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 2 - BASIC ELIGIBILITY CRITERIA › Section 144-332-2-13 - ELIGIBILITY PERIODS/REVIEWS

Current through 2024-29, July 17, 2024
An individual's eligibility period is based on the month
					 the application is received. Eligibility for the prospective period is
					 determined for 12 months for all MaineCare programs except for Medically Needy
					 and Maine Rx Plus. Eligibility for Medically Needy is determined for a
					 six-month period. Eligibility for Maine Rx Plus is determined for a 24-month
					 period.
The eligibility period begins on the first day of the
					 application month unless temporary coverage is being given. (See "45-Day
					 Processing Standard", Section 12.3.1 of this Part). In some instances, the
					 individual is not eligible for coverage during the month of application but is
					 eligible for the following month. In this situation, the length of the
					 eligibility period remains the same (6, 12 or 24 months), depending on the type
					 of coverage.
A review is a re-determination of eligibility. Reviews may
					 be completed online through the My Maine Connection website or by using the
					 review form provided by OFI. If the recipient is determined no longer eligible
					 a timely and adequate notice of the adverse action must be sent (See Section
					 15 of this Part). Recipients are
					 provided at least 30 days from the date of the renewal form to respond and
					 provide any necessary information to determine ongoing eligibility. If the
					 completed review form is not received by the Department by the end of the month
					 in which it is due coverage will end.
If the completed review form and/or required verifications
					 are submitted within 90 days after the date of termination, a new application
					 for MaineCare coverage will not be required. If found eligible, the
					 individual's coverage will be reinstated back to the date of
					 termination.
Section 13.1:
Changes within the Eligibility Period
Changes reported by recipients during the eligibility
					 period must be reviewed to determine the effect of the change on the
					 individual's eligibility.
If the new information results in a change in the level of
					 coverage, timely and adequate notice of the change of level or termination of
					 benefits must be provided (See Section
					 15 of this Part.).
Certain categorically eligible individuals have a
					 continuous period of eligibility even if changes occur. These groups
					 are:
I.
Newborns
If the newborn's mother is receiving Medicaid (or is
					 covered as part of the retroactive period) on the date the baby is born, the
					 baby is eligible regardless of the income of the assistance unit. The mother
					 must be fully covered by Medicaid on the day of the baby's birth. If mother
					 meets the deductible amount on the day of the baby's birth and is partially
					 responsible for any medical bills on that date, the newborn is not eligible in
					 this group.
Coverage continues for one year without regard to changes
					 in income or other household changes. Coverage under this category ends
					 effective the last day of the month in which the child reaches age one.
II.
Children Under Age
				  19
Any categorically eligible child is continuously eligible
					 for full benefits for 12 months after eligibility is determined by application
					 or review without regard to changes in income or composition of the assistance
					 unit. This provision includes a child on newborn coverage as well as children
					 found eligible for an SSI-Related coverage group even if the SSI or State
					 Supplemental benefits or disability determination end prior to the next
					 MaineCare review. It does not apply to those receiving coverage under
					 Transitional MaineCare. The 12-month period begins with the month of
					 application or review. Eligibility within the 12-month period will end:
A. at the end of the month the child turns
				  19;
B. if the child ceases to be a
				  state resident; or
C. if mail
				  addressed to the child or child's household is returned as
				  undeliverable.
III.
Pregnant Individual
A. Effective
				  August 1, 2022, pregnant individuals who are found eligible for MaineCare under
				  Part 3, Section 2.3(I) are continuously eligible for 12 months beyond the date
				  the pregnancy ends.
B. Effective
				  December 1, 2023, pregnant individuals who are found eligible for the
				  Children's Health Insurance Program (CHIP), and enrolled in CHIP while
				  pregnant, under Part 3, Section 2.3(III) are continuously eligible for 12
				  months beyond the date the pregnancy ends.