Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter II - Specific Policies By Service › Section 144-101-II-19 - Home and Community Benefits for the Elderly and Adults with Disabilities › Subsection 144-101-II-19.02 - ELIGIBILITY FOR CARE

Current through 2024-29, July 17, 2024
19.02-1
General and specific requirements
To be eligible for services under this section, a member
						must be eighteen (18) years or older and meet the general MaineCare eligibility
						requirements found in the
MaineCare Eligibility Manual
(10-144
						C.M.R. Ch. 332), medical requirements, and other specific requirements for Home
						and Community Benefits (HCB) for the Elderly and Adults with Disabilities. Even
						if a member meets all criteria for eligibility for services under this section,
						the provision of these services is subject to available funding for this
						program, individual cost limitations as set forth in this Section and aggregate
						cost neutrality assurances required by
						42 C.F.R. §
													441.302. Some members may have restrictions
						on the type and amount of services they are eligible to receive. It is the
						responsibility of the Service Coordination Agency (SCA) to verify a member's
						eligibility for MaineCare, as described in Chapter I of the
MaineCare
						Benefits Manual
, prior to coordinating the provision of services
						authorized by the ASA.
19.02-2
Medical requirements
A person meets the medical eligibility requirements for
						this Section if he or she meets the medical eligibility requirements specified
						in Chapter II, Section
						67.02, Nursing
						Facility Services, of this Manual.
The Department, or its Assessing Services Agency, using
						the Medical Eligibility Determination (MED) Form must complete a face-to-face
						assessment. The clinical judgment of the ASA shall be determinative of the
						scores given on the MED assessment.
19.02-3
Other specific
					 requirements
A member meets the requirements of this Section when all
						of the additional following conditions are met:
A. The projected cost of services under this
					 Section needed by the member on a monthly basis must be established within the
					 limits set forth in Section
					 19.06; and
B. A member or applicant who meets the
					 eligibility criteria for nursing facility level of care has been informed of,
					 and offered the choice of available, appropriate and cost-effective HCB; and
C. The member selected HCB as
					 documented by a signed Choice Letter; and
D. The health and welfare of the
					 applicant/member would not be endangered receiving services at home or in the
					 community; and
E. The particular
					 services needed by the member are available in the geographic area and a
					 willing provider is available; and
F. The member must make themselves available
					 for any eligibility assessment; and
G. The member must have a permanent or
					 chronic disability or functional impairment which interferes with his/her own
					 capacity to provide self-care and daily living skills without assistance as
					 verified by the member's MED form; and
H. Members will be accepted into the program
					 on a first-come, first-served basis, based upon the availability of funding.
					 The waitlist will be maintained by the Office of Aging and Disability Services.