Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › Part 2 - BASIC ELIGIBILITY CRITERIA › Section 144-332-2-1 - PROGRAM SCOPE

Current through 2024-29, July 17, 2024
MaineCare is the name used by the State of Maine for
					 programs that help individuals pay for health care costs. The Department's goal
					 is to assist Maine residents in obtaining the benefits to which they are
					 entitled. The programs are:
Medicaid
(Title XIX of the Social Security
					 Act). To be enrolled in Medicaid an individual must be both categorically and
					 financially eligible. Each category has its own eligibility rules. Medicaid
					 includes coverage for people living in the community or living in a long-term
					 care facility.
Categorically Needy
- This Medicaid category
					 is made up of different mandatory and optional coverage groups covered within
					 the state plan. An individual qualifies for Medicaid in this category if they
					 meet the requirements of one of the Categorically Needy coverage groups.
Medically Needy
- This Medicaid category
					 provides coverage for individuals who meet the nonfinancial requirements of a
					 Categorically Needy group but are financially ineligible. Coverage is gained by
					 meeting a deductible.
Medicaid Waiver Groups
- These are optional
					 coverage groups approved by the Center for Medicare and Medicaid Services (CMS)
					 under which an individual can become enrolled in Medicaid who might not
					 otherwise be eligible. Examples are the Home and Community Based Waivers and
					 the HIV Waiver.
Children's Health Insurance Program
(CHIP),
					 formerly known as Cub Care in Maine until 2024, is authorizing under Title XXI
					 of the Social Security Act - This program provides coverage for children under
					 the age of 19 within certain income limits. CHIP also provides coverage to
					 pregnant individuals who are eligible for Medicaid but for their noncitizen
					 status.
Medicare Savings Program
(Buy-In) - This
					 Medicaid category is a benefit for those who are entitled to Medicare Part A
					 and who meet certain income criteria. Depending on income, the benefit is
					 payment of Medicare Part B premium or payment of Medicare Part A and B premiums
					 as well as coinsurance and deductibles.
The Office for Family Independence (OFI) also administers
					 the following additional benefits under MaineCare:
Health Insurance Purchase Option
(HIPO) - This
					 program provides 18 months of extended health coverage to children under the
					 age of 19 who are no longer eligible for MaineCare due to changes in income.
					 (See 10-144 C.M.R. Ch. 335.)
Coverage for Noncitizens Under Age 21
- This
					 state funded program provides coverage to individuals under the age of 21 who
					 would be eligible for Medicaid but for their noncitizen status.
Low Cost Drugs for the Elderly and Disabled
(DEL) - This state funded program assists elderly or disabled individuals with
					 the cost of their medications. (See 10-144 C.M.R. Ch. 333.)
Maine Rx Plus
- This state funded program
					 assists Maine residents with the cost of their medications. Income guidelines
					 are higher than under DEL and the benefit is less. (See 10-144 C.M.R. Ch.
					 334.)
State Supplement
- This is a cash payment to
					 SSI recipients, and individuals who would otherwise be eligible for SSI except
					 for income or citizenship criteria. (See Part 11.)
Spousal Living Allowance
- This is a cash
					 payment to a spouse of a resident of a Residential Care Facility or Cost
					 Reimbursed Boarding Home. The spouse must meet income and asset criteria. (See
					 Part 12 Section
					 5.)