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 13 - HOME AND COMMUNITY-BASED WAIVER › Section 144-332-13-1 - DEFINITIONS

Current through 2024-29, July 17, 2024
Individuals can get Medicaid coverage and special services
					 if they meet the medical and financial requirements of one of the following
					 coverage groups:
I.
Home and
				  Community Benefits for the Elderly and for Adults with Disabilities
				  Waiver
:This is for individuals (age 18 or older) who meet nursing
				  facility level-of-care requirements and choose to remain at home. Some of the
				  services include: care coordination, personal support services, home health
				  services, adult day health services, transportation, emergency response system,
				  environmental modifications and respite services. The program rules are in
				  Section 19 of the
MaineCare Benefits Manual
, (10-144 CMR
				  Chapter 101)
II.
Support
				  Services for Members with Intellectual Disability or Autistic Disorders
:
				  This benefit provides support services to members who most commonly live on
				  their own or with families; there are occasionally individuals living in group
				  homes who are also eligible. The major support services are community support
				  and work support. This waiver does not provide any residential services. The
				  program rules are in the
MaineCare Benefits Manual
, Section
				  29.
III.
Home and Community
				  Benefits for Members with Intellectual Disabilities or Autistic Disorder
				  Waiver
:This waiver offers a comprehensive mix of services to members age
				  18 or older. The major services offered are: home support-including support to
				  live alone or in settings with others (i.e. group homes), community support,
				  and work support. The program rules are in the
MaineCare Benefits
				  Manual
, Section 21.
These individuals are residing in the community, and have
					 been classified as needing nursing facility level-of-care requirements or
					 meeting the ICF-IID level of care.
IV.
Home and Community Based Waiver
				  Benefit for Children with Intellectual Disabilities and/or Pervasive
				  Developmental Disorders (ID and/or PDD):
This waiver provides an
				  alternative to institutional care to children aged five through twenty with ID
				  and /or PDD who would otherwise require services in an ICF-IID or a psychiatric
				  hospital. The services offered through this waiver and other program rules are
				  specified in the
MaineCare Benefits Manual
, Section 32.
V.
Home and Community Based
				  Waiver Benefit for Adults with Other Related Conditions Aged 21 and
				  Over:
This waiver provides an alternative to institutional care to
				  adults aged 21 and older with a "related condition," as defined at
				  42 C.F.R. §
											435.1010. The services offered through this
				  waiver and other program rules are specified in the
MaineCare Benefits
				  Manual
, Section 20.
VI.
Home and Community Based Waiver Benefit for Adults with Brain
				  Injury:
This waiver provides an alternative to institutional care to
				  adults aged 18 and older with brain injury. The services offered through this
				  waiver and other program rules are specified in the
MaineCare Benefits
				  Manual
, Section 18.
An individual eligible for waiver may live with family
					 members eligible for community MaineCare. The waivered individual's income and
					 assets are used in the eligibility determination for the remaining family
					 members.
Example
Mr. Clooney lives with his wife, Wendy. They meet SSI -
					 Related criteria as a married couple. Mr. Clooney's eligibility for community
					 MaineCare will be based on the combined income and resources of the couple,
					 with an income limit for a household of two. Wendy's eligibility for waiver
					 services is based on income and resources owned solely by her.
Eligibility for the Medicare buy-in is determined using
					 community rules for a couple. Eligibility for waiver does not affect how the
					 Medicare Buy-In is determined.