procedures or drugs 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 7 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    Health club memberships, such as the YMCA 
  Massage therapy 
 
How do I find out if a service is covered? 
Talk with your health care provider or call MaineCare Member Services at 1-800-977-6740. 
TTY users, dial711 (Maine Relay). To see if your medication is covered, call the Pharmacy 
Help Desk at 1-866-796-2463, TTY users, dial 711 for Maine Relay. 
 
Do I need anything before I can get a health care service? 
Some services needsomething before your provider can provide the service.  
Some covered services need a: 
 
  Referral from your primary care provider 
  Prior Authorization, often called a PA  
  Prescription  
  Copay  
  Medical assessment  
 
For more information, see the chapter about Benefit Packages in this handbook. 
 
Cost to You   
Do I have to pay for MaineCare coverage? 
Your healthcareprovider cannot charge you for services they provide to you that are covered by 
MaineCare. You may have to pay a copayment, premium, or cost of care for MaineCare services 
depending on your coverage group. 
 
Copayments  
You may have to pay for part of the cost of some services that are covered by MaineCare. What 
you pay is called a copayment, or copay. 
Members do not have a copay for the following: 
  Services provided in Indian Health Service Centers 
  Family Planning services and supplies 
  Emergency Services 
  Hospice services 
  All Oxygen and Oxygen Equipment services 
  Tobacco Cessation services and products 
 
Members do not have a copay when they are: 
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 8 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    Under 21 years of age 
  Pregnant, including 12 months after the pregnancy ends   
  In state custody       
  Under state guardianship 
  Tribal members or are eligible to receive services funded by Contract Health Services or 
Indian Health Service Tribal Union when their tribal membership has been verified 
through the Office for Family Independence (OFI)  
  Members paying for part of their care as set by DHHS and residing in one of the below 
facilities: 
  Hospital 
  Skilled nursing facility 
  Nursing facility 
  In a medical institution, Intermediate Care Facility for Individuals with 
Intellectual Disabilities (ICF-IID), or a Private Non-Medical Institution (PNMI) 
where DHHS sets the cost of care  
 
To see what you might have to pay for a copay for services and prescription drugs, see the 
MaineCare Member Copayments (PDF) on the Coverage & Benefits webpage at: 
https://www.maine.gov/dhhs/oms/member-resources/coverage-benefits.  
 
Some services must beprovided to you even if you cant pay a copay. For example, a drug store 
must give you your drugs even if you do not pay your copay. If you do not pay your copay, the 
provider may bill you, and send your bill to a collection agency or takeyou to court if youdont
pay.  
 
Call MaineCare Member Services for more information about copays at 1-800-977-6740.  
 
Premiums  
A premium is a fee that some members pay to have MaineCare coverage. For some MaineCare 
services, if you are over the income level for MaineCare you may have the option to pay a 
premium for MaineCare coverage. An example includes the Katie Beckett program. You will 
know if you must pay a premium because you will get a letter when you enroll in MaineCare. 
 
If you must pay a premium, MaineCare will send you a bill in the mail. You must pay the bill 
when it is due. You can pay each month or the entire year up front. If you do not pay the 
premium you may lose your MaineCare coverage. If you have any questions about your 
premium contact your local DHHS office. See Chapter 10 of this handbook for your local DHHS 
office address and telephone number.  
 
Cost of Care  
If you live in a medical facility, you may have to pay for a portion of your care. This is called the 
Cost of Care and it is the amount you pay toward your care at the medical facility. Members who 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 9 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  pay a Cost of Care usually live in a nursing facility, residential care facility, cost-reimbursed 
boarding home, or an adult family care home.   
 
Whether you pay a cost of care depends on your income. If you have a cost of care, you will get 
a letter showing your monthly payment. Unless your income is set aside for your at-home 
spouse, you must use most of your income to pay for your care.  
 
Some members who are eligible to live in a nursing facility may get services in their own home 
instead.  
 
Members who receive the following services usually must pay a cost of care:  
 
  Home and Community Benefits for Members with Intellectual Disabilities or Autism 
Spectrum Disorder (Adults over age 18) 
  Home and Community Benefits for the Elderly and Adults with Disabilities 
  Home and Community-Based Benefits Services for Adults with Brain Injury   
  Home and Community-Based Services for Adults with Other Related Conditions 
  Support Services for Adults with Intellectual Disabilities or Autistic Disorder 
 
Other Payments 
You may have to make other payments. For example, you must pay when you: 
 
  Get services from someone who is not a MaineCare provider. Make sure your provider is 
enrolled with MaineCare before you receive services. 
  Get a service that is not covered by MaineCare and you agree with your provider in 
advance that you will pay for the service. 
  Did not follow the rules of your other health insurance when you are covered by more 
than one insurance, and your other health insurance denies your 
claim.                                                                                                                                   
 
 
 
Interpreter Services  
If you do not speak English, have limited-English speaking ability, or are deaf or hard of hearing, 
you can have an interpreter help you. If you want an interpreter at your appointment, you must 
ask your provider in advance. 
If you prefer, you can have a family member or a friend over age 18 interpret foryou. You must 
give this person permission to go with you to an appointment and set it up with your provider 
before your appointment. MaineCare cannot pay a family member or friend to interpret for you. 
 
Interpreter services are also available when calling MaineCare Member Services.
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 10 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  I have a question about MaineCare, and English is not my first language. How can I talk 
with someone?  
 
If you are a MaineCare member and need an interpreter, MaineCare will pay for one. You can 
call MaineCare Member Services at 1-800-977-6740, and they will contact an interpreter.  
 
How do I ask for an interpreter?   
To ask for an interpreter, follow these steps: 
 
1.  Call MaineCare Member Services at 1-800-977-6740. 
2.  When you hear a voice on the phone, select 2.  
3.  When someone answers the phone, say your language slowly and clearly. The person will 
call an interpreter and have them join the call. This may take a few minutes. 
4.  Once the interpreter is on the phone, the person will introduce themselves and ask you 
some questions to makesureits you that they are speaking with before they share any 
information. 
5.  After you haveanswered the interpreters questions, you may ask your MaineCare 
questions. 
 
Can a friend or family member be my interpreter? 
Yes. When you call MaineCare Member Services, your friend or family member should say they 
areyourinterpreter. MemberServices will ask you somequestions to makesureits you and that
its okay to talk to yourfriend orfamily member about your information.  
 
What if I need written information translated into my language? 
Please call MaineCare Member Services at 1-800-977-6740 and ask for an interpreter. Once you 
have an interpreter on the phone and you answer some questions, you can request to have 
something translated into your language. It may take a few days for your document to be 
translated. 
 
Will I have to pay to have a document translated into my language? 
No, you do not have to pay to have MaineCare documents translated. 
   
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 11 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Chapter 2: Getting Services  
 
COVID-19  
At the beginning of the COVID-19 pandemic, the federal DHHS declared a Public Health 
Emergency (PHE) and relaxed certain rules to make sure you could still get the health careyou 
needed. This included allowing all members receiving MaineCare(Maines Medicaid program)
to keep their coverage even if they had changes to things like their income that would normally 
make them lose MaineCare. 
 
The federal DHHS announced that all Medicaid programs across the country, including 
MaineCare, need to make sure that every member enrolled is still eligible, starting in April 2023. 
Thefederal DHHS has called this unwinding, orthe end of continuous coverage requirement.  
 
The federal DHHS also announced that the PHE will end on May 11, 2023. This means that, 
starting May 12, 2023, there were some additional changes to how you access health care 
services as things went back to how they used to be. For information about pharmacy, Non-
Emergency Transportation services, and other COVID-19 related benefits, see Information for 
MaineCare Members section of our COVID-19 webpage at: 
https://www.maine.gov/dhhs/oms/about-us/projects-initiatives/covid-19.
 
Does MaineCare cover COVID-19 testing and treatment? 
Yes, MaineCare covers COVID-19 treatment and COVID-19 at-home tests or tests at the 
pharmacy with no cost to members. For more detail, see the COVID-19 At-Home Tests and Kits 
(PDF) - April 28, 2023 at: www.maine.gov/dhhs/sites/maine.gov.dhhs//files/inline-files/COVID-
19-At-Home-Test-Members-04282023_0.pdf. 
 
Are COVID-19 vaccines covered by MaineCare? 
Yes, COVID-19 vaccines and boosters are covered by MaineCare with no cost to members. For 
more information about COVID-19 vaccines and boosters, see the Getting Vaccinated for 
COVID-19 (PDF) - Updated May 5, 2023, at: 
www.maine.gov/dhhs/sites/maine.gov.dhhs//files/inline-files/Getting-Vaccinated-for-COVID19-
Member-FAQ-05052023.pdf.  
 
 
For moreinformation about MaineCares coverageof COVID-19 services, see the COVID-19 & 
PHE Ending webpage at: www.maine.gov/dhhs/oms/about-us/projects-initiatives/covid-19.  
 
Contact 211 Maine for answers to frequently asked questions about COVID-19. This resource is 
TTY and Video Relay accessible if calling from Maine.  
  Dial 211or 1-866-811-5695 
  Text your ZIP code to 898-211   
  Email: info@211maine.org  
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 12 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Where can I find more information about COVID-19 vaccines, including where to get one? 
For up-to-date vaccine site information and a list of vaccination sites, go to: 
http://www.maine.gov/covid19/vaccines.  
 
If you wish to order COVID-19 tests to your home, visit COVID.gov/tests. Every U.S. 
household is eligible to order 4 free at-home COVID-19 tests. Project Access COVID Tests 
(ACT) is offering free, rapid, at-home tests to Maine residents of eligible communities while 
supplies last. Visit www.AccessCovidTests.org to see if tests are available in your area. 
 
Hospital Emergency Department (ED) 
If you think you are having a life-threatening health emergency, go to the hospital ED right 
away. If you go to the ED and it is not an emergency, you may have to wait a long time for care. 
If you are not sureif it is an emergency, call your Primary Care Provider (PCP). Use the ED only 
for an emergency, not for routine or urgent care.  
 
Some examples of emergencies are: 
 
  Chest pain 
  Bad burns 
  Broken bones  
  Being unable to speak or move 
  Severe bleeding 
  Deep cuts 
  Head injuries 
  Thoughts of harming yourself or others 
  Trouble breathing 
  Mental confusion 
  Poisoning or drug overdose 
  Severe injury to a joint 
  Rape or other attack 
  Sudden or severe pain 
  Coughing blood 
 
Urgent Care 
Urgent care, also called walk-in care, is not for emergencies and can be used if your injury or 
ailment is not life-threatening. Use urgent care when you need care right away, but your primary 
care officeis closed, or they do not have an appointment available. 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 13 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Preventive Services 
MaineCare pays for many preventive services. These services keep you well and can find health 
problems before they become serious. 
 
Examples of preventive services for members of all ages: 
 
  Healthy visits, also called well-child exams 
  Annual physical exams for adults 
  Dental cleanings and fluoride 
  Tobacco and substance use counseling 
  Lead testing 
  Immunizations, also called vaccines or shots, for children and adults 
  Pap smears  
  Mammograms 
  Prostate screenings  
 
Preventive services for members under age 21: 
MaineCare supports parents taking their child to a well-child exam. A well-child exam is a visit 
to thedoctor thatis not forasickness. Instead, it is for checking thechilds health and growth, 
getting shots, and taking tests to make sure the child is well. Call MaineCare Member Services if 
you need help to set up appointments, find a ride, or find a MaineCare provider. A child can get 
some services and medical equipment that are considered optional treatment services. Optional 
treatment services are not usually covered by MaineCare unless the service is medically 
necessary. An example of a covered optional service is a helmet for a child who has seizures.   
 
Seethe Childrens Serviceschapter ofthis handbook for moredetail about services for members
under age 21. 
 
Prior Authorization (PA) 
 
 
What is a Prior Authorization?
Before you can get some services or equipment, MaineCare must approve it. This approval is 
called Prior Authorization (PA). Your provider sends a form to MaineCare, and we will send you 
and your provider a letter to let you know if the service or medical equipment is approved. If you 
get theserviceor themedical equipment without MaineCares approval, you mayhaveto pay the
bill. 
Examples of services and medical equipment that need PA: 
  Some prescription drugs 
  Some mental health services 
  Some surgeries 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 14 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    Most medical supplies and medical equipment that cost over $699.99 
  Hearing aids 
  Most out-of-state services 
  Some eye care services 
  Some dental services 
  Some gender-affirming care services 
  All services to straighten teeth 
  Some physical therapy, occupational therapy, and speech therapy 
  Inpatient treatment at an in-state psychiatric hospital 
  Out-of-state and some in-state transportation services 
  Some home care services 
  Some ambulance services 
For questions about a PA fora prescription drug, call MaineCares Pharmacy Help Desk at 1-
866-796-2463. Call MaineCare Member Services at 1-800-977-6740 for questions about all other 
services. 
 
How will I know if I need a PA for my prescription drugs? 
When your provider prescribes a drug, ask if you need a PA. MaineCare has a Preferred Drug 
List and it shows which drugs need PA. For those that need PA, MaineCare must give approval.  
Your provider asks for PA by sending a form to MaineCare. After getting the form, MaineCare 
has 24 hours to let you, thepharmacy, and your doctor know if the drug is approved. The 
Preferred Drug List is not in this handbook because it is long, and it changes often. You can find 
the list on the Limited Benefits webpage at: https://www.maine.gov/dhhs/oms/mainecare-
options/limited-benefits. You can also call MaineCare Pharmacy Help Desk at 1-866-796-2463. 
 
What if I cannot get my drugs because I need PA? 
Call your provider. Your provider will need to complete a form for PA or prescribe a different 
drug. If MaineCare does not approve the drug, you can ask for a Fair Hearing. If MaineCare 
denies a drug that was paid for in the past 48 days and you ask for a hearing within 10 days of 
the denial, you should be able to get your prescription filled while waiting for your Fair Hearing.  
 
Call the Pharmacy Help Desk at 1-866-796-2463 if you have questions about a PA or your drugs. 
If you are deaf or hard of hearing and have a TTY machine, call 711.  
 
 
 
 
   
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 15 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Out-of-State Services 
 
Out-of-State MaineCare Providers  
New Hampshireproviders who are within 15 miles of the Maine border can enroll in MaineCare. 
Check with MaineCare Member Services if you have questions about seeing an out-of-state 
provider. 
 
Emergency Services Out-Of-State 
You may have to pay the bill if you get care from a provider outside of the state of Maine. This is 
because not all providers choose to enroll as a MaineCare provider. If the provider is not enrolled 
with MaineCare, and you have paid a bill, you may not get your money back. If you are not sure 
if what you are experiencing is an emergency, call your Primary Care Provider (PCP) first, and 
he or she may be able to help you get care. Call MaineCare Member Services if you get a bill. 
 
Non-Emergency Services Out-Of-State 
If you need a servicethat is not an emergency and you are outside the state, you must get the 
service in Maine from a MaineCare provider or from a MaineCare-enrolled provider who is 
within 15 miles of the Maine border in New Hampshire. 
 
If your provider thinks you need a service that is not offered in Maine, MaineCare may approve 
care outside of Maine. Your provider must ask MaineCare to approve any services you get in 
another state before you can get that service.  
 
Pharmacy Services Out-Of-State 
Pharmacy Servcices are not covered out-of-state.  If you are planning on being out-of-state and 
will need to obtain medication while you are there, please have your provider submit an early fill 
prior authorization request. 
 
 
Restriction Policy or Lock-In 
In situations wherea member repeatedly accesses services or medications that have not been 
determined medically necessary by his or her medical provider, MaineCare may limit the 
member to specific health care providers, drug stores, and hospitals.  
   
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 16 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Chapter 3: Programs Explained
 
 
Accountable Communities (AC) Program 
 
What is an Accountable Community (AC)? 
An AC is a group of doctors and other health care providers who work together to give better 
health care to their patients and lower the costs of healthcare services.  
 
