reglab/statecodes huggingface dataset:
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 12 - RESIDENTIAL CARE › Section 144-332-12-1 - LIVING ARRANGEMENTS

Current through 2024-29, July 17, 2024
Adult Foster Home (AFH):
Each AFH usually serves one to three individuals who are
					 usually being served by the Office of Aging and Disability Services (OADS).
					 OADS groups AFH into:
* Private AFH or "Foster Waiver Homes" where residents are
					 also enrolled in the OADS Home & Community Based Waiver Program, and
* State Assisted AFH where residents are enrolled in
					 SSI/State Supplement and/or OADS Home & Community Based Waiver Program.
					 This distinction is used for OADS purposes only. Medicaid eligibility is
					 determined using the same rules for all AFH but the State Supplement amount is
					 different for each group (See Part 11 for information on the State
					 Supplement).
Flat Rate Boarding Home (FRBH)
Each FRBH usually serves up to five individuals who are
					 usually being served by OADS.
Cost Reimbursed Boarding Home (CRBH
)
CRBH serve six or more individuals. These facilities are
					 classified as Private Non-Medical Institutions (PNMI).
Residential Care Facility (RCF)
RCF serve six or more individuals. These facilities are
					 classified as Private Non-Medical Institutions (PNMI).
Adult Family Care Home (AFCH)
AFCH serve up to five individuals. Residents of AFCH
					 receive a greater level of care than is provided in a CRBH or RCF but less than
					 that provided in a nursing facility. These facilities are classified as a
					 Private Non-Medical Institutions (PNMI).
Eligibility for coverage requires that the
					 individual:
* has a coverable group.
* meets asset criteria.
* meets income criteria For individuals residing in a CRBH,
					 RCF, or AFCH above it is necessary to determine the amount that the individual
					 is expected to pay toward the cost of their care if they are found to be
					 eligible for coverage.
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 12 - RESIDENTIAL CARE › Section 144-332-12-2 - COVERABLE GROUPS

Current through 2024-29, July 17, 2024
For all living arrangements individuals must have a
					 Medicaid coverable group. This can be any coverable group including
					 Non-Categorical. The individual need not be in an elderly or disability
					 coverage group.
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 12 - RESIDENTIAL CARE › Section 144-332-12-3 - RESIDENTIAL CARE ASSET CRITERIA

Current through 2024-29, July 17, 2024
For all living arrangements, when determining eligibility
					 for Medicaid "countable assets" are assets after exclusions (see Part
					 16).
For all facilities in this Part, countable assets must be
					 under $2000 for an individual or $3000 for a couple.
Countable assets, exclusions and deductions are identified
					 in Part 16. Apply these rules based on the coverable group the individual is
					 in.
Transfer of asset rules found in Chapter 336 of this Manual
					 apply to individuals residing in a CRBH, RCF, or AFCH.
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 12 - RESIDENTIAL CARE › Section 144-332-12-4 - RESIDENTIAL CARE INCOME CRITERIA

Current through 2024-29, July 17, 2024
For all living arrangements, when determining eligibility
					 for Medicaid "countable income" is gross income minus exclusions (See Part 17)
					 and disregards (See Part 7, Section 2.1 ).
Section
				  4.1:
Adult Foster Homes (AFH)
Residents are considered to be individuals 'living with
					 others". If a married couple resides in the facility, at the option of the
					 couple, eligibility may be determined as a couple if either member of a couple
					 is not eligible when treated as an individual. The countable income of each
					 spouse is totaled. Each spouse is deemed to receive one-half of this total and
					 each is compared to 100% FPL.
I. If
				  countable income is under the income limit for SSI/State Supplement the
				  individual needs to apply for SSI/State Supplement in order to get help with
				  their costs for residing in the AFH. When eligible for SSI/State Supplement,
				  Medicaid coverage is also provided.
Note
: Residents of "State Assisted" AFH are
					 potentially eligible for a $49.00 State Supplement. Residents of "Private AFH"
					 are potentially eligible for $10.00 State Supplement.
II. If countable income is equal to or over
				  the State Supplement income limit for this living arrangement the individual is
				  eligible for Medicaid if countable income is equal to or under 100%
				  FPL.
III. If countable income is
				  over 100% FPL the individual may be eligible for Medicaid under Medically Needy
				  (See Part 10).
IV. If countable
				  income is over 100% FPL and the individual is applying for a Home and Community
				  Based Waiver Program (See Part 13), Medicaid eligibility is determined using
				  the rules of that program.
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 12 - RESIDENTIAL CARE › Section 144-332-12-5 - SPOUSAL LIVING ALLOWANCE (SLA)

