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 1 - GENERAL INFORMATION › Section 144-332-1-1 - INTRODUCTION

Current through 2024-29, July 17, 2024
The Maine Department of Health and Human Services is
					 responsible for administering the MaineCare Program in compliance with Federal
					 and State statutes and administrative policies. It is also responsible for
					 state funded assistance programs found within this manual. Within the
					 Department, the Office for Family Independence (OFI) establishes and applies
					 written policies and procedures for taking applications and determining
					 eligibility for assistance, consistent with the objectives of the Program. It
					 also respects the rights of individuals under the United States Constitution,
					 the Social Security Act, Title VI of the
Civil Rights Act of
					 1964
, the
Americans with Disabilities Act
and all
					 other relevant provisions of Federal and State laws which do not result in
					 practices that violate the individual's privacy or personal dignity. The
					 Department further holds any policies or procedures developed at the regional
					 level to be consistent.
Title VI of the
Civil Rights Act of 1964
and the
Americans with Disabilities Act
states that no person
					 shall be excluded from participation, be denied benefits, or be subjected to
					 discrimination on the grounds of race, color, national origin, sex, gender
					 orientation, religion or disability under any program or activity receiving
					 federal financial assistance. Therefore, the programs of the Department, like
					 every program or activity receiving financial assistance from the Federal
					 Department of Health and Human Services, must be operated in compliance with
					 the law.
In accordance with the Americans with Disabilities Act, no
					 qualified individual with a disability will, by reason of such disability, be
					 subjected to discrimination; or be excluded from participation or be denied the
					 benefits of the services, programs or activities of the Maine Department of
					 Health and Human Services.
Section 1.1
: Definitions
"
Assistance unit
" means the individuals whose
					 need the department considers when determining whether an applicant or
					 recipient is eligible for program benefits.
An "
Administrative Hearing
" (Hearing) is a
					 hearing between a participant and the Department that is less formal than a
					 proceeding in traditional courtroom, but there still is an authority presiding
					 and testimony and evidence are presented by both sides. A Hearings Officer or
					 the Commissioner of the Department will oversee the Administrative Hearing by
					 hearing both sides and review the action taken by the Department. The purpose
					 of the Administrative Hearing is to ensure that Federal and State rules have
					 been applied correctly. A hearing decision will be made in writing and provided
					 to the participant and the Department within the timelines allotted in the
					 Appendix.
Federally Facilitated Marketplace:
The
					 federally facilitated marketplace (FFM) is a website established and operated
					 by the US federal government to facilitate the purchase of health insurance in
					 accordance with the Patient Protection and Affordable Care Act.
"
Intentional Program Violation
" means that a
					 recipient, applicant, or any other individual in the "Assistance Unit" has
					 intentionally misrepresented facts (including, but not limited to such facts as
					 living arrangement, income, or assets) in order to receive MaineCare, and the
					 recipient, applicant, or any other individual in the Assistance Unit would not
					 have been eligible for MaineCare if the Department had been notified of the
					 correct facts, or of a material change in facts. This includes, but is not
					 limited to:
A. False or misleading
				  statements or representations, or withholding of facts, or
B. An action intended to mislead,
				  misrepresent, conceal or withhold facts.
"
Overpayment
" means program benefits that
					 exceed the amount of program benefits, if any, for which an individual or
					 assistance unit is actually eligible when the department or a court has
					 determined that the benefits were provided as a result of an Intentional
					 Program Violation by the individual.
"
Program benefits
" means payments for medical
					 services or durable medical equipment and supplies, and/or the durable medical
					 equipment and supplies, reimbursed by the department under the MaineCare
					 program established pursuant to 22 MSRA ch. 855.