What does this mean to me? 
You can still choose the healthcare providers you want to see. MaineCare wants you to have 
the best healthcare you can. To be sure this happens, we may share your Protected Health 
Information (PHI) with the AC and other healthcare providers you see. The PHI we may 
share includes information about your doctor and hospital visits, prescriptions, medical and 
mentalhealth conditions, and lab work.  
 
You can read an example of a letter to members for more detail on the Primary Care and Your 
Health webpage at: https://www.maine.gov/dhhs/oms/member-resources/primary-care-and-your-
health. You can decide to opt-out of this program at any time by contacting MaineCare Member 
Services at 1-800-977-6740. 
Adult Dental Coverage 
Beginning on July 1, 2022, MaineCare expanded dental coverage to adults. All individuals over 
age 21 years old will have access to comprehensive dental coverage. 
What services may be covered? 
  Diagnostic services, such as oral evaluations and x-rays 
  Preventive services, such as cleanings, fluoride, and tobacco and substance use 
counseling 
  Restorative services, such as fillings and crowns 
  Endodontic services, such as root canals 
  Periodontic services, such as various gum surgeries and cleanings that occur below the 
gums 
  Complete, partial, and immediate dentures and denture repairs 
  Oral surgeries, such as tooth extractions and removal of tumors and lesions 
  Adjunctive services, such as sedation and night guards 
Private Health Insurance Premium (PHIP) 
The PHIP program can help you pay your share of the cost for your private health insurance. 
PHIP has new guidelines, so you may qualify! If you have private insurance or if it is available 
through work, please call Member Services at (800) 977-6740 to learn more about this program. 
You can also get an application and/or more information online at: 
https://www.maine.gov/dhhs/oms/mainecare-options/limited-benefits  
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 17 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
What is PHIP? 
 PHIP stands for Private Health Insurance Premium benefit. This benefit can pay your share of 
the cost of your private health insurance.  
  
How can PHIP help me? 
   If you qualify, MaineCare will pay your share of the cost for your private health 
insurance. Your share of the cost is called a premium. 
  You will still have MaineCare coverage. You may also have additional services covered 
under your private health insurance.  
  Your MaineCare coverage will pay for deductibles and copays required by your private 
insurance. 
 
Do I qualify for PHIP? 
You may qualify for PHIP if: 
  You or someone in your household is eligible for MaineCare.  
  You are eligible for private health insurance coverage.  
  You might be covered by the plan as an employee, child, or spouse. 
 
How do I apply? 
  To print an application, go to: 
https://www.maine.gov/dhhs/sites/maine.gov.dhhs/files/documents/PHIPweb-
Application.pdf.  
  Call the PHIP team at 1-800-977-6740 to ask them to mail you an application. 
 
Will I have out-of-pocket costs? 
The only times therewill be out of pocket costs for PHIP members are when: 
  You have a MaineCare copay. MaineCare will pay the copay for the private health 
insurance.  
  If you or a member of your family receives a service that is not covered by MaineCare, 
you may have an out-of-pocket expense. 
  Your doctor should tell you if it is aserviceMaineCaredoesnt coverbeforeproviding
the service. 
 
What do I need to do? 
  You must sign up for private health insurance. ThePHIP team cant do that foryou.  
  If you qualify for PHIP, give your health care provider your MaineCare card and your 
private health insurance card at all appointments and services. 
 
What happens if I lose MaineCare?  
If MaineCare ends, PHIP ends. 
 
What happens if I lose my private health insurance? 
If you lose or cancel your private health insurance, you no longer qualify for PHIP. Please 
contact us right away if that happens. 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 18 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Telehealth 
Your health care provider may offer telehealth, which is a way for you to see your provider from 
the comfort of your own home or another setting. 
 
What is telehealth? 
Telehealth is theuse of technology for health care appointments and services. It allows you to 
see your care provider without having to go to their office. Visits are covered by MaineCare, 
Medicare, and most insurance companies.  
 
What kind of appointments can I have using telehealth? 
  Conversations with your doctor about your chronic health care, diagnosis and treatment 
of new illnesses, and other medical care 
  Physicals, mental health, substance use disorder treatment and some developmental 
disability services 
  Routine child check-ups and developmental services 
 
How do I use telehealth? 
  Mobile apps 
  Video conferencing platforms  
  Patient portal message and telephone calls without video are considered "virtual health" 
visits 
 
How do I ask for a telehealth appointment? 
1.  Call your care provider and ask if you can use telehealth for your appointment. This may 
also be an option for your childrens health care needs. 
2.  They will tell you about the best way to use telehealth for your appointment.  
 
What if I don't have a smartphone or internet access?  
Call your doctor and discuss your telehealth options. If you do not have a smartphone but have a 
computer, you may be able to do a telehealth visit on your computer. If you do not have a 
computer or internet access, you may be able to conduct your appointment over telephone with 
audio (voice) only.   
If you need help with paying for your phone, cell minutes, or internet access, you can also apply 
for Lifeline, afederal program thats availableto help eligibleindividuals pay fortheir cell
phone minutes and internet access. Go to this webpage to apply: 
https://www.fcc.gov/consumers/guides/lifeline-support-affordable-communications  
 
How much data will this use?  
Some face-to-face video chats can use a lot of data. Using Wi-Fi can reduce the amount of cell 
phonedata you use. Ifyou havealimited amount of data, call yourdoctors office, and discuss 
your options. Theremay beoptions that dont use as much data, such asaphonecall or sharing
pictures and text, if necessary. You can also contact your phone carrier if you have questions on 
your data limits. 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 19 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
What if I need an interpreter? 
An interpreter can be available during a telehealth visit like they are for an in-person 
appointment. Your provider's office will contact you before your telehealth appointment to talk 
about what you need for the appointment and may ask if you need an interpreter. If they don't 
ask, you can request one. Ifyourprovider doesn't call or email you before your visit, you should 
call the office to request an interpreter. 
Your provider will arrange to have the interpreter join your telehealth visit. You will see both 
your provider and your interpreter on your screen. If you are receiving care at a hospital or health
clinic, the interpreter may join you in person or from another location. You can also talk with 
your provider about having your family member or friend join you as an interpreter if you 
prefer.  
 
How can I besure it's safe to use telehealth? 
You should always be careful whenusing technology, whetherits for health care, banking, or
simply connecting with family and friends. Your privacy is very important to us and your 
healthcare provider. 
 
There are some simple things you can do to help make sure that your telehealth visit is safe and 
secure: 
  Ask your health care provider if the technology they are using is HIPAA-compliant  this 
means that it meetsthefederal governments strict privacy and security standards.
HIPAA-compliant technologies make it much more difficult for hackers to access your 
information or get access to a telehealth visit uninvited. 
  Make sure you are located in a private space before you start your telehealth visit and be 
sure your provider is also in a private space once you are connected via audio/video. A 
room with a door that can be closed is best to avoid interruptions and prevent others from 
hearing your discussion with your provider. 
  Use a private network to connect to the internet, which is one that requires a password to 
join, such as your home network. Do not use public networks such as those at coffee 
shops or libraries to join a telehealth visit, as these are much less secure, and your 
information and privacy may be at risk. 
See the Telehealth webpage for more details at: https://www.maine.gov/dhhs/oms/member-
resources/telehealth.  
 
Quitting Tobacco 
 
MaineCare can help! 
If you are thinking about quitting, you are not alone.  
Approximately three out of four people who use tobacco want to quit. 
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 20 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  What happens when you quit? 
  Your blood pressure and circulation improve.  
  Your heart rate improves. 
  Your lungs work better. 
  Your chances of developing cancer, heart disease, diabetes, or having a stroke go down. 
 
How can MaineCare help you quit? MaineCare pays for: 
  Tobacco treatment counseling services. 
  Nicotine replacement options like the nicotine patch or gum.  
  Doctor visits.  
 
Ready to quit now? 
  You can get help by calling 1-800-QUIT-NOW or by visiting MaineQuitLink.com. 
  Call your doctor for help finding services and choose which treatment might be best for 
you. 
Starting to think about quitting? 
  Visit the Maine QuitLink at: http://mainequitlink.com/.  
  Learn about free tools and resources. 
 
Not ready to quit yet? 
  Take the Smoke Free Home Pledge at:  
https://breatheeasymaine.org/smoke-free-homes-pledge/.  
  Remember, there is no risk-free level of secondhand smoke. 
 
Transitional MaineCare 
If your income goes up becauseof work or child support, and you are no longer eligible for 
regularMaineCare, you may beable to get up to six months of Transitional MaineCare. Call 
 
your local DHHS office eligibility specialist for information. 
 
Transportation 
MaineCare covers Non-Emergency Transportation (NET) for eligible members. You may get a 
ride to your MaineCare-covered appointment or have your ride reimbursed by MaineCare. 
Make sure to make an appointment at least two business days in advance and check that it is 
covered by MaineCare and approved by the transportation broker. 
The transportation broker in your region will decide if you qualify for transportation services and 
what type you qualify for.  
 
 
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 21 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  How do I schedule a ride to my appointment? 
MaineCare works with transportation brokers to schedule rides for our members. Call the broker 
in your area to ask about scheduling a ride. To see if you are eligible for NET, please contact the 
broker in your area. For a list of brokers, go to the NET webpage at: 
https://www.maine.gov/dhhs/oms/member-resources/transportation.  
 
The transportation broker will choose the least expensive way to get you to your appointment. 
The brokers do not arrange emergency transportation. In a medical emergency, you should call 
911 and they will send an ambulance. 
 
Some examples of ways the broker may get you to your appointments are:  
 
  Paying you for mileage from your home to and from your appointment if you use your 
own vehicle. 
  Paying a friend or family member for mileage from your home to your appointment and 
back if he or she brings you. 
  Giving you a pass or fare if you use public transportation such as a bus, train, or ferry. 
  Setting up a ride with a volunteer to and from your appointment. 
  Setting up a ride with an agency to and from your appointment. 
  If you have special medical needs, setting up a ride to and from your appointment in a 
specialty vehicle, such as a wheelchair van. 
  In certain cases, the broker may set up a ride with a taxi to and from your appointment. 
 
The broker must follow MaineCare rules about what type of transportation they offer you. You 
must use whatever type of transportation the broker provides unless there is a health reason not 
to use that type of service.  
 
When should I schedule a ride to my appointment? 
Call fora ride as soon as you schedule your MaineCare-covered appointment. You must call the 
broker in your region at least two business days before the appointment. Before scheduling your 
ride, the broker checks that your appointment is covered by MaineCare and that you are eligible 
for transportation services. 
 
When are other times that I should talk to the broker? 
  If you cancel or change the date or time of an appointment, call the broker right away.  
  If you schedule a medical service outside of Maine, call the broker right away. The 
broker will need time to confirm that MaineCare has given permission for the out-of-state 
service. 
  If you need to bring someone to help you at your appointment due to a medical need, let 
the broker know so they can make sure there is room for you and the other person. 
  You should make every effort to arrange childcare if you need it. The broker may not be 
able to set up the trip so that you can bring your children with you. 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 22 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    If you need emergency care, call an ambulance. Emergency care means there is a risk to 
your life or long-term health. Brokers do not arrange emergency transportation. 
  If you need urgent care, you can call the broker. Urgent care means you need to see your 
doctor soon, but it is not an emergency. If you need urgent care, the broker will arrange 
transportation even if you did not call two business days in advance.  
 
What if I have an urgent appointment and need a ride? 
If it is an urgent appointment and you cannot call two business days ahead of time you can still 
get a ride. The broker will verify the trip is urgent. 
 
Examples of when transportation is allowed for urgent care: 
  Your doctor tells you to get medical care on the same day you call, or the next day. 
  Your doctor tells you to come back for follow-up in two days or less. 
  You are released from the hospital. 
  Your doctor refers you to a specialist who can see you in two days or less and if you 
cannot make the appointment within two days you would have to wait two weeks or 
longer for an appointment. 
  You rescheduled an appointment because the broker caused a delay. 
 
The broker is required to verify appointments. The broker may: 
  Call yourdoctorsoffice to confirm your appointment beforeyour trip and after your
appointment to confirm that you went to it. 
  Ask your doctor if you need to be seen on the same day or next day for an urgent request. 
  Contact MaineCare to see if your service needs approval before your appointment.  
 
See the Transportation webpage for a list of transportation broker addresses and phone numbers, 
frequently asked questions, and how to report a transportation complaint at: 
https://www.maine.gov/dhhs/oms/member-resources/transportation  
 
   
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 23 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Chapter 4: Pharmacy Services 
 
When you have full MaineCare coverage, you can get prescription drugs paid for with your 
pharmacy benefit. 
 
Please contact the Pharmacy Help Desk toll free at 1-866-796-2463 with questions about 
Pharmacy services. If you are deaf or hard of hearing and have a TTY machine, call 711. 
 
Out-Of-State Pharmacy Services 
Out-of-State Pharmacy Services are not covered. If you are planning on being out-of-state and 
will need to obtain medication while you are there, please have your provider submit an early fill 
prior authorization request. 
 
Please contact the Pharmacy Help Desk toll free at 1-866-796-2463 with questions about 
Pharmacy services.  TTY users dial 711. 
 
Preferred Drug List 
See MaineCare's Preferred Drug List (PDL) for a list of medications your doctor can prescribe 
on the Limited Benefits webpage at: https://www.maine.gov/dhhs/oms/mainecare-
options/limited-benefits. Drugs listed as Preferredgenerally do not need apriorauthorization
(PA).Drugs listed asNon-Preferred will need a PA from your provider. 
 
 
Mail Order Pharmacies
You can get brand name or generic drugs from mail order pharmacies that are approved by 
MaineCare. Mail order saves you time and money. You can get a 90-day supply of most generic 
and brand name drugs delivered to your mailbox. When you order drugs through the mail you 
will not be charged a copay. 
 
If you have prescription drug questions, please contact the Pharmacy Help Desk: 1-866-796-
2463. TTY users dial 711. 
 
Discount Drug Programs 
  Drugs for the Elderly and Disabled (DEL) 
  Maine Rx Plus 
 
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 24 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Drugs for the Elderly and Disabled (DEL) 
If you are elderly or disabled you may be eligible for DEL. With DEL, you may get a discount 
on some prescription drugs. If you are eligible, you may get up to 80% off the cost of your drugs. 
You may also have to pay a $2.00 copayment. 
 
To be eligible for DEL, you must be: 
  Age 62 or older  
  Age 19 through age 61 and meet the disability criteria for Supplemental Security Income 
(SSI) 
 
See the MaineCare Eligibility Guidelines document for the income limits for this program on the 
Health Care Assistance webpage at: https://www.maine.gov/dhhs/ofi/programs-services/health-
care-assistance. You may be eligible for this program if your monthly income, before you pay 
taxes, is up to your household size listed. 
If you are close to the income limits, you should go to My Maine Connection or contact the 
Office for Family Independence (OFI) to apply because some of your income may not count 
toward this limit. 
 
To apply for DEL, you can do one of the following: 
  Go to My Maine Connection to see if you are eligible or to apply online for MaineCare. 
The web address is: https://www.mymaineconnection.gov/ 
  Print an application by going to this web address: 
https://www.maine.gov/dhhs/ofi/applications-forms. You can then mail it to: 114 Corn 
Shop Lane, Farmington, ME 04938. 
  Call 1-855-797-4357; TTY users, dial 711. 
  Visit a local DHHS - DHHS offices are located throughout the state. To see what office 
your town is assigned to, go to the Office Finder webpage at: 
http://gateway.maine.gov/dhhs-apps/office_finder/index.asp.  
 
What drugs are discounted? 
You may not get a discount on all your prescription drugs with DEL. If you have DEL, call the 
Pharmacy Help Desk at 1-866-796-2463 to see what drugs are covered. TTY users, dial 711. 
   