Current through 2024-29, July 17, 2024
I. Aspousal
				  living allowance can be given to the spouse of an individual who is residing in
				  a Cost Reimbursed Boarding Home (CRBH)/Adult Family Care Home AFCH)/Residential
				  Care Facility (RCF).
II. In this
				  section, the term "individual" refers to the spouse residing in a CRBH, AFCH,
				  or RCF. The term "at home spouse" refers to the spouse applying for or
				  receiving the spousal living allowance. The "at home spouse" must be legally
				  married under State of Maine law to the individual.
III. When an individual is getting help from
				  Medicaid with their expenses in a CRBH, AFCH, or RCF, the at home spouse may be
				  eligible for a spousal living allowance. This is a payment that is made
				  directly to the at home spouse.
The living allowance starts the month of application by the
					 at home spouse or the first full calendar month the individual is residing in a
					 CRBH, AFCH, or RCF, whichever is later.
Example
The at home spouse applies in 10/08 but 11/08 is the first
					 full calendar month his/her spouse is residing in a Residential Care Facility.
					 11/08 is the first month of payment.
IV. An application is considered to be filed
				  for the living allowance when:
A. the
				  individual residing in the CRBH/AFCH/RCF files an application for help to pay
				  for their residential care expenses or;
B. the at home spouse requests a spousal
				  living allowance and s/he is receiving assistance through the Food Supplement
				  Program, Medicaid, SSI or the State Supplement.
If none of the above applies, the at home spouse must file
					 a separate application with OFI.
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 144-332-13-2 - COVERABLE GROUPS

Current through 2024-29, July 17, 2024
Individuals applying for Waivers must have a coverable
					 group.
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 144-332-13-3 - CLASSIFICATION

Current through 2024-29, July 17, 2024
Individuals must be eligible for nursing facility, ICF-IID,
					 or psychiatric hospital level of care, depending on the medical criteria of the
					 specific waiver program. This determination is done by the Department of Health
					 and Human Services or a designated agency.
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 144-332-13-4 - WAIVER ASSETS

Current through 2024-29, July 17, 2024
The waivered individual's assets must not exceed the SSI -
					 Related asset limit for an individual (See Part 7, Section 1 ).
Countable assets are defined in Part 16 with the following
					 exceptions:
I. Assets of a
				  non-waivered spouse are not deemed when determining eligibility for the spouse
				  applying for the Waiver as of the first day of the month in which the
				  individual is considered to be in nursing facility or ICF-IID level care
				  status.
II. Assets that are owned
				  jointly are considered wholly owned by the waivered individual.
III. If both eligible individuals are in a
				  waiver status, the asset limit is $2000 for each.
IV. There is no computation of the community
				  spouse's protected share of assets.
Section
				  4.1:
Transfer of Assets
Transfers by the individual or their spouse may be subject
					 to a penalty. Follow the procedures outlined in Part 15. Individuals who are
					 Medicaid eligible under the following coverage groups are not subject to the
					 transfer of asset penalty:
I. any
				  MAGI-based group;
II. an SSI -
				  Related group with an income limit of 100% FPL.
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 144-332-13-5 - WAIVER INCOME

Current through 2024-29, July 17, 2024
Income guidelines for individuals under the Waiver Programs
					 follow the definitions in Part 17 with the following exceptions:
I. Gross income of an individual must be less
				  than or equal to the Categorical Nursing Care limit (See Chart 4.1). If income
				  exceeds this amount, determine eligibility using the Medically Needy process in
				  Part 10.
II. There is no deeming of
				  income from the non-waivered spouse.
III. If the income of the individual is being
				  reduced due to previous overpayments by government agencies, the reduced
				  payment amount is used.
IV. VA
				  pensions that are Aid and Attendance or based on unusual medical expenses are
				  not counted as income.
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 14 - INDIVIDUALS IN MEDICAL INSTITUTIONS › Section 144-332-14-1 - INSTITUTIONALIZED

Current through 2024-29, July 17, 2024
Institutionalization
: A person is considered
					 institutionalized when he/she resides in a hospital or nursing facility and is
					 expected to remain for thirty consecutive days.A hospital is one that is
					 primarily for the care and treatment of patients with disorders other than
					 tuberculosis or mental disease.
Individuals who die prior to the end of the thirty day
					 period are considered to be institutionalized.
Special income and asset rules are triggered for the person
					 who is institutionalized. These special rules are effective on the first day of
					 the month in which the thirty days of institutionalization starts.
Example
The individual enters a hospital or nursing facility on
					 March 20th and remains for at least thirty consecutive days. Special income and
					 asset rules are effective March 1st.
Section
				  1.1:
Special income and asset limits
The special income and asset limits for
					 institutionalization are as follows:
I.
Residing in a Hospital
A. Gross income of the individual must be
				  equal to or less than the Categorically Needy Income Limit in Chart 4.1. If the
				  individual's gross income exceeds the Categorically Needy Income Limit in Chart
				  4.1, eligibility is determined using Medically Needy rules. See Part
				  7.
B. Countable assets of the
				  individual must be under $2,000. If there is a community spouse, the Community
				  Spouse Share of Assets is determined as defined in Section 4.3 of this
				  Part.
C. The cost of care for the
				  individual starts in the first full calendar month residing in a hospital. If
				  there is a community spouse, a Community Spouse Monthly Income Allowance and
				  Income Allocation is determined, as defined in this Part.
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 14 - INDIVIDUALS IN MEDICAL INSTITUTIONS › Section 144-332-14-2 - COVERABLE GROUPS

