Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 707 - RULES RELATING TO THE NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM (NBCCEDP) IN MAINE › Section 144-707-2.0 - Eligibility for Services

Current through 2024-29, July 17, 2024
2.1.General.
If a woman does not meet the criteria below, she is offered
				  written information regarding MaineCare, "free care" and sliding-fee clinics
				  available in the county in which she lives.
To the extent that funding is available from Federal, State
				  and other sources, in order to determine eligibility for MBCHP, an applicant
				  must be:
A woman age 35 through 64 (or older than age 64 if the woman
				  does not have Medicare Part B coverage);
Women age 35-39 must further meet the following criteria:
Rule in Effect since 4/25/07
Recently had an abnormal Pap test result and the health care
				  provider has recommended further testing; and/or
Have not had a Pap test in five (5) or more years.
A resident of Maine or a New Hampshire resident whose
				  primary residence is located less than15 miles from the Maine border;
Financially eligible, and;
Uninsured or underinsured.
2.2.Residency.
Women residing in Maine with the intention of making Maine
				  their permanent or principal home are eligible for the program.
A woman who is visiting in Maine, or residing in the state
				  temporarily, is not considered a Maine resident for the purpose of these Rules.
There is no length of residency requirement.
Proof of citizenship is not required.
New Hampshire residents who live less than15 miles from the
				  Maine border are eligible for the program. MBCHP has a
Memorandum of
				  Agreement
with the state of New Hampshire, which allows women who live
				  in New Hampshire or Maine to choose to enroll in either state.
2.3. Financial Eligibility.
Definition
MBCHP will use an applicant's "Countable Income" at the time
				  of application to determine financial eligibility. Self-declaration of income
				  may be accepted; however, MBCHP reserves the right to require official
				  documentation to prove the amount, timing and/or source of the self-reported
				  income.
"Countable Income" means:
Earned and/or unearned income for the calendar year.
				  Examples include, but are not limited to, wages, unemployment, alimony,
				  worker's compensation, Social Security, etc.
Included are the incomes of the applicant, spouse, and
				  dependent children under the age of 21. Earned income of dependent children who
				  are under the age of 21, are full-time or part-time students, or receiving SSI
				  payments will be disregarded.
Income is calculated before taxes and/or payroll deductions
In the case of self-employment, the previous year's federal
				  and state income tax returns will be used, and countable income is the reported
				  income after allowable self-employment related expenses are deducted, but
				  before other tax deductions are taken out. If the person did not file a tax
				  return then other suitable documentation may be required to establish
				  eligibility.
In the case of self-employment with significant reduction in
				  income from the previous year, statements from quarterly income tax report, or
				  other suitable documentation, may be required to determine actual countable
				  income.
MBCHP will determine a client financially eligible when the
				  applicant's self-declared countable income is less than or equal to 250% of the
				  Federal Poverty Level (FPL) for the applicant's family size. The "Poverty
				  Guidelines-Federal" is issued annually by the U. S. Department of Health and
				  Human Services. Each year's FPL is available on the Internet at
http://aspe.hhs.gov/poverty
.
				  An individual can also obtain a copy of the current FPL by contacting MBCHP; by
				  calling 1-800-350-5180, Press 1; TTY 1-800-438-5514; or in writing to the Maine
				  Breast and Cervical Health Program.
2.4. Insurance Status.
MBCHP will determine a client to be uninsured if the women
				  does not have health insurance coverage
Women who have MaineCare or Medicare Part B are
not
eligible.
MBCHP will determine a client to be underinsured if the
				  woman has health insurance with unreasonably high co-payments, deductibles, or
				  co-insurance, or the insurance does not cover MBCHP Covered Services.
Women who have health insurance, but the plan has
				  co-payments, deductibles or co-insurance amounts that are financial barriers to
				  receiving MBCHP covered services, are eligible. Co-payments, deductibles or
				  co-insurance will be considered a "Financial Barrier" if the
				  applicants':
Countable income is less than 100% FPL, and the applicant
				  reports co-payments, deductibles or co-insurance greater than $50;
Countable income is greater than 100% FPL and less than 150%
				  FPL, and the applicant reports co-payments, deductibles or co-insurance greater
				  than $100;
Countable income is greater than 150% FPL and less than 200%
				  FPL, and the applicant reports co-payments, deductibles or co-insurance greater
				  than $250;
Countable income is greater than 200% FPL and less than or
				  equal to 250% FPL, and the applicant reports co-payments, deductibles or
				  co-insurance greater than $500.