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 25 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Maine Rx Plus
Maine Rx Plus members may get a discount on some prescription drugs. If you are eligible you 
may save: 
 
  Up to 60% on generic drugs 
  Up to 15% on brand name drugs 
The amount you save will vary with each prescription. 
See the MaineCareEligibility Guidelines document for the income limits for this program on the 
Health Care Assistance webpage at: https://www.maine.gov/dhhs/ofi/programs-services/health-
care-assistance. You may be eligible for this program if your monthly income, before you pay 
taxes, is up to your household size listed. 
If you are close to theincome limits you should go to My Maine Connection or contact the 
Office for Family Independence (OFI) to apply because some of your income may not count 
towards this limit. 
 
To apply for Maine Rx Plus, you can do one of the following: 
  Go to My Maine Connection to see if you are eligible or to apply online for MaineCare. 
The web address is: https://www.mymaineconnection.gov/ 
  Print an application by going to this web address: 
https://www.maine.gov/dhhs/ofi/applications-forms. You can then mail it to: 114 Corn 
Shop Lane, Farmington, ME 04938. 
  Call 1-855-797-4357; TTY users, dial 711. 
  Visit a local DHHS - DHHS offices are located throughout the state. To see what office 
your town is assigned to, go to the Office Finder webpage at: 
http://gateway.maine.gov/dhhs-apps/office_finder/index.asp.  
 
What drugs are discounted? 
You may not get a discount on all your prescription drugs with Maine Rx Plus. This benefit 
covers all MaineCare preferred drugs. If you have Maine Rx Plus, call the Pharmacy Help Desk 
at1-866-796-2463 to see what drugs are covered. TTY users, dial 711. 
   
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 26 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Chapter 5: Services for Children 
 
Free and low-cost health coverage options ensure kids under age 21 can get the routine check-
ups, immunizations, and care they need to stay healthy.  
 
What are someexamples of preventive services that are covered by MaineCare? 
  Well-child exams 
  Well-child dental exams 
  Lead testing 
  Immunizations, also called vaccines or shots 
 
Well-Child Exams 
Well-Child Exams are covered by MaineCare. Your childs health careproviderwill check to
see how your child is growing and if they are healthy. Your child can also receive vaccines and 
tests, if needed. Children can also get optional treatment services. Optional treatment services are 
medically necessary services or equipment that may be needed to prevent illness or injury to a 
child. For more detail, see the Childrens webpage at:
https://www.maine.gov/dhhs/oms/mainecare-options/children. 
 
Preventive Dental Care 
Among other services, MaineCare covers preventive dental care for children. This means that 
your childs teeth and gums arechecked to make surethey arehealthy. The Maine Center for 
Disease Control (Maine CDC) recommends that children see a dentist for well-child visits 
starting by age one or younger. 
Some examples of dental services that are covered for children include: 
 
  Teeth cleanings and routine checkups, twice a year 
  X-rays and fillings 
  Fluoride treatments 
  Other care the dentist says is necessary 
   
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 27 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  MaineCare Coverage Options 
Childrens Coverage 
MaineCare provides free health insurance, other health services and benefits, and assistance to 
children under age 19 who meet eligibility income guidelines. Seethe Childrens webpage for
more information: https://www.maine.gov/dhhs/oms/mainecare-options/children.  
 
Coverage for Children without Citizenship 
Starting July 1, 2022, MaineCare provides full coverage to children under 21 who would be 
eligiblefor federal Medicaid benefits if not for their immigration status. Children with or without 
documentation or citizenship are eligible for this coverage, as long as they meet all other 
eligibility requirements, including household income. See Chapter 9 of the Handbook for more 
information. 
 
Newborn Coverage 
After your baby is born, call the Office for Family Independence as soon as possible to add your 
baby to MaineCare. If you do not add your baby to MaineCare right away, you may get a bill 
from the hospital. If you had full MaineCare coverage when your baby was born, the baby can 
have MaineCare coverage until their first birthday even if your income changes. 
 
Katie Beckett 
Children under age 19 with serious health conditions who are over the income level for free 
MaineCare may get MaineCare coverage through the Katie Beckett program. KatieBeckett 
eligibility allows children to be cared for at home instead of in an institution. There is no income 
limit to Katie Beckett eligibility and children enrolledin Katie Beckett pay a low-cost premium 
forhealth coverage. SeetheChildrens webpage for more detail about eligibility requirements 
and general program information at: https://www.maine.gov/dhhs/oms/mainecare-
options/children.  
 
Purchasing MaineCare through Health Insurance Purchase Option (HIPO) 
If a child under age19 loses MaineCare coverage because family income goes up, you can buy 
MaineCare coverage for up to 18 months or until your child turns 19, whichever comes first. If 
you want more information about this, call the eligibility office at 1-855-797-4357. Ask about 
the Full Cost Purchase Option forChildren Under 19 Years ofAge.This is also calledthe
Full-Cost Purchase Option for Children under 19. 
 
Services for Children 
Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT) 
EPSDT services provide preventive care to children under 21 years old. Preventive care helps to 
catch and treat disease or ill health early, when its easier to treat. EPSDT focuses on a childs or 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 28 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  adolescents physical, oral, and mental or behavioral health care needs. EPSDT can pay for 
medically necessary services or equipment that are not regularly covered by MaineCare. Some 
EPSDT services require Prior Authorization (PA).  
School Health Related Services  
There are threeways MaineCare covers medical services when a member is at school: 
 
1.  Individuals with Disabilities Education Act (IDEA) Related Services 
This program covers medically necessary services listed in themembers Individualized
Education Program (IEP) or Individualized Family Service Plan (IFSP). 
 
Examples of IDEA services include, but are not limited to: 
  Children's Behavioral Health Day Treatment (Section 65) 
  Speech therapy (Section 109) 
  Physical therapy (Section 85) 
  Occupational therapy (Section 68) 
  Private Duty Nursing services (Section 96) 
  Rehabilitative and Community Support Services for Children with Cognitive 
Impairments and Functional Limitations (Section 28) 
  Specialized Transportation (Section 113) 
 
2.  School-Based Health Centers 
Some school administrative units run School-Based Health Centers. School-Based Health 
Centers are different from one school district to another. They can deliver a range of 
services from preventive care to acute care. Services delivered by School-Based Health 
Center staff are offered to all eligible MaineCare members.  
 
*Services provided through a School-Based Health Center do not need to be listed on a 
members IEP or IFSP. 
  
3.  Provider Discretion 
Some MaineCare providers use space in a school to provide medical services to students. 
Thestudent may get servicesattheschool instead of theproviders officeand these
services are not considered IDEA services because the referral was not made based on 
services listed in an IEP or IFSP. 
 
 
Written Consent or Permission 
Individuals with Disabilities Education Act (IDEA) regulations state that a parent or guardian 
must give written consent, or permission, for a child to receive services provided through 
IDEA.  
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 29 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  You can also give permission for providers to get paid by MaineCare for services by signing 
a consent form. Without your signed consent, MaineCare cannot be billed by any provider 
for school-based services. Ifyou choosenot to allow yourchilds provider to bill MaineCare, 
federal law states that your Local Education Agency (LEA) must still provide services to 
your child if theyarelisted on thechilds IEP or IFSP.  
 
Your Choice 
When your child has MaineCare, it is your choice which school-based services provider 
works with your child. You are not limited to choosing only providers recommended by your 
LEA. 
 
Medical Necessity  
For IDEA services, through the IEP or IFSP process, the IEP team determines what 
services are medically necessary for your child so they can access their education. These 
services must be listed on the IEF or IFSP. Members may access additional services 
outside of what is provided during the school day. 
 
Transportation Requests 
Pleasecontact your childs school administrator with questions about transportation.
Requests fortransportation to school-based service appointments must be made by your 
childs provider.  
 
Katie Beckett Limit 
If your child receives school-based services and has MaineCare through the Katie Beckett 
program, the cost of the services is not included in yourchilds annual benefit limit if you
have given written consent for theseservices. See the Katie Beckett section of this document 
for more information about the Katie Beckett program.  
 
Questions 
For all questions regarding school-based services, pleasecontactMaineCares State
Medicaid Educational Liaison by email at MaineCareinEducation.DHHS@maine.gov or by 
calling (207) 624-4094. 
 
Definitions 
The Individuals with Disabilities Education Act (IDEA) is a federal law that makes free 
appropriate public education available to eligible children with disabilities. This law ensures 
special education and related services are available. For more information about IDEA 
regulations, seethe Department of Educations IDEA webpage at: 
https://sites.ed.gov/idea/about-idea/. 
 
Local Educational Agency (LEA) refers to either your school district or to an agency 
delegated by the Department of Education to provide services such as Child Development 
Services. 
   
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 30 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Chapter 6: Services for Older Adults and Adults with 
Disabilities 
 
This section is about services for members who are over the age of 65, are blind, or have another 
disability.  
 
Home and Community-Based Waiver Recipients 
If you are in an eligibility category and meet the medical and financial requirements, then you 
may qualify to receive services through one of our Home and Community Based Services 
(HCBS) waiver programs. To view the eligibility categories, go to the Older Adults and Adults 
with Disabilities webpage at: https://www.maine.gov/dhhs/oms/mainecare-options/older-adults-
and-adults-with-disabilities.   
 
Deductibles for the Medically Needy 
If you qualify for MaineCare but are over the income or asset limits, you will have a deductible. 
A deductible is a specific dollar amount that is based on your income.  
 
To meet your deductible, your qualifying medical bills must add up to that dollar amount. If you 
meet your deductible, you receive full MaineCare coverage for the rest of the deductible period. 
MaineCare will cover qualifying medical services for whatever is left once the deductible is met. 
You are responsible for the medical bills you received before you met your deductible and 
MaineCare will not pay for them. When the deductible period ends, your MaineCare coverage 
will end and you must reapply for a new deductible. 
 
Medicare  
Some MaineCare members are also covered by Medicare. Medicare is not the same as 
MaineCare. Medicare covers people who: 
 
  Are age 65 and older; or 
  Have received social security disability benefits for 24 months in a row; or  
  Have end-stage renal disease. 
 
Medicare has four parts: 
  Part A (hospital insurance) pays for inpatient hospital care, some skilled nursing facility 
care, Hospice care, and some home health care.  
  Part B (medical insurance) pays for doctors, outpatient hospital care, and some other 
medical services that Part A does not cover, like physical and occupational therapies. It 
does not pay for most prescription drugs. 
  Part C (Medicare managed care) is called Medicare Advantage. These are health plan 
options that include Part A and Part B covered services and may include prescription 
drug coverage, preventive care, and other services.    
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 31 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    Part D (prescription drug coverage) covers outpatient prescription drugs through private 
companies. For more information on Part D, call DHHS Pharmacy Help Desk toll free at 
1-866-796-2463. If you are deaf or hard of hearing and have a TTY machine, call 711. 
 
If you have MaineCareand Medicare, Medicare should always pay first. There are several ways 
that MaineCare and Medicare work together:   
 
  MaineCaremembers enrolled in both MaineCare and Medicarearecalled dualeligible.
For most people in this group, MaineCare pays their Part B premiums and their Medicare 
co-insurance and deductibles. MaineCare pays for services that are not covered by 
Medicare.  
  For some people with low income, MaineCare pays the Part B premium only.  
  MaineCare members who are eligible must enroll in a Medicare Part D Prescription Drug 
Plan.   
 
For more information about Medicare, call 1-800-MEDICARE (1-800-633-4227). 
 
Medicare Savings Programs  Also called Buy-In 
 
If you have Medicare, you may qualify for a Medicare Savings Plan. Depending on your income, 
MaineCare may pay for Part A premiums, Part B premiums, Medicare deductibles, coinsurance, 
and copayments. 
 
It is important to note that this benefit is not full MaineCare coverage, so check with MaineCare 
Member Services to see if your service is covered by MaineCare. 
 
Medicare Savings Programs: 
  Qualified Medicare Beneficiary (QMB) 
  Specified Low-Income Medicare Beneficiary (SLMB) 
  Qualifying Individual (QI) 
  Qualified Disabled and Working Individuals (QDWI) 
 
See the Medicare Savings Programs webpage for more detail about eligibility guidelines and 
what is covered at: https://www.medicare.gov/your-medicare-costs/get-help-paying-
costs/medicare-savings-programs. 
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 32 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Long-Term Care Coverage 
 
Residents of Nursing Facilities 
You may qualify for long-term care coverage if you live in a nursing facility. MaineCare may 
pay for the cost of the room, food, nursing care, routine supplies, and equipment provided by 
your nursing facility. 
 
Residential Care Facilities 
You may qualify for long-term care coverage if you live in apartment or small adult family care 
home and get assisted living services. MaineCare may pay for the assisted living services that 
you receive. 
 
Electronic Visit Verification 
Electronic Visit Verification (EVV) only affects you if you receive Personal Care Services (PCS) 
or Home Health Care Services (HHCS). 
 
Personal care services and home health care services that require an in-home visit by your 
provider will require your provider to electronically confirm that the service was delivered. This 
is called Electronic Visit Verification. Your personal care or home health provider may ask you 
to verify thatthey have provided a service to you.  
 
What are Personal Care Services (PCS)? 
PCS are services related to activities such as: 
 
  Getting in and out of a bed, wheelchair, or vehicle  
  Using the toilet  
  Bathing and other personal hygiene like combing hair or brushing teeth 
  Dressing 
  Eating  
  Taking medicine 
  Grocery shopping and shopping for medicines and other supplies 
  Housework and laundry 
  Managing money 
  Preparing food and clean up 
 
What are Home Health Care Services (HHCS)? 
 
  Skilled nursing services 
  Home health aid services 
  Physical therapy services 
  Occupational therapy services 
  Speech language pathology services 
  Medical social work services 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 33 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
What is EVV? 
EVV allows MaineCareto electronically confirm that a personal care or home health service was 
provided. 
 
How does EVV work?  
The provider must use a mobile phone, tablet, or landline to show they provided a service. 
 
How does EVV affect me? 
Your benefits and services will not be changed by EVV. The only change you will see is that 
providers will use a phone or tablet at the beginning and end of your visit to confirm that a 
personal care or home health service was provided.  
 
What do I have to do? 
Your personal careor home health provider may ask you to sign a mobile phone or tablet or 
speak into a phone to verify the service took place.  
 
When will my provider ask me to confirm I received a service? 
Your provider may have already asked you to confirm a visit. PCS began using EVV on January 
1, 2021. HHCS providers must verify they provided services to you beginning on January 1, 
2023. 
 
Why do I have to confirm I received an in-home service? 
Verifying a PCS or HHCS is required by the federal government. MaineCare and the federal 
government want to makesureyou aregetting the servicesyou need. Its important thatyou
verify the service took placeso your provider can get paid for the services they provided to you. 
 
What if I have more questions about EVV? 
Seethe EVVMember Questions & Answers document postedon MaineCares Member
Resource webpage at: https://www.maine.gov/dhhs/oms/member-resources. You can also 
contact MaineCare Member Services with questions at 1-800-977-6740; TTY users dial 711. 
   
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 34 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Chapter 7: Primary Care Provider 
 
A Primary Care Provider (PCP) can be a doctor, physician's assistant, nurse practitioner, and 
 
may include other providers within the health care practice, clinic, or center. 
 
A PCP is the main health care provider responsible for managing your care. 
Working with your PCP has benefits. Your PCP: 
  Knows you and your health best. 
  Understands your medical history. 
  Will review all parts of your health care including your medical needs and medications 
for your health conditions. 
  Can refer you to other types of providers or services if you need them. 
 
If you need help finding a provider or selecting a PCP, call MaineCare Member Services at       
1-800-977-6740.  
 
Choose a PCP  
YourPCP can beadoctor, physicians assistant, nursepractitioner,orahealth careclinic.  
 
MaineCare has a program called Primary Care Plus to support primary care. 
 
Primary Care Plus rewards PCPs when they work with other healthcare providers to give you 
and your family the best care possible. You will receive a letter if the PCP you visit is part of the 
PCPlus program. You can decide to opt-out of this program at any time by contacting MaineCare 
Member Services at 1-800-977-6740. 
 