Current through 2024-29, July 17, 2024
Individuals applying for nursing facility coverage must
					 have a Medicaid coverable group. This can be any coverable group including
					 Family - Related. The individual need not be in a elderly or disability
					 coverage group.
If the individual only qualifies for a coverage group that
					 does not pay for nursing care services the individual is not given a cost of
					 care since nursing care services are not being paid. This includes
					 Non-Categorical, HIV Waiver and Breast and Cervical Cancer groups (See Part
					 9).
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 14 - INDIVIDUALS IN MEDICAL INSTITUTIONS › Section 144-332-14-4 - INSTITUTIONAL ASSET CRITERIA

Current through 2024-29, July 17, 2024
Individuals must use their assets to meet their needs.
					 Specific types and amounts may be retained by the individual and community
					 spouse to meet current and future needs.
All available assets are to be used in determining
					 eligibility. Countable assets are defined in Part 16. Asset limits are defined
					 in Part 7, Section
					 1.
Unless exempt, a transfer of assets by the individual is
					 subject to a penalty. Refer to Part 15 to assess if a transfer has occurred and
					 if a penalty needs to be applied.
Countable assets of the individual must be under $2000 on
					 any day of the month for which eligibility is determined.
Section 4.1:
Long Term Care Partnership
				  Program
This program provides incentives to Maine's citizens to
					 purchase long term care insurance by disregarding some assets of the person, if
					 they must apply for financial assistance for help with their long term care
					 needs.
I.
Insurance
				  Policy
A. To meet the requirements of
				  this MaineCare program, the long term careinsurance policy must be a qualified
				  State long term care insurance partnership as certified by the Maine Bureau of
				  Insurance. Certification requires several factors which include:
1. The policy must cover an insured who was a
				  Maine resident when coverage became effective under the policy. If the
				  individual has a long term care partnership policy from another state which
				  also participates in this program and has agreed to provide reciprocal
				  disregards for Medicaid applicants with qualified partnership plans, Maine will
				  provide the same disregards. The individual must still otherwise qualify for
				  MaineCare assistance as detailed in sub-sections II and III of this
				  section.
2. The policy must meet
				  the definition of a qualified long term care insurance policy in the IRS Code
				  §7702 B(b) and
				  26 U.S.C. §
														7702B(b), and must meet the
				  Model regulations specified in
				  42 USC
				  §
														1396p(b)5.
3. the policy must have been issued or
				  re-issued on or after July 1, 2009 (the effective date of the applicable
				  approved State Plan Amendment.
4.
				  the policy must meet consumer protection standards of inflation protection, and
				  its issuers are subject to training requirements of the Bureau of Insurance
				  (Maine Bureau of Insurance Regulations 02-031 CMR chapter 425).
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 14 - INDIVIDUALS IN MEDICAL INSTITUTIONS › Section 144-332-14-5 - INCOME CRITERIA

Current through 2024-29, July 17, 2024
Individuals must use their income to meet their
					 needs.
Gross non-excluded income is used in determining
					 eligibility. Gross non-excluded income is defined in Part 17 with the following
					 exception: If the income of the institutionalized spouse is being reduced due
					 to previous overpayments by government agencies, the reduced payment amount is
					 used.
Income exclusions used for SSI - Related categories are
					 used to determine gross non-excluded income.
Unless exempt, a transfer of income by the individual is
					 subject to a penalty. Refer to Part 15 to assess if a transfer has occurred and
					 if a penalty needs to be applied.
Section
				  5.1:
Income Ownership
The income ownership rules for purposes of this Part
					 supersede any State laws relating to community property or the division of
					 marital property. The rules of ownership of income are as follows:
I. Income payments made solely in the name of
				  one spouse are available only to that respective spouse.
II. When an income payment is made in the
				  names of both spouses, one half is considered to be available to each, unless
				  there is documentation to the contrary.
III. If the payment of income is made in the
				  names of the institutionalized spouse or the community spouse, or both, and to
				  another person or persons, the income is available to each spouse in proportion
				  to the spouse's interest. When both spouses' names are on the payment and no
				  interest is specified, one half of the couples 'interest is considered
				  available to each spouse.
IV.
				  Income from a trust is counted to the extent it is considered available (Part
				  16, Section 4.53 ).
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 15 - TRANSFER OF ASSETS › Section 144-332-15-1 - TRANSFER OF ASSETS FOR INSTITUTIONALIZED INDIVIDUALS

