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 9 - LIMITED BENEFIT GROUPS › Section 144-332-9-1 - BENEFIT FOR PEOPLE LIVING WITH HIV/AIDS

Current through 2024-29, July 17, 2024
The Benefit for People Living With HIV/AIDS is a section
					 1115 health care reform demonstration agreement between the Office of MaineCare
					 Services and the Centers for Medicare and Medicaid Services. The Office for
					 Family Independence determines eligibility for this benefit. This benefit
					 provides limited MaineCare coverage to individuals with an HIV/AIDS diagnosis
					 if they meet the medical and financial requirements identified in this section.
					 This benefit is also known as the Special Benefit Waiver (SBW).
Individuals who do not meet the eligibility requirements
					 for MaineCare, but who are HIV-positive and are at or below 250 percent of the
					 federal poverty level, may be eligible for SBW. If an individual who is
					 eligible for this benefit becomes eligible for full MaineCare coverage, they
					 will be moved to the appropriate MaineCare full coverage group. This
					 contingency includes someone who meets a deductible or has a reduction in
					 income that qualifies them for full MaineCare coverage. If an individual,
					 enrolled in a full MaineCare coverage group, becomes ineligible for that group,
					 including someone who must meet a new deductible, but is eligible for SBW, that
					 individual will be granted coverage through SBW. This enrollment will happen
					 even if SBW has a wait list.
An individual cannot receive SBW coverage and the Maine Rx
					 Plus or Low Cost Drugs for the Elderly and Disabled (DEL) programs at the same
					 time. SBW coverage and DEL coverage can overlap when DEL is supplementing
					 Medicare Part D.
1.
Basic
				  Eligibility Requirements
Basic Non-Financial eligibility requirements for receiving
					 MaineCare coverage identified in Part 2 apply to this group. This condition
					 includes meeting the requirements for residency, citizenship, social security
					 numbers, assignment of rights to medical payments and support rights, as well
					 as applying for other benefits. SBW has no age requirement.
A.
Medical Eligibility
The individual must be diagnosed as HIV positive. This
					 diagnosis is confirmed by the Maine Center for Disease Control (MCDC). The
					 individual must also comply with a treatment regimen as defined by their
					 licensed healthcare professional.
If an individual reports a disabling condition and is
					 financially eligible for SSI-Related coverage, eligibility for full MaineCare
					 coverage must be determined first. If the Social Security Administration has
					 not completed a disability determination, this determination will be done by
					 the Medical Review Team.
B.
Assets
SBW has no asset criteria.
C.
Income
Individuals must meet the SSI - Related financial
					 eligibility requirements as listed in Part 7 to be financially eligible for
					 SBW. The SSI - Related rules on income exclusions, in Part 17, are applicable
					 to this coverage group. There is no deeming of income from the spouse. There is
					 no cost of care.
Gross income must be equal to or less than 250% of the
					 Federal Poverty Level.
When determining MaineCare coverage for a spouse not
					 applying for, or enrolled in, SBW, the income and assets of both individuals
					 are used to determine eligibility for the spouse.