Appointments with your PCP 
 
Make an appointment with your PCP right away. 
Do not wait until you are sick. To get the best care, you should know your PCP and your PCP 
should know you. You must havean appointment with your PCP before he or she can refer you 
to a specialist.     
 
Call ahead for an appointment.  
Most providerswill not see patients who come into the office without an appointment. If you 
need a ride to a MaineCare-covered service, call the transportation agency that is closest to you. 
You need to call them as soon as possible. Go to Chapter 10 of this handbook for a list of 
transportation agencies. 
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 35 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Keep your appointments and be on time. 
Call your provider if you are going to be late. Call your provider if you cannot keep an 
appointment assoon as you know. MaineCare does not pay providers for missed appointments. 
Many providers will not see you again if you miss an appointment. 
 
Take your MaineCare card to all your appointments. 
If you do not have your card with you, providers may choose not to see you. 
 
 
Losing your PCP 
Your PCP can choose not to have you as a patient. Some reasons your PCP may not want to see 
you as a patient are: 
 
  You dontshow up foryour appointments or you dont call ahead to cancel. 
  You dontbring your card to your appointments. 
  You dontget areferral when you need one. 
  You do not follow the office rules. 
  Your PCP no longer accepts MaineCare. 
 
If you lose your PCP, you should call MaineCare Member Services right away to see if there is 
another provider in your area who accepts MaineCare.  
 
Referrals 
A referral is approval from your PCP to get services from another provider or specialist. Please 
speak to your providers to see when a referral may be requested. 
 
 
 
 
 
 
 
 
 
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 36 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Chapter 8: Your Rights as a MaineCare Member  
 
Advance Health Care Directive or Living Will 
 
An Advance Health Care Directive is sometimes called a Living Will. You write it to tell people 
what kind of careyou want at the end of your life. It is important for your family and caregivers 
to know what you would like. An Advance Health Care Directive can also be used when you are 
unable to make decisions on your own. 
 
Disability Rights Maine has a manual and forms for an Advanced Directive for Planning Mental 
Health Care on their website at https://drme.org/resources/advance-directives-mh. Legal Services 
for the Elderly also has Advance Health Care Directive forms on their website at: 
https://mainelse.org/content/advance-directives-forms. The phone numbers and websites for both 
programs can be found in Chapter 10 of this handbook.  
 
Estate Recovery  
 
Definition of Estate Recovery 
Estate recovery is a process required by the federal government for states to seek reimbursement 
for Medicaid (MaineCare in Maine) benefits from the estates of deceased Medicaid recipients 
who are age 55 and older at the time of death. MaineCare seeks recovery for the cost of certain 
MaineCare benefits that were provided to the deceased. MaineCare does not seek recovery for 
any Medicare cost-sharing paid on behalf of Medicare Savings Program beneficiaries. 
 
Effective November 24, 2021, MaineCare will only seek to recover costs for nursing facility 
services (Section 67 of the MaineCare Benefits Manual (MBM)), Home and Community Based 
Services (HCBS), and hospital (Section 45 of the MBM) and prescription drug services (Section 
80 of the MBM) related to these services. For the purposes of estate recovery, HCBS is defined 
as services under the following sections of the MBM: 
 
  Section 12, Consumer Directed Attendant Services 
  Section 18, Home and Community Based Services for Adults with Brain Injury 
  Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities 
  Section 20, Home and Community Based Services for Adults with Other Related 
Conditions 
  Section 21, Home and Community Benefits for Members with Intellectual Disabilities or 
Autism Spectrum Disorder 
  Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum 
Disorder 
  Section 40, Home Health Services 
  Section 96, Private Duty Nursing and Personal Care Services 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 37 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Seeking Estate Recovery 
All of the following must be true for MaineCare to seek recovery for costs related to the services 
listed above. The MaineCare member must: 
  Be age 55 or older at date of death 
  Have received nursing facility services or HCBS  
  Have no surviving spouse at the time the Department seeks recovery 
  Have no children under the age of 21 at the time the Department seeks recovery 
  Have no disabled children of any age at the time the Department seeks recovery 
 
Recoverable Property 
The following are examples of types of property subject to recovery by MaineCare: 
  A home 
  Land 
  Automobiles of significant value 
  Recreational vehicles such as boats, campers, motorhomes, and All Terrain Vehicles 
  Liquid assets such as bank accounts, stocks, bonds, and annuities  
 
Only the amount of MaineCares cost forpast expensesis subject to recovery. For example, if an 
estate is worth $150,000 and MaineCarecosts were $20,000, then MaineCare would seek to 
recover $20,000, not the value of the whole estate. The only benefits for which MaineCare will 
seek recovery are nursing facility services, HCBS, and hospital and prescription drug services 
related to these services.  
 
Not Subject to Estate Recovery 
The following may not be recovered:  
  For members who passed on or after September 1, 2019: For estates of $20,000 or less, a 
$15,000 family allowance if there is a surviving child of any age 
  For members who passed prior to September 1, 2019: For estates of $10,000 or less, a 
$7,000 family allowance if there is a surviving child of any age 
  Reasonable funeral expenses  
  Attorneys fees  
  Probate court costs  
  Upkeep of property (e.g. taxes, insurance, repairs to property to make it marketable)  
  Personal representative fees for handling the estate, up to $3,000  
 
 
Waivers from Recovery  
Maine offers two options for MaineCare members to seek a waiver from full estate recovery of 
MaineCare payments. MaineCare deducts the amount of the waiver granted from the value of the 
estate assets.   
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 38 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
The waiver options are:  
 
1.  CareGiven Waiver 
Heirs who provided care forthe MaineCarememberwhileliving in the members home
for at least two years prior to the member being admitted to a long-term care facility or 
death may seek a waiver from recovery. The heir must have an income below 200% of 
the federal poverty level. 
 
The amount waived from recovery depends on the level and type of home care the heir 
provided. For each of the two years: 
  $6,000 is waived for basic help at least three times a week with transportation, 
housekeeping, appointments, and daily in-home personal care.  
  $12,000 is waived for care that includes the above plus dispensing medications, 
changing dressings, and bathing. 
  $32,000 is waived if the level of care is personal care that would have been 
provided in an institutional setting. 
 
2.  Hardship Waiver   
Iffull recovery of MaineCares claim will create an unduehardship, heirs may request a 
hardship waiver. Theheirsincomeand assets combined must be below 180% of federal
poverty level, and they must havelived in themembers home for aperiod ofat least two
years prior to themembers death.  
 
Fair Hearings 
In most situations, if you disagree with a MaineCare decision to deny, terminate, or reduce your 
covered services, you have a right to a Fair Hearing. 
When MaineCare makes a decision about your services, you will receive a letter explaining the 
decision. The letter will also tell you how you can ask for a Fair Hearing if you disagree with the 
decision. You can ask for a Fair Hearing up to 60 days from the date of your letter. If you ask for 
a Fair Hearing within 10 days of the date on the letter, your current services will continue until a 
decision is made. 
How do I request a hearing? 
Call MaineCare Member Services at 1-800-977-6740. TTY users dial 711. You can also email 
at: MaineCareMember@dxc.com  
 
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 39 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  You can also write to: 
MaineCare Hearings Coordinator 
MaineCare Services 
11 State House Station 
Augusta, ME  04333-0011 
 
If you feel the decision was made based on inaccurate or incomplete information, you can ask 
your provider(s) to submit additional information to the Office of MaineCare Services at the 
above address prior to the hearing. MaineCare will evaluate these documents to determine if it 
changes the decision made. You will also have the opportunity to present these documents as 
evidence at your hearing. 
 
Before your hearing, you can ask your provider to show the services requested are medically 
necessary by sending new information to the Office of MaineCare Services at the above address.  
 
You can bring anyone you choose to the hearing. For example, you can bring a lawyer, an 
advocate, or a friend to support you. MaineCare may also choose to bring a lawyer. 
 
A hearing officer who is not from MaineCare and does not know your case will attend the Fair 
Hearing. Staff from MaineCare will explain how and why they made the decision they did. You 
will get a chance to say why you disagree. The hearing officer will listen to both sides. They will 
issue a decision or,in some situations, recommend a decision to the Commissioner of the 
Department of Health and Human Services.   
 
After the hearing, you will get a letter explaining the final decision.  
 
The Fair Hearing process can take up to 90 calendar days from the date that you ask for an 
appeal. If you are dissatisfied with the final decision, you have the right to appeal that decision to 
the Maine Superior Court.  
 
Who do I call with questions?  
Call MaineCare Member Services at 1-800-977-6740. TTY users dial 711. Or you can email 
mainecaremember@gainwelltechnologies.com. 
 
Medical Records  
Under Maine law, your provider must give you your medical records or a detailed summary of 
your records if you ask for this information. You can request your records by writing a letter or 
by signing a release. However, if the provider believes that giving you your records could be 
harmful to your health, he or she can ask that you choose someone else to get your records.  
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 40 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Medical Support from the Other Parent 
If your child is receiving MaineCare and lives with you, and the non-custodial parent can get 
insurance for the child through work, MaineCare will ask the non-custodial parent to enroll the 
child for health coverage.  
 
We may need your help to get in touch with the non-custodial parent. If you do not help, your 
child can still enroll in MaineCare, but you will not be able to get coverage for yourself. You do 
not have to help DHHS find theother parent if you think reporting this information would be a 
threat to you or your family. Let your eligibility specialist know if this is a problem for you.  
If the non-custodial parent has health insurance for your child, he or she should not drop it even 
if the child enrolls in MaineCare. MaineCare could hold the non-custodial parent responsible for 
the medical costs. 
 
Other Health Insurance and MaineCare 
When you see your provider, always show all your insurance cards.  
 
Examples of other insurance are: 
 
  Private insurance like Anthem, Aetna, and Cigna 
  Medicare            
  TriCare  
 
If your other health insurance changes or you lose it, call MaineCare Member Services. Your 
other insurance is billed before MaineCare. If you have other insurance that covers what 
MaineCare covers, then the other insurance always pays first. If your other health insurance does 
not pay your claims because you did not follow their rules, MaineCare may not pay for a covered 
service.  
 
When you apply for MaineCare, you are asked to assign yourrights to otherinsurance. This
means you give MaineCarethe right to get money back for services it paid for that other 
insurance or source should have covered.  
Examples of payments from other insurance or sources include: 
 
  Private insurance payment 
  Court-ordered medical support from a non-custodial parent 
  Workers Compensation  
  Accident settlements  
 
Your other health insurance does not have to pay MaineCare back when MaineCare pays only 
for your Medicare premium, co-insurance, or deductible. 
 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 41 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  If you have other health insurance and are eligible for MaineCare, you may qualify to havethe 
other health insurance premium paid forby MaineCares Private Health InsurancePremium
(PHIP) program. See Chapter 3 of this handbook for more information about the PHIP program. 
 
Protected Health Information 
When you apply for MaineCare, we ask for some personal information to make sure you are 
eligiblefor the program.  
 
Some information we will ask for: 
 
  Social security number 
  Date of birth 
  Address 
  Yourchilds orother family members information 
  Other health insurance 
  Disabilities 
We use certain personal information about you to see if you are eligible for MaineCare and to 
pay for your health services. We are required by law to make sure that Protected Health 
Information (PHI) is safe. For the more information, see the Privacy and Security of Health 
Information webpage: https://www.maine.gov/dhhs/privacy.  
 
We may use or disclose your PHI for the following purposes:  
 
1.  For Payment. We pay for your health services. 
We may use and disclose your PHI to pay for your care, and to determine whether certain 
services or medications are covered. Example: We may share information about the type 
of MaineCare coverage you have in order for your doctor to know what services are 
covered or in case as service requires special permission (also called prior authorization). 
We may help coordinate your care, review your use of services, and to tell you about 
program changes and updates.  
 
2.  For Treatment. We help manage the health care treatment you receive.  
We may disclose your PHI with health care providers who are treating you. Example: A 
doctor sends us information about your treatment plan so we can see what other services 
may help you. 
 
3.  For Healthcare Operations. To help do our work and comply with government 
requirements. 
 
We can use and disclose your PHI to run our program.   
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 42 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Examples: We are permitted to use your information for audit and accounting purposes, 
for educating our staff, and for reviewing the quality of our program.  
 
The law says that we may use or disclose your PHI in certain situations, including: 
 
  To persons authorized by law to act on your behalf, such as a guardian, health care 
power of attorney or surrogate. 
  To comply with a state or federal law. 
  To remind you of an appointment or to provide you with information about treatment 
alternatives or other health related benefits and services that may be of interest to you. 
  To help prevent or reduce threats to health and safety, stop the spread of disease, or 
report abuse or neglect. 
  For research where the information does not identify you or we have received 
permission from a special research review board. 
  For planning our programs. We may disclose general information about a certain 
population of people.  
  To comply with state or federal program requirements. We may disclose PHI to the 
Food and Drug Administration, the Centers for Medicare and Medicaid Services, and 
the U.S. Department of Health and Human Services when required. 
  To comply with a valid court order, subpoena, or other appropriate administrative, 
judicial or legal request. 
  In an emergency or for disaster relief purposes, such as to notify family members 
about your location and condition. 
  To military departments if you are a veteran or member of the armed forces. We may 
be required to disclose information for national security or intelligence purposes. If 
you are an inmate, we may release your information for your health or safety in the 
correctional facility. 
  To assist a medical examiner or funeral director in carrying out their duties.  
  In connection with WorkersCompensation claims for benefits. 
  To assist law enforcement where there was a possible crime on the premises. We may 
also share your information where necessary to prevent or lessen a serious or imminent 
threat to you or another person. 
 
We will not use or disclose your information in any ways other than described in this notice 
unless you tell us in writing that wecan. If you sign an authorization, you may change your mind 
and take back your permission (revoke it) at any time, except to the extent that we have already 
shared your information based upon your written permission. 
 
You have the right to: 
A.  See and copy your Protected Health Information. This request must be in writing. 
 
  If you ask us to copy your record, we may ask for a reasonable, cost-based copy fee. 
  You may ask for your electronic record in a digital format. 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 43 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    You may ask us to send your protected health information to someone by email if you 
fill out the email section of the authorization form. 
  Your provider may not allow you to see certain parts of your medical record. You 
may ask that this decision be reviewed by another licensed professional. 
 
B.  Ask us to contact you in a certain way.  
 
You may ask us to contact you only in a certain way to keep your PHI confidential and 
safe. For example, you may ask us only to call you at a certain phone number or send 
letters to a certain address. We are required to contact you in the way that you request, 
whenever possible. 
 
C.  Ask us not to use or disclose certain information in your medical record. 
 
You may ask us to limit the information we use or disclose. You may ask us not to use 
or disclose certain kinds of information. We will carefully consider your request, but we 
are not required to agree to the request. We can refuse your request if it would affect 
your care. If you ask us not to use or disclose certain information, we may not be able to 
pay your bill. In this case, you may be responsible for your bill. 
 
D.  Get a list of those to whom we have disclosed your Protected Health Information.  
 
You may ask for a list of those to whom we have disclosed your PHI other than for 
treatment, payment, healthcare operations, or where you have received the information 
or previously given us written permission to share your information. We can go back six 
years for paper files and three years for electronic records. 
 
E.  Ask us to fix your health and claims record if it is wrong or add a statement to your file. 
 
You may ask us to fix a mistake to your information. While we cannot erase your 
record, we will add your written statement to your PHI to correct or clarify the record.   
 
F.  Decide not to have your Protected Health Information shared through HealthInfoNet.  
 
HealthInfoNet is one way that we share your health information with your doctors and 
other health care professionals. You can opt out of this method of information sharing 
by completing a form. HIV and mental health information is never included unless you 
opt in or give us special permission. 
 