Current through 2024-29, July 17, 2024
When an individual disposes of assets for less than fair
					 market value on or after the look back period they may have to serve a penalty
					 period before coverage can begin for institutional level of care services. The
					 services are:
* Nursing facility services
* Nursing facility services in a medical institution
* Home and Community Based Waiver Services
The individual may be eligible for all other Medicaid
					 services.
Section 1.1:
Definition of the look back period
The look back period for all transfers is sixty months
					 prior to the month in which the individual is institutionalized and applies for
					 Medicaid.
If the individual has had multiple periods of
					 institutionalization and/or applications, the look back period starts with the
					 first date on which the individual was institutionalized and applied for
					 Medicaid.
Section 1.2:
Definition of "Individual"
In establishing whether a transfer of assets has taken
					 place, the term "individual" includes the individual him/herself as well
					 as:
I. the individual's spouse;
				  or
II. a person, including a court
				  or administrative body, acting at the direction or upon the request of the
				  individual or the individual's spouse or with legal authority to act in place
				  of or on behalf of the individual or the individual's spouse.
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 16 - ASSETS › Section 144-332-16-1 - DEFINITIONS

Current through 2024-29, July 17, 2024
ANNUITIZED ANNUITY:
An annuity under which the
					 individual is receiving a benefit payment under a payment option (life only,
					 ten year certain, etc.) which they have selected.
ANNUITY:
An annuity is an investment on which
					 an individual receives fixed payments for a lifetime or a specified period of
					 time.
ASSETS
: Cash, other liquid resources or real
					 or personal property.
AVAILABLE ASSET:
An asset that has a value
					 which is legally obtainable by the individual. If there is a penalty for early
					 or late withdrawal to get the asset, the available asset is the amount after
					 the penalty is taken.
DEFERRED ANNUITY:
An annuity under which the
					 benefit payment will begin at some future date. The individual has not yet
					 selected a payment option (life only, ten year period certain, etc.)
EQUITY VALUE
: The fair market value of real or
					 personal property minus any encumbrances. Examples of encumbrances are:
					 mortgages, liens, and other debts on or attached to the property.
Any asset which has no saleable value will not be used in
					 determining eligibility because it has no equity value.
Examples
Homes that, due to structural damage, and their
						location on leased property, have no resale value.
										Vacant property not large enough to be sold due to
						changes in zoning laws. 
										Vehicles, which cannot be sold due to mechanical or
						other problems.
FAIR MARKET VALUE
: Amount that can be expected
					 to be received for selling a similar article on the open market in the
					 geographic area involved. The individual may refute the fair market value
					 determined by the Department by providing statements from two credible sources.
LIQUID ASSETS
: Cash or other resources that
					 can be converted into cash on demand.
NON-LIQUID ASSETS
: Real or personal property
					 that cannot be converted into cash on demand.
OWNERSHIP:
Power, authority or title to sell,
					 exchange, convert or redeem any property. Property in the name of a child is
					 available to both child and parent, as the parent can make it available.
REAL ESTATE AND OTHER NON-LIQUID
					 ASSETS:
In determining the value of this countable asset, the type
					 of ownership must be established.
If the owners have "joint tenancy", each owner has an equal
					 interest in the total value of the property.
If the owners are "tenants in common", each owner has a
					 share in the property. Generally, each owner can sell that share without the
					 consent of the other owners. If the terms of ownership prohibit sale of one
					 owner's portion or the other owner(s) refuses to agree to sell, the real estate
					 is excluded.
UNAVAILABLE ASSET:
An asset that has a value
					 which is legally unobtainable to the individual.
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 16 - ASSETS › Section 144-332-16-2 - USE OF ASSETS

Current through 2024-29, July 17, 2024
Individuals must use their assets to meet their needs
					 before MaineCare will be available. Specific types and amounts may be retained
					 to meet current and future needs. See explanation of specific assets that
					 follow.
If assets are potentially available, applicants, recipients
					 or others acting on their behalf must take action to make them available.
All available assets are to be used in determining
					 eligibility.
Unavailable assets are not to be used in determining
					 eligibility.
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 16 - ASSETS › Section 144-332-16-3 - TREATMENT OF ASSETS

Current through 2024-29, July 17, 2024
Section 3.1:
Eligibility Groups for Which MAGI-based Methodology Applies
All assets are excluded for eligibility groups for which
					 MAGI-based methodology applies.
Section
				  3.2:
All Other Eligibility Groups
Unless specifically indicated as excluded or unavailable,
					 all assets are counted toward the appropriate limit (Part 7) whether listed in
					 Section 4 of this Part or not.
For the purpose of this Part, SSI - Related categories
					 refer to Parts 6, 9. 11, 12, 13, and 14.
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 16 - ASSETS › Section 144-332-16-4 - TYPES OF ASSETS

