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 144-332-9-5 - COVID-19 TESTING FOR UNINSURED INDIVIDUALS

Current through 2024-29, July 17, 2024
The
Families First Coronavirus Response
					 Act
(FFCRA) H. R. 6201, 116 Cong. (2019-2020), P. L. No. 116-127
					 (3/18/2020), 134 STAT 178
et seq
. specified in Division F,
					 Section 6004(a)(3) that State Medicaid programs were authorized to create an
					 optional coverage group to ensure services related to testing and diagnosis of
					 COVID-19 are available in response to the pandemic, pursuant to Section
					 1902(a)(10)(A) (ii)(XXIII) of the
Social Security Act
,
					 42 U. S. C.
					 1396a(a)(10) as amended.
					 This is a limited coverage benefit that is effective March 18, 2020 and ends on
					 the last day of the month within which the federal public health emergency
					 (PHE) ends unless otherwise directed by CMS. Coverage under this group is
					 available to individuals who are without health insurance, or whose health
					 insurance coverage does not meet the requirements for minimum essential
					 coverage.
On April 28, 2020 the Governor's Executive Order
					 48, FY19/20 suspended and modified the relevant provisions of the Maine
					 Administrative Procedure Act in order for these rule changes
					 to:
(1)
remain in
				  effect until the later of the end of the Federal Proclamation of Emergency or
				  the end of CMS's approval of the MaineCare program changes, even if that period
				  exceeds ninety days; and
(2)
automatically repeal upon
				  termination of the Federal Proclamation of Emergency or the end of CMS's
				  approval of the MaineCare program changes (whichever is later), without further
				  rulemaking by the Department.
In the event of a conflict between this emergency
					 rule and any other MaineCare rule, the terms of this rule supersede other rules
					 and shall apply.
Section 5.
				  1: Basic Eligibility Requirements
Basic Non-Financial eligibility requirements for getting
					 full MaineCare coverage, identified in Part 2 apply to this coverage group.
					 This includes the rules on residency, citizenship, social security numbers, and
					 assignment of rights to medical payments and support rights, as well as
					 applying for other benefits.
In order to receive benefits under this category, an
					 individual must not be:
A.  Eligible
				  to receive coverage under a mandatory Medicaid eligibility group.
B.  Enrolled in Medicaid health care
				  coverage, except that individuals who are enrolled in a limited benefit
				  Medicaid eligibility group will not be considered to be enrolled in health
				  coverage as a result of such enrollment and therefore may meet the definition
				  of uninsured individual. Limited coverage groups include individuals infected
				  with tuberculosis, individuals eligible for the Limited Family Planning
				  Benefit, and individuals eligible as Medically Needy.
C.  Enrolled in another health care program
				  funded by the federal government, including CHIP, Basic Health Program,
				  Medicare, TRICARE and Veterans Administration, and federal employee plans.
D.  Enrolled in a group health
				  plan or health insurance coverage offered by a health insurance issuer (as
				  defined in section 2791 of the Public Health Service Act), including: a
				  qualified health plan through the federally facilitated marketplace,
				  employer-sponsored health insurance, retiree health plans and COBRA
				  continuation coverage.