G.  You may file a complaint if you think your privacy rights have been violated. We cannot 
retaliate against you for making a complaint. 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 44 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
You may file a complaint in one of the following ways:  
 
  Contact to the Privacy Official through your local DHHS office.  
  Contact Michelle Wile, Deputy Privacy Officer, at (207) 624-6929. TTY users dial 
711.  
  Contact the Office of Civil Rights, DHHS, Government Center, John F Kennedy 
Federal Building, Room 1875, Boston MA 02203, or by going to the following 
webpage: https://www.hhs.gov/hipaa/filing-a-complaint/what-to-expect/index.html  
 
We must protect your Protected Health Information: 
  The law says we must keep your PHI private and safe. 
  The law says we must tell you about any breach in the security of your PHI.  
 
HIPAA, Privacy, and Security webpage  
Seethe Department of Health and Human Services Privacy and Security of Health 
Information webpage for detail about how we protect your personal information and for the 
Authorization to Release Information form at the following web address: 
https://www.maine.gov/dhhs/privacy  
   
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 45 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Chapter 9: Benefit Packages 
 
Services that May Be Covered 
MaineCare pays for medically necessary services. The services covered depend on your 
MaineCare eligibility category. MaineCare may not cover all services listed. If you are not sure 
what services arecovered, call MaineCare Member Services at 1-800-977-6740. TTY users dial 
711 (Maine Relay). Make sure MaineCare covers the service you need before you get care. 
There are limits or special rules for most covered services. 
 
For more information, seethe MaineCare Benefits Manual online at: 
https://www.maine.gov/sos/cec/rules/10/ch101.htm. You can also call MaineCare Member 
Services at 1-800-977-6740. 
 
Benefit Packages Explained 
A benefit package is the list of services that MaineCare pays for. Your benefit package depends 
on your income, age, medical needs, and if you need help with Activities of Daily Living 
(ADLs).  
How to find out what benefit package you have: 
MaineCare eligibility is determined by the Office for Family Independence. Your eligibility 
category determines which benefit package you have. Not all benefit packages offer the same 
services. If you are not sure what services are covered, call MaineCare Member Services at       
1-800-977-6740. TTY users dial 711.  
 
Your benefit packagecan change:   
Your benefit packagemay change based on changes to your income, assets, household size, age, 
or medical condition. It may also change when laws and MaineCare rules change.  
 
Benefit Package Categories 
Benefit packages are organized in three categories: 
 
  Full Benefit Packages 
  Limited Benefit Packages 
  Long-Term Care Benefits 
 
Full Benefit Packages  
The following eligibility categories may get a full benefit package: 
 
  Children or Young Adults - Individuals who are newborn through 20 years old. This 
category includes members with Katie Beckett. 
 
For more information, call MaineCare Member Services at 1-800-977-6740.               Page 46 
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    Parent or Caretaker Relatives - Guardians, caretakers, or relatives of a dependent child. 
The childs caretaker must be related by blood or marriage or have adopted the child. The 
child must also be living with the caretaker and the caretaker assumes primary 
responsibility forthe childs care. 
  Pregnant Women - Women who are pregnant or whose pregnancy ended within the last 
60 days. 
  Former Foster Care Children - Individuals under 26 years old, who were in foster care 
in the State of Maine and were enrolled in Medicaid through the State of Maine at age 18, 
and are not otherwise eligible for, or enrolled in, other mandatory Medicaid coverage. 
  Aged, Blind, or Disabled - Individuals 65 years or older, or who are blind or disabled. 
  Home and Community Based Waiver Recipients - Individuals who have an eligibility 
category and meet the medical and financial requirements of one of the Home and 
Community Based Waiver programs. The waiver programs are listed on the next page. 
  Spenddown: Deductibles for the Medically Needy - Individuals who qualify for a 
MaineCare coverage group but are over the income or asset limits for MaineCare. They 
must meet a deductible to receiveMaineCares full benefit package. 
 
There are limits or special rules for most covered services. The policy sections are numbered so 
you can find them in the MaineCare Benefits Manual (MBM) at: 
https://www.maine.gov/sos/cec/rules/10/ch101.htm.  
 
Services that may be covered for members with full benefits (with MBM Policy Section listed):  
 
  Adult Family Care Services (Section 2) 
  Advanced Practice Registered Nursing Services (Section 14) 
  Ambulance Services (Section 5) 
  Ambulatory Care Clinic Services (Section 3) 
  Ambulatory Surgical Center Services (Section 4) 
  Behavioral Health Homes (Section 92) 
  Behavioral Health Services (Section 65) 
  Chiropractic Services (Section 15) 
  Childrens Rehabilitation & CommunitySupport(Section 28) 
  Community Support Services (Section 17) 
  Consumer Directed Attendant Services (Section 12) 
  Day Health Services (Section 26) 
  Dental Services (Section 25) 
  Developmental and Behavioral Clinic Services (Section 23)  
  Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT) (Section 94) 
  Family Planning Agency Services (Section 30) 
  Federally Qualified Health Center Services (Section 31) 
  Free Standing Dialysis Services (Section 7) 
  Health Home Services  Community Care Teams (Section 91)   
  Home Health Services (Section 40)   
  Hospice Services (Section 43)       
  Hospital Services (Section 45) 
Page 47 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    Indian Health Services (Section 9) 
  Intermediate Care Facility for Individuals with Intellectual Disability (Section 50) 
  Laboratory Services (Section 55) 
  Medical Imaging Services (Section 101) 
  Medical Supplies and Durable Medical Equipment (Section 60) 
  Nursing Facility Services (Section 67) 
  Occupational Therapy Services (Section 68) 
  Opioid Health Homes (Section 93) 
  Pharmacy Services (Section 80) 
  Physical Therapy Services (Section 85) 
  Physician Services (Section 90) 
  Podiatric Services (Section 95) 
  Primary Care Plus Services (Chapter VI, Section 3)  
  Private Duty Nursing and Personal Care Services (Section 96) 
  Private Non-Medical Institution Services (Section 97) 
  Psychiatric Facility Services (Section 46) 
  Psychiatric Residential Treatment Facility (Section 107) 
  Rehabilitative Services (Section 102) 
  Rural Health Clinic Services (Section 103) 
  Speech and Hearing Services (Section 109) 
  Targeted Case Management Services (Section 13) 
  Telehealth (Chapter 1, Section 4) 
  Transportation Services (Section 113) 
  Vision Services (Section 75) 
 
Home and Community Based Services Waivers 
Individuals who are applying for a Home and Community Based Services (HCBS) waiver may 
need to complete a long-term care application. The Maine Department of Health and Human 
Services (DHHS) or an agency we work with will complete the required medical assessment. 
There are a limited number of openings. Before a person can get this benefit package, an opening 
must be available.  
 
The HCBS waiver descriptions: 
 
  Home and Community Benefits for Members with Intellectual Disabilities or Autism 
Spectrum Disorders (Policy Section 21) and Support Services for Adults with 
Intellectual Disabilities or Autism Spectrum Disorder (Policy Section 29): Adults 18 
years old and older who have intellectual disabilities or autism spectrum disorder. 
  Home and Community Benefits for the Elderly and Adults with Disabilities (Policy 
Section 19): Older adults and adults who are 18 years and older, have physical 
disabilities, and do not live in an institution. 
  Home and Community Based Services for Adults with Brain Injury (Policy Section 
18): Adults 18 years and older who have an acquired brain injury. 
Page 48 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    Home and Community Based Services for Adults with Other Related Conditions 
(Policy Section 20): Adults 21 years and older with Cerebral Palsy, epilepsy, or any 
other condition other than mental illness that requires treatment similar to those persons 
with intellectual disabilities. 
 
Home and Community Benefits for Members with Intellectual Disabilities or Autism 
Spectrum Disorders (Policy Section 21) and Support Services for Adults with Intellectual 
Disabilities or Autism Spectrum Disorder Waiver (Policy Section 29) 
 
This full benefit package is for members 18 years and older who have intellectual disabilities or 
autism and do not live in an institution. There are a limited number of openings. Before a person 
can get this benefit package, an opening must be available. Also, the member must have an 
Individual Plan of Care approved by DHHS or an agency we work with. 
 
This benefit package includes Policy Section 21, Home and Community Benefits for Members 
with Intellectual Disabilities or Autism Spectrum Disorders, and Policy Section 29, Support 
Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder. 
 
The policy sections are numbered so that you can find them in the MaineCare Benefits Manual 
(MBM) at: https://www.maine.gov/sos/cec/rules/10/ch101.htm.  
 
PolicySection 21 services that may be covered include: 
 
  Assistive Technology 
  Career Planning 
  Community Support 
  Consultation Services 
  Communication Aids 
  Crisis Assessment 
  Crisis Intervention Services 
  Employment Specialist Services 
  Home Accessibility Adaptation 
  Family-Centered Support 
  Home Support  
  Non-Medical Transportation 
  Non-Traditional Communication Assessment  
  Non-Traditional Communication Consultation 
  Occupational Therapy for maintenance 
  Physical Therapy for maintenance 
  Per Diem Home Support 
  Shared Living 
  Specialized Medical Equipment and Supplies 
  Speech Therapy for maintenance 
  Work Support  
 
Page 49 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  PolicySection 29 services that may be covered include:   
 
  Assistive Technology 
  Career Planning 
  Home Support 
  Community Support                        
  Employment Specialist Services 
  Home Accessibility Adaptations 
  Respite 
  Shared Living 
  Transportation 
  Work Support  
 
In addition, Policy Sections 21 and 29 members may receive the following services (with MBM 
PolicySection listed): 
 
  Advanced Practice Registered Nursing Services (Section 14)                                                                       
  Ambulance Services (Section 5) 
  Ambulatory Care Clinic Services (Section 3) 
  Ambulatory Surgical Center Services (Section 4) 
  Behavioral Health Homes (Section 92) 
  Behavioral Health Services (Section 65) 
  Chiropractic Services (Section 15) 
  Community Support Services (Section 17) 
  Day Health Services, if not living in a PNMI (Section 26) 
  Dental Services (Section 25)  
  Family Planning Agency Services (Section 30) 
  Federally Qualified Health Center Services (Section 31) 
  Free Standing Dialysis Services (Section 7) 
  Health Home Services- Community Care Teams (Section 91) 
  Home Health Services, except for personal care provided by a home health aide (Section 
40)  
  Hospice Services (Section 43) 
  Hospital Services (Section 45) 
  Laboratory Services (Section 55) 
  Medical Imaging Services (Section 101) 
  Medical Supplies and Durable Medical Equipment (Section 60) 
  Occupational Therapy Services (Section 68) 
  Pharmacy Services (Section 80) 
  Physical Therapy Services (Section 85) 
  Physician Services (Section 90) 
  Podiatric Services (Section 95) 
  Primary Care Plus Services (Policy Chapter VI, Section 3) 
  Private Duty Nursing and Personal Care Services, nursing only, no personal care (Section 
96)  
Page 50 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    Private Non-Medical Institution Services (Section 97) 
  Psychiatric Facility Services (Section 46) 
  Rehabilitative Services (Section 102) 
  Rural Health Clinic Services (Section 103) 
  Speech and Hearing Services (Section 109)    
  Targeted Case Management Services (Section 13) 
  Transportation Services (Section 113) 
  Vision Services (Section 75)  
 
Home and Community Benefits for the Elderly and Adults with Disabilities Waiver (Policy 
Section 19) 
This full benefit package is for adults 18 years and older who have physical disabilities and older 
adults who do not live in an institution. Before a MaineCare member can get this benefit 
package, DHHS or an agency we work with must approve an Individual Plan of Care.  
 
This benefit package includes Policy Section 19, Home and Community Benefits for the Elderly 
and Adults with Disabilities.  
 
The policy sections are numbered so that you can find them in the MaineCare Benefits Manual 
(MBM) at: https://www.maine.gov/sos/cec/rules/10/ch101.htm.  
 
Policy Section 19 services that may be covered include: 
 
  Assistive Technology Devices and Services 
  Assistive Technology - Remote Monitoring 
  Assistive Technology - Transmission 
  Attendant Care Services 
  Care Coordination Services 
  Environmental Modifications 
  Financial Management Services 
  Home Delivered Meals 
  Home Health Services 
  Living Well 
  Matter of Balance 
  Personal Care Services 
  Personal Emergency Response System Services 
  Transportation Services 
  Respite Services 
  Skills Training 
 
In addition, this benefit package also may include (with MBM Policy Section listed): 
 
  Advanced Practice Registered Nursing Services (Section 14) 
  Ambulance Services (Section 5) 
  Ambulatory Care Clinic Services (Section 3) 
Page 51 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    Ambulatory Surgical Center Services (Section 4) 
  Behavioral Health Homes (Section 92) 
  Behavioral Health Services (Section 65) 
  Chiropractic Services (Section 15) 
  Community Support Services (Section 17)  
  Dental Services (Section 25)  
  Family Planning Services (Section 30) 
  Federally Qualified Health Center Services (Section 31) 
  Free Standing Dialysis Services (Section 7) 
  Health Home Services- Community Care Teams (Section 91) 
  Hospice Services (Section 43) 
  Hospital Services (Section 45) 
  Laboratory Services (Section 55) 
  Medical Imaging Services (Section 101) 
  Medical Supplies and Durable Medical Equipment (Section 60) 
  Occupational Therapy Services (Section 68) 
  Pharmacy Services (Section 80) 
  Physical Therapy Services (Section 85) 
  Physician Services (Section 90) 
  Podiatric Services (Section 95) 
  Primary Care Plus Services (Policy Chapter VI, Section 3) 
  Psychiatric Facility Services (Section 46) 
  Rehabilitative Services (Section 102) 
  Rural Health Clinic Services (Section 103) 
  Speech and Hearing Services (Section 109) 
  Transportation Services (Section 113) 
  Vision Services (Section 75)  
 
 
Home and Community Based Services for Adults with Brain Injury Waiver (Policy Section 
18) 
This full benefit package is for adults age 18 and older with an acquired brain injury. Members in 
this waiver must meet the criteria to receive services from an Intermediate Care Facility for 
Individuals with Intellectual Disabilities (ICF-IID). Before a MaineCare member can get this 
benefit package, DHHS or an agency we work with must approve an Individual Plan of Care.  
 
This benefit package includes the Policy Section 18, Home and Community Based Services for 
Adults with Brain Injury.  
 
The policy sections are numbered so that you can find them in the MaineCare Benefits Manual 
(MBM) at: https://www.maine.gov/sos/cec/rules/10/ch101.htm. 
 
PolicySection 18 services that may be covered are listed below: 
 
Page 52 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    Assistive Technology Device 
  Care Coordination  
  Career Planning 
  Employment Specialist  
  Home Support 
  Non-Medical Transportation 
  Work Ordered Day Club House 
  Work Support  
 
In addition, this benefit package may include (with MBM Policy Section listed): 
 
  Advanced Practice Registered Nursing Services (Section 14) 
  Ambulance Services (Section 5) 
  Ambulatory Care Clinic Services (Section 3)  
  Ambulatory Surgical Center Services (Section 4) 
  Behavioral Health Services (Section 65) 
  Chiropractic Services (Section 15) 
  Community Support Services (Section 17) 
  Day Health Services (Section 26) 
  Dental Services (Section 25)      
  Family Planning Agency Services (Section 30)   
  Federally Qualified Health Center Services (Section 31)  
  Free Standing Dialysis Services (Section 7) 
  Health Home Services- Community Care Teams (Section 91) 
  Home Health Services (Section 40) 
  Hospice Services (Section 43) 
  Hospital Services (Section 45) 
  Laboratory Services (Section 55) 
  Medical Imaging Services (Section 101) 
  Medical Supplies and Durable Medical Equipment (Section 60) 
  Occupational Therapy Services (Section 68) 
  Pharmacy Services (Section 80) 
  Physical Therapy Services (Section 85) 
  Physician Services (Section 90) 
  Podiatric Services (Section 95) 
  Primary Care Plus Services (Policy Chapter VI, Section 3) 
  Private Duty Nursing and Personal Care Services (Section 96) 
  Psychiatric Facility Services (Section 46) 
  Rehabilitative Services (Section 102) 
  Rural Health Clinic Services (Section 103) 
  Speech and Hearing Services (Section 109) 
  Transportation Services (Section 113) 
  Vision Services (Section 75)  
 
 
Page 53 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  Home and Community Based Services for Adults with Other Related Conditions Waiver 
(Policy Section 20) 
This full benefit package is for members aged 21 years and older with Cerebral Palsy, epilepsy, 
or any other condition other than mental illness that requires treatment similar to members with 
Intellectual Disabilities. Members must meet the criteria to receive services from an Intermediate 
Care Facility for Individuals with Intellectual Disabilities (ICF-IID).  
 