Current through 2024-29, July 17, 2024
Section 4.1:
Agent Orange
-
excluded for SSI-Related
				  categories
All Agent Orange settlements as provided for under PL 100-
					 687 and 101-201 are excluded.
Section
				  4.2:
Alaskan Native Claims
-
excluded for
				  SSI-Related categories
The tax-exempt portions of payments made pursuant to PL
					 92-203, the
Alaskan Native Claims Settlement Act
are
					 excluded.
Section 4.3:
Annuities
-
partially excluded for SSI-Related
				  categories
A. Policy applicable to
				  all MaineCare including residential care and long term care
An annuity may be purchased by the individual or a third
					 party. If the annuity is purchased by other than the individual, the payments
					 are counted as income. There is no countable resource nor is there a transfer
					 of assets.
(1) Annuities purchased
				  before 2/8/06
(a) The current cash value of
				  the annuity available to the individual, including the principal and interest
				  earned on the principal, minus any penalty fees for withdrawal, is a countable
				  resource.
(b) Payments from
				  annuities are considered income to the individual for whom the payments are
				  designated.
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 16.5 - ASSETS › Section 144-332-16.5-3 - TREATMENT OF ASSETS

Current through 2024-29, July 17, 2024
Section 3.1
:
				  Eligibility Groups for Which MAGI-based Methodology Applies
All assets are excluded for eligibility groups for which
					 MAGI-based methodology applies.
Section
				  3.2
: All Other Eligibility Groups
Unless specifically indicated as excluded or unavailable,
					 all assets are counted toward the appropriate limit (Part 7) whether listed in
					 Section 4 of this Part or not.
For the purpose of this Part, SSI - Related categories
					 refer to Parts 6, 9. 11, 12, 13, and 14.
SECTION 4: TYPES OF ASSETS
Section 4.1
: Agent Orange
-
				  excluded for SSI-Related categories
All Agent Orange settlements as provided for under PL 100 -
					 687 and 101-201 are excluded.
Section
				  4.2
: Alaskan Native Claims
- excluded for
				  SSI-Related categories
The tax-exempt portions of payments made pursuant to PL
					 92-203, the Alaskan Native Claims Settlement Act are excluded.
Section 4.3
:
				  Annuities
-partially excluded for SSI-Related categories
A. Policy applicable to all MaineCare
				  including residential care and long term care
An annuity may be purchased by the individual or a third
					 party. If the annuity is purchased by other than the individual, the payments
					 are counted as income. There is no countable resource nor is there a transfer
					 of assets.
(1) Annuities purchased
				  before 2/8/06
(a) The current cash value of
				  the annuity available to the individual, including the principal and interest
				  earned on the principal, minus any penalty fees for withdrawal, is a countable
				  resource.
(b) Payments from
				  annuities are considered income to the individual for whom the payments are
				  designated.
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 17 - INCOME › Section 144-332-17-2 - INCOME FOR ELIGIBILITY GROUPS FOR WHICH MAGI-BASED METHODOLOGY APPLIES

Current through 2024-29, July 17, 2024
Section 2.1:
MAGI-based Income
MAGI-based income is defined as income calculated using the
					 same financial methodologies used to determine modified adjusted gross income
					 as defined in section36 B(d)(2)(B) of the Internal Revenue Code, ["Modified
					 adjusted gross income" means adjusted gross income increased by - (a) Any
					 amount excluded from gross income under section 911 of the Internal Revenue
					 Code; (b) Any amount of interest received or accrued by the taxpayer during the
					 taxable year which is exempt from tax; and (c) An amount equal to the portion
					 of the taxpayer's social security benefits (as defined in the Internal Revenue
					 Code Section 86(d) which is not included in gross income under section 86 for
					 the taxable year"], with the following exceptions:
A. An amount received as a lump sum is
				  counted as income only in the month received;
B. Scholarships, awards, or fellowship grants
				  used for education purposes and not for living expenses are excluded from
				  income;
C. American Indian/Alaska
				  Native exceptions. The following are excluded from income:
(1) Distributions from Alaska Native
				  Corporations and Settlement Trusts;
(2) Distributions from any property held in
				  trust, subject to Federal restrictions, located within the most recent
				  boundaries of a prior Federal reservation, or otherwise under the supervision
				  of the Secretary of the Interior;
(3) Distributions and payments from rents,
				  leases, rights of way, royalties, usage rights, or natural resource extraction
				  and harvest from:
(a) Rights of ownership or
				  possession in any lands located within the most recent boundaries of a prior
				  Federal reservation, or otherwise under the supervision of the Secretary of the
				  Interior; or
(b) Federally
				  protected rights regarding off-reservation hunting, fishing, gathering, or
				  usage of natural resources;
(4) Distributions resulting from real
				  property ownership interests related to natural resources and improvements :
(a) Located on or near a reservation or
				  within the most recent boundaries of a prior Federal reservation; or
(b) Resulting from the exercise of
				  federally-protected rights relating to such real property ownership
				  interests;
(5) Payments
				  resulting from ownership interests in or usage rights to items that have unique
				  religious, spiritual, traditional, or cultural significance or rights that
				  support subsistence or a traditional lifestyle according to applicable Tribal
				  Law or custom;
(6) Student
				  financial assistance provided under the Bureau of Indian Affairs education
				  programs.
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 17 - INCOME › Section 144-332-17-4 - TREATMENT OF INCOME