This benefit package includes Policy Section 20, Home and Community Based Services for 
Adults with Other Related Conditions.  
 
The policy sections are numbered so that you can find them in the MaineCare Benefits Manual 
(MBM) at: https://www.maine.gov/sos/cec/rules/10/ch101.htm.  
 
PolicySection 20 services that may be covered include: 
 
  Assistive Technology Device and Services 
  Care Coordination 
  Communication Aids 
  Community Support  
  Consultation and Assessment 
  Employment Specialist  
  Home Accessibility Adaptations 
  Home Support  
  Non-Medical Transportation  
  Non-Traditional Communication Assessment 
  Non-Traditional Communication Consultation 
  Occupational Therapy Service for maintenance 
  Personal Care  
  Physical Therapy Service for maintenance 
  Specialized Medical Equipment 
  Speech Therapy Service for maintenance 
  Work Support  
 
In addition, this benefit package may include (with MBM Policy Section listed): 
 
  Advanced Practice Registered Nursing Services (Section 14) 
  Ambulance Services (Section 5) 
  Ambulatory Care Clinic Services (Section 3)  
  Behavioral Health Services (Section 65) 
  Chiropractic Services (Section 15) 
  Community Support Services (Section 17) 
  Day Health Services (Section 26) 
  Dental Services (Section 25)      
  Family Planning Agency Services (Section 30)   
  Federally Qualified Health Center Services (Section 31)  
Page 54 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    Free Standing Dialysis Services (Section 7) 
  Health Home Services- Community Care Teams (Section 91) 
  Home Health Services (Section 40) 
  Hospice Services (Section 43) 
  Hospital Services (Section 45) 
  Laboratory Services (Section 55) 
  Medical Imaging Services (Section 101) 
  Medical Supplies and Durable Medical Equipment (Section 60) 
  Occupational Therapy Services (Section 68) 
  Pharmacy Services (Section 80) 
  Physical Therapy Services (Section 85) 
  Physician Services (Section 90) 
  Podiatric Services (Section 95) 
  Primary Care Plus Services (Policy Chapter VI, Section 3) 
  Private Duty Nursing and Personal Care Services (Section 96) 
  Psychiatric Facility Services (Section 46) 
  Rehabilitative Services (Section 102) 
  Rural Health Clinic Services (Section 103) 
  Speech and Hearing Services (Section 109) 
  Transportation Services (Section 113) 
  Vision Services (Section 75)  
 
 
Inmates or Prison Coverage, Exception to Full Benefit Package 
 
MaineCare only covers inpatient services for individuals involuntarily confined in a public 
institution, state or federal prison, jail, detention facility, or penal facility. Services received 
when in the public institution are not covered by MaineCare. 
 
This package covers only inpatient services in: 
 
  Hospitals 
  Intermediate Care Facilities for individuals with intellectual disabilities 
  Nursing facilities 
  Juvenile psychiatric facilities      
 
Limited Benefit Packages 
 
These benefit packages are for:  
 
  Special Benefit Waiver 
  Pregnant women who are presumptively eligible   
  Limited family planning benefits 
Page 55 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.    Emergency Services 
 
MaineCare pays for medically necessary services. The services covered depends on your 
MaineCare eligibility category. MaineCare may not cover all services listed. If you are not sure 
what services arecovered, call MaineCare Member Services at 1-800-977-6740. TTY users dial 
711. Make sure MaineCare covers the service you need before you get care. There are limits or 
special rules for most covered services. The policy sections are numbered so that you can find 
them in the MaineCare Benefits Manual (MBM) at: 
https://www.maine.gov/sos/cec/rules/10/ch101.htm.  
 
Special Benefit Waiver or HIV Waiver 
The Special Benefit Waiver is a limited MaineCare benefit for individuals living with HIV or 
AIDS who do not qualify for full MaineCare benefits because they are over the income limit or 
do not have a coverage group. 
 
Who is eligible?  
You are eligible if you:  
  Test positive for HIV  
  Do not qualify for regular MaineCare  
  Are within the income limits, a gross individual income less than or equal to 250% of the 
Federal Poverty Level  
  Sign a consent form with the application that states you agree to the rules for getting this 
benefit  
See the MaineCareEligibility Guidelines document for the income limits for the Special Benefits 
Waiver on the Health Care Assistance webpage at: https://www.maine.gov/dhhs/ofi/programs-
services/health-care-assistance. You may be eligible for the Special Benefits Waiver if your 
monthly income beforeyou pay taxes is up to your household size listed. If you are close to the 
income limits, you should go to the My Maine Connection online portal or contact the Office for 
Family Independence (OFI) to apply because some of your income may not count toward this 
limit. 
If you have Medicare or other health insurance, you may still qualify. If you are currently 
enrolled in MaineCare you do not need to apply for this benefit.  
If eligible, members may be charged copayments and a monthly premium based on their income. 
See the Limited Benefits webpage for the Special Benefit Waiver pamphlet for more information 
about who qualifiesand what this program covers at: 
https://www.maine.gov/dhhs/oms/mainecare-options/limited-benefits.  
Page 56 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
The goalof the waiver is to improve the health status of individuals living with HIV/AIDS in 
Maine by:  
 
  Improving access to continuous health care services. 
  Slowing the disease progress of HIV/AIDS by providing early, high-quality care while 
being cost efficient. 
   
Some of the services covered may include: 
 
  Ambulance rides 
  Behavioral health and substance abuse services 
  Case management 
  Hospital, inpatient and outpatient 
  Laboratory and X-ray 
  Medications 
  Physician, physician assistant and nurse practitioner 
  Transportation  
 
For more information contact the Special Benefit Waiver Nurse Coordinator at 1-866-796-2463 
ext. 44008 or 207-624-4008. TTY users dial 711. 
 
Pregnant People Who Are Presumptively Eligible  
Pregnant people can have prenatal care for up to 12 months, beginning the date their health care 
provider finds them eligible. To get care for the rest of the pregnancy, the person must apply for 
MaineCare and be found eligible by the DHHS eligibility office. 
Some of the services covered may include: 
 
  Independent lab and x-ray services 
  Physician services 
  Prescription drugs 
  Other pregnancy-related services 
  Outpatient hospital services 
  Rural health clinic services 
 
Limited Family Planning Benefit 
This benefit covers services for members wishing to prevent or delay pregnancy or regulate the 
number of children and timing of pregnancies. To qualify, you must not be pregnant.  
Page 57 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Individuals areeligible when they have all the following criteria:  
  Are not pregnant 
  Have income that is at or below 209% of the Federal Poverty Level (FPL) 
  Any additional criteria for the benefit required under the MaineCare Eligibility Manual 
 
Some of the services covered may include limited (with MBM Policy Section listed): 
 
  Physician Services (Section 90) 
  Rural Health Clinic Services (Section 103) 
  Federally Qualified Health Center (Section 31) 
  Indian Health Services (Section 9) 
  Laboratory (Section 55) 
  Pharmacy (Section 80) 
  Hospital (Section 45) 
 
Coverage for Individuals who are not Citizens or have no Documents from the 
U.S. Department of Homeland Security  
Federally Non-Qualified Children under 21 and People who are Pregnant 
 
Beginning on July 1, 2022, MaineCare offers full coverage to:  
 
  Children under 21 years of age who would be otherwise eligible for federal Medicaid 
benefits but are not eligible due to their immigration status
  Adults who are 21 years of age or older and are pregnant who would otherwise be 
eligible for federal Medicaid benefits but are not eligible due to their immigration status  
 
Emergency Services (also called Emergency MaineCare) 
This limited benefit package is for people who are not citizens or have no documents from the 
U.S. Department of Homeland Security, and are not pregnant or under 21 years of age. 
The only covered service is emergency medical services to stabilize an emergency condition. 
Any further treatment after the emergency is stabilized is not covered. Labor and delivery are 
also covered.  
 
Who determines if I am eligible for MaineCare? 
The Office for Family Independence (OFI) determines eligibility for MaineCare and other 
benefits. These benefits have certain requirements for non-citizens.    
 
How does the OFI eligibility office determine my immigration status? 
Page 58 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
OFI uses the U.S. Citizenship and Immigration Services (USCIS) Systematic Alien Verification 
for Entitlements Program (SAVE) system to verify immigration status. 
 
When is OFI unable to verify my immigration status? 
OFI is unable to verify immigration status for an individual who: 
 
  Intends to apply for Asylum but has not yet done so, or  
  Has sent an application to USCIS but the application status is not showing in SAVE as 
received and pending. 
 
Who can I call with questions about my eligibility for MaineCare? 
Contact the OFI eligibility office with questions about your MaineCare eligibility at:                    
1-855-797-4357. TTY users dial 711. 
 
What services am I eligible for if OFI cannot verify my immigration status? 
If you do not have a verifiable status in the SAVE system, you are not eligible for full benefits in 
any program. Ifyou have no verifiableimmigration status, you may beeligibleforEmergency
ServicesOnlythrough MaineCareif you: 
 
1.  Meet financial eligibility requirements, and  
2.  Meets all other qualification for the MaineCare program (e.g., age, disability, residency, 
etc.). 
 
Rules for these coverage groups are listed in the MaineCare Eligibility Manual, available online 
at https://www1.maine.gov/sos/cec/rules/10/ch332.htm.  
 
What if I am over 21 and not pregnant, what services may I receive from MaineCare? 
  
If you are over age 21 and not pregnant, you may receive emergency services. Emergency
services may or may not be provided in a hospital emergency room.  
 
Emergency services are provided when without medical attention it is expected that there is: 
 
1.  Serious jeopardy to your health; 
2.  Serious damage to your bodily functions; or 
3.  Serious dysfunction of any of your bodily organ or part. 
 
Examples of services that are not considered an emergency medical condition include, but are 
not limited to: dialysis, organ transplants, school-based services, personal care services, waiver 
services, nursing facility services and hospice services. 
 
Page 59 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
An explanation of covered benefits is available at 
https://www.maine.gov/sos/cec/rules/10/ch101.htm, Chapter 1, Section 1.02-4(D).  
 
Who can answer questions about MaineCare Emergency Services Only coverage? 
MaineCare members with Emergency Services Only coverage should contact MaineCare 
Member Services at 1-800-977-6740 with questions.  
 
Long-Term Care Benefits 
These benefit packages are for the following eligibility categories:  
 
  Residents of Nursing Facilities 
  Residents of Residential Care Facilities  
 
Residents of Nursing Facilities  
This benefit package is for members living in a nursing home. This benefit package is for Policy 
Section 67, Nursing Facility Services. These services include the cost of the room, food, nursing 
care, routine supplies, and equipment provided by the nursing home. 
 
The policy sections are numbered so that you can find them in the MaineCare Benefits Manual 
(MBM) at: https://www.maine.gov/sos/cec/rules/10/ch101.htm.  
 
In addition, this benefit package may include the following services if the nursing home is not 
responsible for providing them (with MBM Policy Section listed): 
 
  Advanced Practice Registered Nursing Services (Section 14)  
  Ambulance Services (Section 5) 
  Ambulatory Care Clinic Services (Section 3)  
  Behavioral Health Services (Section 65) 
  Chiropractic Services (Section 15) 
  Community Support Services (Section 17) 
  Dental Services (Section 25)  
  Family Planning Agency Services (Section 30) 
  Federally Qualified Health Center Services (Section 31) 
  Free Standing Dialysis Services (Section 7) 
  Home Health Services (Section 40)  
  Hospice Services (Section 43) 
  Hospital Services (Section 45) 
  Laboratory Services (Section 55) 
  Medical Imaging Services (Section 101) 
  Medical Supplies and Durable Medical Equipment (Section 60)  
  Occupational Therapy Services (Section 68) 
  Pharmacy Services (Section 80) 
Page 60 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
  Physical Therapy Services (Section 85) 
  Physician Services (Section 90) 
  Podiatric Services (Section 95) 
  Primary Care Plus Services (Chapter VI, Section 3) 
  Rehabilitative Services (Section 102) 
  Rural Health Clinic Services (Section 103) 
  Speech and Hearing Services (Section 109) 
  Transportation Services (Section 113) 
  Vision Services (Section 75)  
 
Residents of Residential Care Facilities  
This benefit package is for people living in residential care facilities that provide assisted living 
services. Examples of residential care facilities are apartments or small adult family care homes.  
 
The policy sections are numbered so that you can find them in the MaineCare Benefits Manual 
(MBM) at: https://www.maine.gov/sos/cec/rules/10/ch101.htm. 
 
Services that may be covered include (with MBM Policy Section listed): 
 
  Advanced Practice Registered Nursing Services (Section 14) 
  Ambulance Services (Section 5) 
  Ambulatory Care Clinic Services (Section 3) 
  Behavioral Health Services (Section 65) 
  Chiropractic Services (Section 15) 
  Community Support Services (Section 17) 
  Dental Services (Section 25) 
  Developmental and Behavioral Clinic Services (Section 23) 
  Family Planning Agency Services (Section 30) 
  Federally Qualified Health Center Services (Section 31) 
  Free Standing Dialysis Services (Section 7) 
  Home Health Services (Section 40)  
  Hospice Services (Section 43)  
  Hospital Services (Section 45)  
  Laboratory Services (Section 55) 
  Medical Imaging Services (Section 101) 
  Medical Supplies and Durable Medical Equipment (Section 60) 
  Occupational Therapy Services (Section 68) 
  Pharmacy Services (Section 80) 
  Physical Therapy Services (Section 85) 
  Physician Services (Section 90) 
  Podiatric Services (Section 95) 
  Primary Care Plus Services (Policy Chapter VI, Section 3) 
  Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT) (Section 94) 
Page 61 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
  Private Duty Nursing and Personal Care Services (Section 96, Level VIII nursing 
services only)  
  Psychiatric Facility Services (Section 46) 
  Rehabilitative Services (Section 102) 
  Rural Health Clinic Services (Section 103)  
  Speech and Hearing Services (Section 109) 
  Targeted Case Management Services (Section 13) 
  Transportation Services (Section 113) 
  Vision Services (Section 75)   
 
Information about your MaineCare Benefits 
For questions about what services MaineCare covers, call MaineCare Member Services at 1-800-
977-6740. 
 
For more information about MaineCare policies, see the MaineCare Benefits Manual online at: 
 
https://www.maine.gov/sos/cec/rules/10/ch101.htm.
   
Page 62 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Chapter 10: Helpful Addresses, Telephone Numbers, and 
Websites 
 
DHHS Eligibility, Office for Family Independence (OFI) 
 
How can I: 
  Apply for benefits? 
  Ask about eligibility? 
  Tell OFI about my household or income changes? 
 
You can: 
  Go to My Maine Connection to see if you are eligible or to apply online for MaineCare. 
The web address is:  https://www.mymaineconnection.gov 
  Print an application by going to this web address: 
https://www.maine.gov/dhhs/ofi/applications-forms. You can then mail it to: 114 Corn 
Shop Lane, Farmington, ME 04938. 
  Call 1-855-797-4357; TTY users, dial 711. 
  Visit a local DHHS - Office for Family Independence (OFI). Go to the following web 
address to see the list district office addresses: 
https://www.maine.gov/dhhs/about/contact/offices. DHHS offices are located throughout 
the state. To see what office your town is assigned to, go to the Office Finder webpage at: 
http://gateway.maine.gov/dhhs-apps/office_finder/index.asp.  
 
At My Maine Connection, you can: 
  Apply for MaineCare 
  Apply for Food Supplemental Nutritional Assistance Program (SNAP) 
  Apply for Temporary Assistance for Needy Families (TANF) 
  Apply for Child Care Subsidy 
  Apply for Medicare Savings Program 
  Update your information 
  Complete your annual review 
 
   
Page 63 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
DHHS Eligibility Offices  Office for Family Independence (OFI) 
 
Contact  Walk-In Services 
District Office 
(TTY: Maine Relay 711) 
Augusta District Office  General Information: (207)  OFI program and service 
35 Anthony Avenue  624-8000  eligibility: 
Augusta, Maine 04333  Toll Free: 1-800-452-1926  https://www.maine.gov/dhhs/ofi
Show Map:  Fax: (207) 624-8124  /programs-services  
https://goo.gl/maps/D71ZqA augusta.dhhs@maine.gov 
nXQcp  
Bangor District Office  General Information: (207)  OFI program and service 
19 Maine Avenue,  561-4100  eligibility: 
Bangor, Maine 04401  Toll Free: 1-800-432-7825  https://www.maine.gov/dhhs/ofi
Show Map:  Fax: (207) 941-8871  /programs-services   
https://goo.gl/maps/LRVMzc bangor.dhhs@maine.gov 
dK23Mxx7g29   For Long Term Care questions, 
see Machias Office. 
Biddeford District Office  General Information: (207)  OFI programs and service 
Park One Eleven  286-2400  eligibility: 
407 Alfred Street, Suite A-1  Fax: (207) 282-5154  https://www.maine.gov/dhhs/ofi
Biddeford, Maine 04005  Toll Free: 1-800-322-1919  /programs-services   
Show Map:  biddeford.dhhs@maine.go
https://goo.gl/maps/A7H9ovg v  For Long Term Care questions, 
W992TTNfKA   see Portland Office. 
Calais District Office  General Information: (207)  OFI program and service 
338 North Street, STE 1  454-2417  eligibility: 
Calais, ME 04619  Fax: (207) 454-2465  https://www.maine.gov/dhhs/ofi
Show Map:  /programs-services  
https://goo.gl/maps/VREJoF
Q2bTAkEQ16A  
Caribou District Office  General Information: (207)  OFI program and service 
30 Skyway Drive  493-4000  eligibility: 
Unit 100  Toll Free: 1-800-432-7366  https://www.maine.gov/dhhs/ofi
Caribou, Maine 04736  Fax: (207) 493-4001  /programs-services 
Show Map:  caribou.dhhs@maine.gov 
https://goo.gl/maps/1tZMyzF
D6QP2  
Page 64 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Contact  Walk-In Services 
District Office 
(TTY: Maine Relay 711) 
Ellsworth District Office  General Information: (207)  OFI program and service 
17 Eastward Lane  664-1400  eligibility: 
Ellsworth, Maine 04605  Toll Free: 1-800-432-7823  https://www.maine.gov/dhhs/ofi
Show Map:  Fax: (207) 667-5364  /programs-services  
https://goo.gl/maps/NTKkxs ellsworth.dhhs@maine.gov 
YicXK2   For Long Term Care questions, 
see Machias Office. 
Farmington District Office  General Information: (207)  OFI program and service 
114 Corn Shop Lane  778-8400  eligibility: 
Farmington, Maine 04938  Toll Free: 1-800-442-6382  https://www.maine.gov/dhhs/ofi
Show Map:  Fax: (207) 778-8410 or  /programs-services  
https://goo.gl/maps/BeimgD (207) 778-8429 
HLzW32   farmington.dhhs@maine.g For Long Term Care questions, 
ov  see Augusta Office. 
For Child Support services, see 
Lewiston Office. 
Fort Kent District Office  General Information: (207)  OFI program and service 
139 Market Street, Suite 109  834-1000  eligibility: 
Fort Kent, Maine 04743- Toll Free: 1-800-432-7340  https://www.maine.gov/dhhs/ofi
1447  Fax: (207) 834-1001  /programs-services  
Show Map:  fortkent.dhhs@maine.gov 
https://goo.gl/maps/zS2Vdue For Child Support services, see 
Mp5U2   Caribou Office. 
Houlton District Office  General Information: (207)  OFI program and service 
11 High Street  532-5000  eligibility: 
Houlton, Maine 04730  Toll Free: 1-800-432-7338  https://www.maine.gov/dhhs/ofi
Show Map:  Fax: (207) 532-7995  /programs-services 
https://goo.gl/maps/rzpX6yu houlton.dhhs@maine.gov 
v85x   For Child Support services, see 
Caribou Office. 
Lewiston District Office  General Information: (207)  OFI program and service 
200 Main Street  795-4300  eligibility: 
Lewiston, Maine 04240  Toll Free: 1-800-482-7517  https://www.maine.gov/dhhs/ofi
Show Map:  Fax: (207) 795-4444  /programs-services 
https://goo.gl/maps/nPKzo7V lewiston.dhhs@maine.gov 
MifJ2  
Page 65 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Contact  Walk-In Services 
District Office 
(TTY: Maine Relay 711) 
Machias District Office  General Information: (207)  OFI program and service 
38 Prescott Drive  255-2000  eligibility: 
Machias, Maine 04654  Toll Free: 1-800-432-7846  https://www.maine.gov/dhhs/ofi
Show Map:  Fax: (207) 255-2022  /programs-services  
https://goo.gl/maps/aSuTvEi machias.dhhs@maine.gov 
xjhu   For Child Support services, see 
Ellsworth Office. 
Portland DistrictOffice  General Information: (207)  OFI program and service 
151 Jetport Boulevard  822-2000  eligibility: 
South Portland, ME  Toll Free: 1-800-482-7520  https://www.maine.gov/dhhs/ofi
(Mailing address -  Fax: (207) 822-2310  /programs-services 
151 Jetport Boulevard,  portland.dhhs@maine.gov 
Portland, ME 04102-1946) 
Show Map: 
https://goo.gl/maps/Wv88ps
AWa4x  
Rockland District Office  General Information: (207)  OFI program and service 
91 Camden Street  596-4200  eligibility, except Aspire: 
Suite 103  Toll Free: 1-800-432-7802  https://www.maine.gov/dhhs/ofi
Rockland, Me 04841  Fax: (207) 596-4331  /programs-services  
Show Map:  rockland.dhhs@maine.gov 
https://goo.gl/maps/6wy7aNF
Mxk82  
Sanford District Office  General Information: (207)  OFI program and service 
890 Main Street  490-5400  eligibility: 
Suite 208  Toll Free: 1-800-482-0790  https://www.maine.gov/dhhs/ofi
Sanford, Maine 04073  Fax: (207) 490-5463  /programs-services 
Show Map:  sanford.dhhs@maine.gov 
https://goo.gl/maps/dtiE2vf7
WgL2  
Skowhegan DistrictOffice  General Information: (207)  OFI program and service 
98 North Avenue  474-4800  eligibility: 
Suite 10  Toll Free: 1-800-452-4602  https://www.maine.gov/dhhs/ofi
Skowhegan, Maine 04976  Fax: (207) 474-4888  /programs-services  
Show Map:  skowhegan.dhhs@maine.g
https://goo.gl/maps/3G1Anup ov  For Child Support services, see 
1Kav   Augusta Office. 
Page 66 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Contact  Walk-In Services 
District Office 
(TTY: Maine Relay 711) 
South Paris District Office  General Information: (207)  OFI program and service 
243 Main Street  744-1200  eligibility: 
Suite #6  Toll Free: 1-888-593-9775  https://www.maine.gov/dhhs/ofi
South Paris, Maine 04281  Fax: (207) 743-8798  /programs-services  
Show Map:  southparis.dhhs@maine.go
https://goo.gl/maps/BApsUM v  For Child Support services, see 
YkXc82   Lewiston Office. 
 
MaineCare Member Services 
Contact MaineCare Member Services to find out what services are covered by MaineCare or to 
ask questions about your benefit. 
 
Phone: 1-800-977-6740. TTY users dial 711.  
Office hours are Monday through Friday from 7:00 AM to 6:00 PM. 
 
Email: mainecaremember@gainwelltechnologies.com 
 
Contact MaineCare Member Services if you have questions about:  
 
  What MaineCare pays for 
  Howmuch you pay for services (copays) 
  Primary Care Plus (PCPlus) 
  Getting approval for certain services   
  A bill from a provider 
  Finding a MaineCare provider 
  Getting a ride to adoctors appointment 
  Disagreeing with a MaineCare decision to reduce or deny services 
 
Website: https://www.maine.gov/dhhs/oms/member-resources  
 
Pharmacy Help Desk 
The Pharmacy Help Desk can answer questions about prescription drug benefits, mail order 
options, and generic drugs. They can help you understand your drug benefit. For questions call 1-
866-796-2463. TTY users dial 711. 
   
Page 67 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Transportation Brokers 
Transportation brokers are companies that schedule rides for you to MaineCare-covered service 
appointments. Locate your county or town information in the table to find out who you should 
contact for transportation services. 
 
If you live in:  Your contact is: 
 
Androscoggin County  All  Your broker is Modivcare, formerly LogistiCare. You can call them at 
Towns  1-855-608-5180 or submit requests online at https://modivcare.com/. 
Aroostook County  All  Your broker is Modivcare, formerly LogistiCare. You can call them at 
Towns  1-855-608-5174 or submit requests online at https://modivcare.com/. 
Cumberland County   Your broker is MidCoast Connector. You can call them at                 
Brunswick and Harpswell  1-855-930-7900 and download reimbursement forms 
at midcoastconnector.org. 
Cumberland County  All  Your broker is Modivcare, formerly LogistiCare. You can call them at 
Other Towns  1-855-608-5178 or submit requests online at https://modivcare.com/. 
Franklin County  All Towns  Your broker is Modivcare, formerly LogistiCare. You can call them at 
1-855-608-5180 or submit requests online at https://modivcare.com/.. 
Hancock County  Town of  Your broker is Modivcare, formerly LogistiCare. You can call them at 
Danforth  1-855-608-5174 or submit requests online at https://modivcare.com/. 
Hancock County  All Other  Your broker is Modivcare, formerly LogistiCare. You can call them at 
Towns  1-855-608-5176 or submit requests online at https://modivcare.com/. 
Kennebec County  All Towns  Your broker is Penquis CAP. You can call them at 1-844-736-7847 or 
visit their website at www.penquis.org. 
Knox County  Town of Isle  Your broker is Modivcare, formerly LogistiCare. You can call them 
au Haut  at 1-855-608-5174 or submit requests online https://modivcare.com/. 
Knox County  All Other  Your broker is MidCoast Connector. You can call them at                 
Towns  1-855-930-7900 and download reimbursement forms 
at midcoastconnector.org. 
Page 68 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
If you live in:  Your contact is: 
 
Lincoln County  All Towns  Your broker is MidCoast Connector. You can call them at                   
1-855-930-7900 and download reimbursement forms 
at midcoastconnector.org. 
Oxford County  Towns of  Your broker is Modivcare, formerly LogistiCare. You can call them 
Porter, Hiram, Brownfield,  at 1-877-659-1302 or submit requests online 
Denmark, Sweden, Fryeburg,  at https://modivcare.com/. 
Lovell, Stow, and Stoneham 
Oxford County  All Other  Your broker is Modivcare, formerly LogistiCare. You can call them at 
Towns  1-855-608-5180 or submit requests online at https://modivcare.com/. 
Penobscot County  Town of  Your broker is Modivcare, formerly LogistiCare. You can call them at 
Patten  1-855-608-5174 or submit requests online at https://modivcare.com/. 
Penobscot County  All other  Your broker is Penquis CAP. You can call them at 1-855-437-5883 or 
Towns  visit their website at www.penquis.org. 
Piscataquis County  All  Your broker is Penquis CAP. You can call them at 1-855-437-5883 or 
Towns  visit their website at www.penquis.org. 
Sagadahoc County  All  Your broker is MidCoast Connector. You can call them at                 
Towns  1-855-930-7900 and download reimbursement forms 
at midcoastconnector.org. 
Somerset County  All Towns  Your broker is Penquis CAP. You can call them at 1-844-736-7847 or 
visit their website at www.penquis.org. 
Waldo County  All Towns  Your broker is MidCoast Connector. You can call them at                 
1-855-930-7900 and download reimbursement forms 
at midcoastconnector.org. 
Washington County  All  Your broker is Modivcare, formerly LogistiCare. You can call them at 
Towns  1-855-608-5176 or submit requests online at https://modivcare.com/. 
York County  All Towns  Your broker is Modivcare, formerly LogistiCare. You can call them at 
1-877-659-1302 or submit requests online at https://modivcare.com/. 
Page 69 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
 
How to Report a Transportation Complaint  
To file a complaint, contact the broker in your region using the phone number listed above. If 
you would like a responsefrom the broker, you must request a follow up call. If you do not 
receive a satisfactory response call Member Services at 1-800-977-6740, TTY users dial 711, 
and request to file acomplaint against the broker. 
 
Maine Center for Disease Control and Prevention 
The Maine Center for Disease Control and Prevention (Maine CDC) website has information 
about staying healthy and preventing illness. 
 
Website: https://www.maine.gov/dhhs/mecdc/  
 
Maine Breast and Cervical Health Program 
The Maine Breast and Cervical Health Program (MBCHP) is a program of the Maine CDC that 
pays for breast and cervical screenings for women who qualify. Screenings covered by the 
program may include breast exams, mammograms, or pap tests. 
 
Address: 
Maine CDC Breast and Cervical Health Program 
DHHS/Maine CDC/Division of Population Health 
286 Water Street, Key Plaza Building - 4th Floor 
11 State House Station 
Augusta, ME 04333-0011 
Phone: 1-800-350-5180 
Website: http://www.maine.gov/dhhs/mecdc/population-health/bcp/ 
 
   
Page 70 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
The Women, Infants, and Children Program  
The Women, Infants, and Children (WIC) Program is a public health program run by Maine 
CDC that provides low-cost healthy foods, nutritional education, breastfeeding promotion, and 
support and referrals to other services to women, infants and children who are at nutrition 
risk. The program is designed for people to enroll during pregnancy and for children to remain 
enrolled until their fifth birthday. WIC is complete nutrition care. 
Here are somekey points you may not be aware of:  
  WIC serves people who are pregnant (in any trimester), who are breastfeeding, or who 
had a baby in the last six months. 
  WIC serves infants and children up to the age of five, including adopted and foster 
children. 
  Fathers may apply for their children. 
  WIC serves anyone living in Maine meeting these criteria, no matter thepersons
immigration status. 
See the WIC website at https://www.maine.gov/wic for more information or call 1-800-437-
9300. 
 
Community Resources 
 
211 Maine 
211 Maine is a free and confidential information and referral service that connects people of all
ages across Maine to local services. 211 is available 24 hours a day, seven days a week. You can 
reach 211 via phone, text, email, or by searching our online database. 
 
211 is known as the resourcewherepeople go whenthey dont know whereelse to go. 
Whetherits financial assistance, domesticviolence,addiction treatment, health care, mental
health, or heating and utilities assistance, 211 Maine specialists will talk to you to find out what 
you need and walk you through all the options to find the right service or program for you. 
 
 
 
Child Development Services 
The Child Development Services (CDS) system is an Intermediate Educational Unit that 
provides both Early Intervention (birth through two years) and Free Appropriate Public 
Education (for ages three through five years) under the supervision of the Maine Department of 
Education. The CDS system ensures the provision of special education rules, federal and state 
regulations statewide, through a network of regional sites. 
 
Page 71 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Address: 
Maine Department of Education  
23 State House Station 
Augusta, ME 04333-0023 
Phone: (207) 624-6600 
TTY: Dial 711 
Website: https://www.maine.gov/doe/learning/cds  
 
 
Consumers for Affordable Health Care 
Consumers for Affordable Health Care is a nonprofit organization based in Maine that works to 
help Maine people access quality health care. They do not sell insurance, and they are not a 
government office. Their Consumer Assistance Helpline is a free service for everyone in Maine. 
The line can help you: 
 
  Find health coverage you can afford 
  Understand your health coverage options 
  Enroll in MaineCare and related programs 
  Understand your health coverage 
  File an appeal or complaint or mediate a dispute 
  Find programs to help with health care and drug costs 
 
All calls are confidential. 
 