Current through 2024-29, July 17, 2024
Section 4.1
:
				  Adoption Assistance -
excluded for Family - Related categories
Adoption Assistance Payments
Section 4.2
: Agent Orange Settlements
				  -
excluded for all categories
Agent Orange Settlements as provided for under PL 100-687
					 and 101-201.
Section 4.3
: ASPIRE Payments -
excluded for Family - Related categories
Exclude all payments made by the ASPIRE-TANF
					 Program.
Section 4.4
: Burial Funds -
excluded for SSI - Related categories
Interest on funds designated for burial or interest earned
					 on the value of agreements representing the purchase of burial spaces (provided
					 the burial spaces are excluded from assets and provided the interest is left to
					 accrue) as long as there is no break in the receipt of assistance. (See Part
					 16, Section 2.6 ).
Section
				  4.5
: Cafeteria Plans -
partially excluded for all
				  categories
Portions of IRS Section 125 payments retained by the
					 employer as payment for benefit items chosen by the employee from the Section
					 125 menu or "cafeteria plan" are excluded.
Section 4.6
: Child Support
For all categories
Child support payments are income to the child(ren) for
					 whom the payments are intended. This rule applies even if the child does not
					 reside with the parent receiving the payment or if the payments include
					 arrearages (past due amounts) or if the "child" for whom the payments are
					 intended is now over age 18.
For Family - Related Categories
The first $50.00 per month of current child support
					 payments received by the assistance unit whether received through DSER or
					 direct is excluded.
Child support paid by the Department that is in excess of
					 the monthly obligation is excluded. This applies only to TANF recipients
Section 4.7
: Children
				  eligible for SSI - Related coverage
The following exclusions from the child's income
					 apply:
I. The first $1640 per month of
				  earned income, not to exceed $6600 per calendar year, for a student attending
				  school regularly as defined by the learning institution.
II. One-third of child support, including a
				  military allotment. The payment may be voluntary or court ordered.
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 17.5 - INCOME › Section 144-332-17.5-3 - INCOME FOR OTHER (NON-MAGI) ELIGIBILITY GROUPS

Current through 2024-29, July 17, 2024
Section
				  3.1
Non-MAGI-Based Income
This is defined asthe gross amount of income before any
					 deductions (including but not limited to payroll deductions).
Section 3.2
Income Conversion
				  Methodology
When income is received once a month, that is the monthly
					 gross income.
When income is received twice a month (usually the first
					 and fifteenth of each month), multiply the gross income by two.
When income is received biweekly, multiply the gross income
					 by 2.15.
When income is received weekly, multiply the gross income
					 by 4.3.
Section 3.3
Garnishment
Garnishment is when income is withheld by administrative or
					 court order to pay a creditor or overpayment by a government agency.
Income is counted even if it is garnished, unless the
					 garnishment was premised on an overpayment of governmental benefits and the
					 individual was receiving Medicaid at the time of the overpayment occurred. In
					 such case the garnished amount is excluded in determining the amount of
					 income.
Section 3.4:
Treatment of Income
Section 3.4.1:
Adoption Assistance - included
Adoption Assistance Payments
Section 3.4.2:
Agent Orange
				  Settlements - excluded
Agent Orange Settlements as provided for under PL 100-687
					 and 101-201.
Section 3.4.3:
ASPIRE Payments - excluded
Exclude all payments made by the ASPIRE-TANF
					 Program.
Section 3.4.4:
Burial Funds - excluded
Interest on funds designated for burial or interest earned
					 on the value of agreements representing the purchase of burial spaces (provided
					 the burial spaces are excluded from assets and provided the interest is left to
					 accrue) as long as there is no break in the receipt of assistance. (See Part
					 16, Section 2.6 ).
Section 3.4.5:
Cafeteria Plans - partially excluded
Portions of IRS Section 125 payments retained by the
					 employer as payment for benefit items chosen by the employee from the Section
					 125 menu or "cafeteria plan" are excluded.
Section 3.4.6:
Child Support -
				  included
Child support payments are income to the child(ren) for
					 whom the payments are intended. This rule applies even if the child does not
					 reside with the parent receiving the payment or if the payments include
					 arrearages (past due amounts) or if the "child" for whom the payments are
					 intended is now over age 18.
Section
				  3.4.7:
Children eligible for SSI - Related Eligibility
				  Groups
The following exclusions from the child's income
					 apply:
A. The first $1640 per month of
				  earned income, not to exceed $6600 per calendar year, for a student attending
				  school regularly as defined by the learning institution.
B. One-third of child support, including a
				  military allotment. The payment may be voluntary or court ordered.
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 18 - PRESUMPTIVE ELIGIBILITY DETERMINED BY HOSPITALS › Section 144-332-18-1 - HOSPITAL QUALIFICATION REQUIREMENTS