Helpline: 1-800-965-7476 
TTY: 1-877-362-9570  
Website: www.mainecahc.org 
 
 
Consumer Council System of Maine  
The Consumer Council System of Maine (CCSM) advocates for consumers of mental health 
services in Maine. CCSM provides an independent and effective consumer voice on mental 
health public policy, services, and funding decisions. 
 
Website: https://maineccsm.org/ 
Address: 219 Capital Street, Suite 7, Augusta, ME 04330 
Phone: (207) 430-8300 
Toll-free: 1-877-207-5073 
Email: info@maineccsm.org 
 
 
Page 72 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Disability Rights Maine  
Disability Rights Maine(DRM) is Maines protection and advocacy agency forpeople with
disabilities. They provide the following services: 
 
  Information and referral 
  Individual advocacy 
  Legal representation 
  Education and training 
  Assistance with self-advocacy 
 
Website: https://drme.org/ 
Address: 24 Stone Street, Suite 204, Augusta, ME 04330-5209 
Phone for voice or TTY: (207) 626-2774 or 1-800-452-1948 
 
 
EqualityMaine  
EqualityMaine works to secure full equality for lesbian, gay, bisexual, and transgender people in 
Maine since 1984. 
 
Website: https://www.equalitymaine.org/ 
Mailing Address: P.O. Box 1951, Portland, ME 04104 
Phone: (207) 761-3732 
Email: info@equalitymaine.org 
 
 
Family Planning 
Maine's Family Planning health centers provide a full range of reproductive health care services, 
including pregnancy tests and options counseling, birth control (including emergency 
contraception), STD testing and treatment, pap smears, and annual exams. Family Planning 
services are available to teens and adults of any gender. Referrals are not required, and same-day 
and next-day appointments are often available. Family Planning health centers accept 
MaineCare, private insurance, and offer a sliding scale fee for those paying out of pocket. 
Website: https://mainefamilyplanning.org/for-patients/find-a-clinic/ 
Phone: (207) 622-7524 
 
 
From the First Tooth 
From the First Tooth is a pediatric oral health initiative promoting the oral health of infants, 
toddlers and preschool children in primary care in the State of Maine. All babies and toddlers 
ages six months to three and a half years should have their teeth checked and have fluoride 
varnish applied if needed by a dentist or healthcare provider.  
Page 73 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
 
Website: https://www.fromthefirsttooth.org/ 
 
Lets GO! 
Lets Go!is a community engagement initiative working with communities to create
environments that support healthy choices. Help your kids eat healthy and be active. Follow 
these numbers everyday: 5 - five or more fruits and vegetables, 2 - two hours or less of TV or 
computer time, 1 - one hour or more of physical activity, 0 - zero sugary drinks, more water and 
low-fat milk.  
 
Website: https://www.mainehealth.org/lets-go/  
 
 
Immigrant Legal Advocacy Project 
The Immigrant Legal Advocacy Project (ILAP) helps low-income immigrants improve their 
legal status and works for more just and humane laws and policies affecting immigrants. As 
Mainesonly state-wide immigration legal services organization, ILAP advances justice and 
equity for immigrants and their families through direct legal services, community education, and 
systemic advocacy. 
 
Website: https://ilapmaine.org/ 
Phone:(207) 780-1593 ext. 0 
 
Lead Testing 
Lead is a toxin that can be especially harmful to children under the age of 6. Before the risk to 
young children was known, it was used in many products. Lead poisoning can cause behavior 
problems, learning disabilities, hearing damage, speech delays, and lower intelligence. Most 
young children with lead poisoning do not look or act sick. The only way to tell for sure if your 
child has lead poisoning is to have their blood tested. 
 
  Children ages 1 and 2 years old: All children should be tested for lead poisoning at both 1 
and 2 years of age.  
  Children ages 3 to 5 years old: Should be tested if they havent beentested beforeor if
they are at risk.  
  Talk to your child's doctor to make sure your child is tested. 
 
Dust from lead paint in older homes is the most common cause of childhood lead poisoning in 
Maine. If you live in a home built before 1950 and have children under age 6 years, you can 
order a freelead dust test kit. This will help you find out if you have lead dust in your home. 
  
Populations at greatest risk:  
  Recent immigrants or international adoptees  
Page 74 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
  Children whose parents immigrated to the U.S.  
  Children with pica behavior, which is cravings to eat nonfood items 
  Children with neurodevelopmental disabilities or conditions such as autism that put them 
at higher risk for hand-to-mouth behavior  
  Children entering foster care  
  
For more information and to order a free lead dust test kit 
  https://www.maine.gov/dhhs/mecdc/environmental-health/eohp/lead/parents.shtml 
  Toll Free in Maine: 866-292-3474, TTY call Maine Relay 711 
 
   
Page 75 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Legal Services for the Elderly  
For help with legal matters, call 1-800-750-5353. They will help you or send you to a local 
office. If you are deaf or hard of hearing and have a TTY machine, call 1-800-750-5353. You 
can also visit their website at: http://www.mainelse.org.  
 
Augusta 
5 Wabon Street 
Augusta, ME  04330 
 
Bangor 
450 Essex Street 
Bangor, ME  04401 
 
Lewiston 
8 Falcon Road 
P.O. Box 659 
Lewiston, ME  04243 
 
Scarborough 
136 US Rte. 1 
Scarborough, ME  04074 
 
Presque Isle 
33 Davis Street 
P.O. Box 1288 
Presque Isle, ME  04769 
 
 
Maine Area Agencies on Aging   
Maines five Area Agencies on Aging are the central resource for elder services. They can help 
you either directly or by referring you to the appropriate agency in your area.  
 
Call 1-877-353-3771 from anywhere in Maine to contact the Area Agency on Aging that serves 
the town where you live. 
 
Aroostook Area Agency on Aging  Aroostook County 
One Edgemont Drive, Suite B, P.O. Box 1288 
Presque Isle, Maine 04769 
Phone: (207) 764-3396 or 1-800-439-1789 
TTY: (207) 992-0150 
Office Hours: 8:00 AM  4:30 PM, Monday  Friday 
Page 76 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Website: www.aroostookaging.org  
 
Eastern Area Agency on Aging  Hancock, Penobscot, Piscataquis and Washington Counties 
450 Essex Street 
Bangor, Maine 04401-3937 
Phone: (207) 941-2865 or 1-800-432-7812 
TTY: (207) 992-0150 
Office hours: 8:00 AM  4:30 PM, Monday  Friday 
 
SeniorsPlus  Androscoggin, Franklin and Oxford Counties 
8 Falcon Road 
Lewiston, Maine 04240 
Phone: (207) 795-4010 or 1-800-427-1241 
TTY: (207) 795-7232 
Office hours: 8:00 AM  5:00 PM, Monday  Friday 
 
Southern Maine AreaAgency on Aging  Cumberland, except Brunswick and Harpswell, and 
York Counties 
136 U.S. Route 1 
Scarborough, ME  04074 
Phone: (207) 396-6500 or 1-800-427-7411 
TTY: (207) 883-0532 
Office hours: 8:00 AM  4:30 PM, Monday  Friday 
 
Spectrum Generations (formerly Senior Spectrum)  Kennebec, Knox, Lincoln, Sagadahoc, 
Somerset and Waldo Counties, Brunswick and Harpswell 
One Weston Court, P.O. Box 2589 
Augusta, Maine 04338-2589 
Phone:1-800-639-1553 
TTY: 1-800-464-8703 
Office hours: 8:00 AM  4:30 PM, Monday  Friday 
 
 
Maine Crisis Hotline 
If you are concerned about yourself or someone else, call the crisis hotline. The crisis line is 
available 24-hours a day. 
 
Phone: 1-888-568-1112. TTY: Dial 711. 
 
 
Maine Developmental Disability Council 
Maine Developmental Disability Council (MDDC) is a state and federally funded self-governing 
organization made up of people with developmental disabilities, family members of people with 
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For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
disabilities, and representatives from state agencies and organizations who work to improve the 
lives of those with developmental disabilities. MDDC is committed to creating a Maine in which 
all people are valued and respected because MDDC believes communities are stronger when 
everyone is included. MDDC advocates for equal opportunities for persons with developmental 
disabilities to participate in every aspect of community life. 
 
Website: https://www.maineddc.org/ 
Address: 225 Western Avenue, Suite 4, Augusta, ME 04330 
Phone: (207) 287-4213 
Toll-free: 1-800-244-3990 
 
 
Maine Equal Justice  
Maine Equal Justice is a nonprofit civil legal aid and economic justice organization working to 
increase economicsecurity, opportunity, and equity for people in Maine. They serve as an 
advocacy group and also provide legal services for individuals with low income. 
 
Website: https://maineequaljustice.org/ 
Address: 126 Sewall Street, Augusta, ME 04330 
Phone: (207) 626-7058  
Toll-free: 1-866-626-7059 
E-mail: info@mejp.org 
 
 
Maine Long-Term Care Ombudsman  
Long-term care ombudsmen are advocates for residents of nursing homes, board and care homes 
and assisted living facilities. Ombudsmen provide information about how to find a facility and 
what to do to get quality care.  
 
Website: https://www.maineombudsman.org/  
Phone for voice or TTY: (207) 621-1079 or 1-800-499-0229 
 
 
Maine Parent Federation  
Maine Parent Federation provides information and assistance on a broad range of topics, 
 
including but not limited to:
  Specific Disabilities 
  Parenting Issues 
  Special Education 
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For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
  Family Support 
  Services & resources to assist families and professionals within the home, school, and 
community. 
 
Website: https://www.mpf.org/ 
Address: 484 Maine Ave. 2D, Farmingdale, ME 04344 
Phone: (207) 588-1933 
Toll fee: 1-800-870-7746 
 
 
Maine Tobacco Helpline 
Trying to quit using tobacco? Call the Maine Tobacco Helpline for support. It is free and 
confidential.  
 
Phone: 1-800-207-1230 
Website: https://mainequitlink.com/  
 
 
Maine Intentional Warm Line  
The Intentional Warm Line is a mental health peer-to-peer phone support line for adults aged 18 
and older offering mutual conversations with a trained peer specialist who has life experience 
with mental health recovery. The line operates 24 hour a day, 7 days a week.  
 
Phone: 1-866-771-WARM (9276) 
 
 
Medicare  
Medicare is thefederal health insurance program for people who are 65 or older, certain younger 
people with disabilities, and people with end-stage renal disease. 
 
Website: https://www.medicare.gov/  
Phone: 1-800-633-4227 
 
 
Pine Tree Legal Assistance 
Pine Tree Legal Assistance works to make the justice system more accessible for all Mainers, 
regardless of income. They provide free legal services for low-income residents for non-criminal 
matters. 
 
Website: https://ptla.org/  
Page 79 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
For TTY machines, please call 711, Maine Relay.
 
Augusta 
39 Green Street 
P.O. Box 2429 
Augusta, ME  04338 
(207) 622-4731 
 
Bangor 
115 Main Street, 2nd Floor 
Bangor, ME 04401 
(207) 942-8241 
 
Lewiston 
95 Park St 3rd Floor 
Lewiston, ME  04243-0398 
(207) 784-1558 
 
Machias 
13 Cooper St  
P.O. Box 278 
Machias, ME  04654 
(207) 255-8656  
 
Portland 
88 Federal Street 
P.O. Box 547  
Portland, ME  04112 
(207) 774-8211  
 
Presque Isle 
373 Main Street 
Presque Isle, ME  04769 
(207) 764-4349 
 
Raising Readers 
 
Raising Readers is a program that encourages reading aloud to young children by providing 
family practice and pediatric providers in Maine new books to give at well child visits from two 
months to five years. 
 
Website: https://www.raisingreaders.org/     
 
   
Page 80 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Social Security Administration 
The Social Security Administrations (SSA) is a federal agency that determines if you are eligible 
for social security benefits based on your age or if you have a disability. You apply for benefits 
and receive benefits through the SSA.  
 
The following benefits are available through the SSA: 
  Social Security Income (SSI) 
  Social Security Disability Income (SSDI) 
  Social Security Retirement (SSR) 
 
Phone: 1-800-772-1213  
TTY: 1-800-325-0778  
Local Office List: https://secure.ssa.gov/ICON/main.jsp  
Website: https://www.ssa.gov/ 
 
 
Text 4 Baby 
Pregnant people can sign up to receive texts with information about their babies timed to their 
due dates. 
 
To receive texts: Text BABYto 511411 
Website: https://www.text4baby.org/  
 
 
Vaccinate on time, every time  
Looking for information on vaccines? The U.S. Centers for Disease Control and Prevention 
offers up to date information for families. Vaccines are safe and help keep children 
healthy. Protect your children and teens by making sure they have all vaccines on time.  
 
Website: https://www.cdc.gov/vaccines/parents/index.html  
 
 
Page 81 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.   
Chapter 11: Terms and Definitions 
B 
Benefit Package   
A package of covered services available through MaineCare.
C 
Copay, Copayment   
The amount someMaineCare members must pay to the provider at the time the service is 
provided. 
Cost of Care 
The amount somemembers pay for their care in a facility, like a nursing facility or for a waiver 
program. 
Covered Services 
Services paid for by MaineCare, such as doctor visits, hospital visits, and medications. 
D   
DEL (Drugs for the Elderly and Disabled)  
This benefit helps disabled and elderly people get prescription drugs at a reduced price. It is not 
MaineCare. 
Dual Eligible 
MaineCare members who are eligible for MaineCare and Medicare.  
E 
Eligibility Specialist   
A staff person at the Maine Department of Health and Human Services Office for Family 
Independence (OFI) who reviews applications and decides if you are eligible for MaineCare and 
other programs.   
Emergency   
An emergency is any physical or behavioral health problem that an ordinary person would think 
could cause serious harm, or death, if not treated quickly. 
 
EPSDT 
Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT) Services for members 
under age 21 that are not usually covered by MaineCare but can be covered if certain conditions 
exist.  
K 
Katie Beckett   
Under this program children with special health needs can access MaineCare coverage even if 
their family income is higher than MaineCares usual standards.
M 
MaineCare 
Page 82 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.  MaineCare is a name for Maines Medicaid program. It is a partnership between the federal and 
state governments. The Maine Legislature makes some decisions about eligibility and coverage. 
Maine Rx Plus   
This benefit helps people get prescription drugs at a reduced price. It is not MaineCare. 
Medicaid   
A public health insurance program. It is jointly funded by federal and state governments and 
administered by the states. In Maine, the Medicaid program is called MaineCare. 
Medical Assessment  
A set of tests and measures, the results of which are used to decide if a member needs certain 
services.  
Medicare   
The health insurance program managed by the Social Security Administration for individuals age 
65 and older, people who have received social security disability benefits for 24 months in a row, 
or people who have end-stage kidney disease (renal failure.) 
Member   
A person enrolled in MaineCare. 
Member Services 
Answers questions for people enrolled in MaineCare.
P 
Prior Authorization (PA)  
A process by which services are pre-approved by MaineCare. 
Primary Care Provider (PCP)  
A doctor, physicians assistant, nurse practitioner, or a health care clinic that you choose to 
manage your health care. 
Provider 
A person or agency that provides medical care. 
R 
Referral   
Approval from your primary care provider to get care management services from another 
provider or specialist. 
S 
Social Security Disability Income (SSDI) and Supplemental Security Income (SSI)   
These are Social Security Administration programs that provide cash benefits for low-income 
people who are disabled or age65 and over. 
Specialist   
A health careprovider who deals with one area of health care, such as a cardiologist (heart 
doctor). 
 
Page 83 
For more information, call MaineCare Member Services at 1-800-977-6740.  
If you are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.