Current through 2024-29, July 17, 2024
In order to become qualified to make presumptive
					 eligibility determinations, a hospital must:
1. Participate as a Medicaid provider under
				  the State of Maine's State Plan;
2.
				  Notify the Office for Family Independence (OFI) in writing of its intention to
				  make presumptive eligibility determinations under this Part;
3. Accept training, administered by OFI, for
				  all applicable staff on relevant MaineCare eligibility rules and
				  regulations;
4. Not have been
				  previously disqualified for performing presumptive eligibility as result of
				  failing to meet the performance requirements outlined in section
				  8.
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 18 - PRESUMPTIVE ELIGIBILITY DETERMINED BY HOSPITALS › Section 144-332-18-2 - ELIGIBILITY FOR PRESUMPTIVE ELIGIBILITY DETERMINATIONS BY HOSPITALS

Current through 2024-29, July 17, 2024
1. Hospital presumptive eligibility
				  determinations must be limited to persons who meet all eligibility requirements
				  for coverage under one of the following eligibility groups included in this
				  Part:
A. Children under age 21 (Part 3,
				  Section 2.1 )
B. Parents/caretaker
				  relatives (Part 3, Section 2.2 )
C.
				  Pregnant women (Part 3, Section 2.3 )
D. Expansion Adults (Part 3, Section 2.4
				  )
E. Former foster care children
				  (Part 3, Section 3.2- C)
F. Women
				  who are in treatment for breast and cervical cancer (Part 9, Section 2
				  )
G. Family Planning (Part 9,
				  Section 4 ) - Effective retroactive to October 1, 2016, upon approval from
				  CMS.
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 18 - PRESUMPTIVE ELIGIBILITY DETERMINED BY HOSPITALS › Section 144-332-18-3 - PRESUMPTIVE ELIGIBILITY DETERMINATION PROCESS

Current through 2024-29, July 17, 2024
A qualified hospital must use a Hospital Presumptive
					 Eligibility application (HPE-App) to establish the applicant's household size
					 and income. If the hospital determines the applicant meets all of the
					 eligibility requirements for coverage in one of the eligibility groups listed
					 in Section 2 of this Part, the hospital shall determine that the applicant is
					 presumptively eligible for MaineCare coverage.
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 18 - PRESUMPTIVE ELIGIBILITY DETERMINED BY HOSPITALS › Section 144-332-18-4 - PRESUMPTIVE ELIGIBILITY ENROLLMENT PROCESS

Current through 2024-29, July 17, 2024
Once a qualified hospital has determined an individual is
					 presumptively eligibility for MaineCare coverage, the hospital must complete a
					 MaineCare Hospital Presumptive Eligibility Card (HPE-Card) for the individual.
					 The Provider must provide one copy of the HPE-Card to the individual and must
					 submit a copy of the HPE-Card to the Office for Family Independence within 5
					 working days from the date of the determination.
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 18 - PRESUMPTIVE ELIGIBILITY DETERMINED BY HOSPITALS › Section 144-332-18-5 - PRESUMPTIVE ELIGIBILITY COVERAGE PERIOD

Current through 2024-29, July 17, 2024
Once a hospital determines an individual is presumptively
					 eligible, Medicaid coverage begins immediately and continues until the later
					 of:
1. The last day of the month
				  following the month in which presumptive eligibility was determined;
				  or
2. If a full MaineCare
				  application is filed prior to the last day of the month following the month
				  presumptive eligibility was determined, the date on which a final eligibility
				  decision is made.
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 18 - PRESUMPTIVE ELIGIBILITY DETERMINED BY HOSPITALS › Section 144-332-18-6 - NOTICING

Current through 2024-29, July 17, 2024
The Office for Family Independence (OFI) is required to
					 provide appropriate notices in relation to a full MaineCare application filed
					 by or on behalf of the individual determined to be presumptively eligible, but
					 it is not required to send any notice regarding the discontinuance of the
					 presumptive eligibility period and the individual has no rights of appeal in
					 regards to that discontinuance.
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 18 - PRESUMPTIVE ELIGIBILITY DETERMINED BY HOSPITALS › Section 144-332-18-7 - HOSPITAL RESPONSIBILITIES

Current through 2024-29, July 17, 2024
It is the responsibility of the hospital to:
1. Accept the individual's attestation of
				  income, citizenship status, immigration status, and State residency status; the
				  hospital cannot require verification;
2. Notify OFI of each presumptive eligibility
				  determination within five working days from the date the determination was
				  made;
3. Assist individuals
				  determined to be presumptively eligible with completing and submitting a full
				  MaineCare application form (for children under age 21, parents and caretaker
				  relatives, pregnant women, and former foster care children, and family planning
				  services) or an application for treatment for breast and cervical cancer (for
				  women who are in treatment for breast and cervical cancer);
4. Notify the applicant (in writing and
				  orally if appropriate) that if the applicant does not file a full MaineCare
				  application with OFI, or an application for breast and cervical cancer
				  treatment with the Maine CDC Breast and Cervical Health Program, before the
				  last day of the following month, presumptive eligibility coverage will end on
				  that last day; and
5. Notify the
				  applicant (in writing and orally if appropriate) that if the applicant files a
				  full MaineCare application with OFI or an application for breast and cervical
				  cancer treatment with the Maine CDC Breast and Cervical Health Program before
				  the last day of the following month, presumptive eligibility coverage will
				  continue until an eligibility determination is made on the application that was
				  filed.
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 18 - PRESUMPTIVE ELIGIBILITY DETERMINED BY HOSPITALS › Section 144-332-18-8 - PERFORMANCE STANDARDS FOR QUALIFIED HOSPITALS

Current through 2024-29, July 17, 2024
1.
Performance Standards
OFI will use the following standards to determine the
					 accuracy and legitimacy of presumptive eligibility determinations made by each
					 qualified hospital:
A. Was the
				  MaineCare Presumptive Eligibility Card (HPE-Card) received by OFI within 5
				  working days from the determination date?
B. Was a full MaineCare application received
				  by OFI before the expiration of the presumptive eligibility period?
C. If a full application was received, was
				  the individual found to be eligible for full MaineCare coverage?
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › Appendix 144-332-A - Medicare and the Buy-In Process

Current through 2024-29, July 17, 2024
Medicare (Title 18 of the Social Security Act) is a health
				  program administered by the Centers for Medicare and Medicaid Services (CMS).
				  Coverage is available to nearly everyone over age 65 and those who have been
				  receiving Social Security Benefits as disabled for twenty-four consecutive
				  months.
Medicare Part "A" provides hospital, hospice and skilled
				  nursing facility benefits. It is available without charge to individuals who
				  have worked a certain number of quarters where FICA deductions are mandated.
				  People who are not eligible automatically may enroll by paying a monthly
				  premium.
Medicare Part "B" is optional medical insurance for which
				  everyone enrolling must pay a monthly premium. Most individuals pay the same
				  amount but when enrollment in Part B is postponed, individuals pay a different
				  rate. There is an increase in the premium for each year of delay in enrolling
				  in Medicare Part B. Part "B" assists in payments for doctors, outpatient
				  hospital care, therapy, ambulance and laboratory services.
Both parts of Medicare have deductibles and coinsurance
				  charges which are the responsibility of the individual, although private
				  insurance plans (Medigap) may be purchased which cover these payment
				  gaps.
The following groups of individuals and couples are provided
				  with additional benefits by Medicaid when enrolled in Medicare:
Payment of Part A
Payment of Part B
Payment of Medicare Deductible & Co-Ins.
SSI and State Supplement Recipients
X
X
Pickle Amendment
X
X
Qualified Medicare Beneficiaries (QMB)
X
X
X
Qualified Disabled and Working Individual
							 (QDWI)
X
Specified Low Income Medicare Beneficiaries
							 (SLMB)
X
Qualifying Individuals (QI) Part 1
X
Aside from Medicare Parts A and B there is Medicare Part D
				  which is a prescription drug benefit through private insurance companies.
				  People who are enrolled in Medicare Buy-In have reduced costs for their
				  medications under Medicare Part D.
The state payment for Medicare premiums is done with a
				  monthly data exchange between the State and Federal governments. There is
				  usually a delay between the time an individual is eligible for the buy-in and
				  the time the buy-in begins. During this time, the individual continues to have
				  the premium deducted from their Social Security or Railroad retirement check.
				  Once the buy-in begins, the individual receives the gross Social Security
				  Benefit. They are reimbursed by Social Security or Railroad retirement for the
				  premium collected during any delay period.