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 › Appendix 144-332-D - Other Coverage Groups Still in Federal Law

Current through 2024-29, July 17, 2024
INDIVIDUALS OR COUPLES WHO WOULD HAVE LOST AID TO THE
				  AGED, BLIND OR DISABLED (AABD) COVERAGE SOLELY DUE TO AN INCREASE IN SOCIAL
				  SECURITY BENEFITS IN AUGUST, 1972
Individuals or couples must have been receiving or eligible
				  to receive AABD in 8/72, and must have received an increase in Social Security
				  Benefits in 8/72. Individuals or couples who would have been eligible for AABD
				  except that they were residing in an institution are also included in this
				  section. If the individual or couple would be eligible for SSI after
				  disregarding the increase in Social Security, the individual or couple is
				  eligible for coverage as Categorically Needy.
INDIVIDUALS WHO WERE ELIGIBLE AS "ESSENTIAL SPOUSES" IN
				  DECEMBER 1973
The individual must have been living with a recipient of the
				  Aid to the Aged, Blind or Disabled (AABD) program in 12/73 and receiving
				  Medicaid at that time. "Essential Spouse's needs must have been used to
				  determine the amount of the AABD grant." In order to continue Medicaid for the
				  "essential spouse," the former AABD recipient must continue to be eligible for
				  an SSI payment and the needs of the "essential spouse" must continue to be
				  included in determining the payment to the SSI recipient.
INSTITUTIONALIZED INDIVIDUALS WHO WERE ELIGIBLE IN
				  DECEMBER 1973
The individuals must have been eligible for Medicaid in 12/73
				  as inpatients of medical institutions or intermediate care facilities that were
				  participating in the Medicaid program. The individual must continue to meet
				  Medicaid eligibility requirements in effect in 12/73, continue to reside in the
				  institution and be classified as needing institutionalized care.
BLIND AND DISABLED INDIVIDUALS WHO WERE ELIGIBLE IN
				  DECEMBER 1973
The individuals must meet all current Medicaid eligibility
				  criteria except those for blindness or disability and must have continued to
				  meet all criteria for Medicaid, including blindness and disability, in effect
				  in 12/73.
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-E - Life Estate and Remainder Interest Tables

Current through 2024-29, July 17, 2024
Age
Life Estate
Remainder
0
0.97188
0.02812
1
0.98988
0.01012
2
0.99017
0.00983
3
0.99008
0.00992
4
0.98981
0.01019
5
0.98938
0.01062
6
0.98884
0.01116
7
0.98882
0.01118
8
0.98748
0.01252
9
0.98663
0.01337
10
0.98565
0.01435
11
0.98453
0.01547
12
0.98329
0.01671
13
0.98198
0.01802
14
0.98066
0.01934
15
0.97937
0.02063
16
0.97815
0.02185
17
0.97700
0.02300
18
0.97590
0.02410
19
0.97480
0.02520
20
0.97365
0.02635
21
0.97245
0.02755
22
0.97120
0.02880
23
0.96986
0.03014
24
0.96841
0.03159
25
0.96678
0.03322
26
0.96495
0.03505
27
0.96290
0.03710
28
0.96062
0.03938
29
0.95813
0.04187
30
0.95543
0.04457
31
0.95254
0.04746
32
0.94942
0.05058
33
0.94608
0.05392
34
0.94250
0.05750
35
0.93868
0.06132
36
0.93460
0.06540
37
0.93026
0.06974
38
0.92567
0.07433
39
0.92083
0.07917
40
0.91571
0.08429
41
0.91030
0.08970
42
0.90457
0.09543
43
0.89855
0.10145
44
0.89221
0.10779
45
0.88558
0.11442
46
0.87863
0.12137
47
0.87137
0.12863
48
0.86374
0.13626
49
0.85578
0.14422
50
0.84743
0.15257
51
0.83674
0.16326
52
0.82969
0.17031
53
0.82028
0.17972
54
0.81054
0.18946
55
0.80046
0.19954
56
0.79006
0.20994
57
0.77931
0.22069
58
0.76822
0.23178
59
0.75675
0.24325
60
0.74491
0.25509
61
0.73267
0.26733
62
0.72002
0.27998
63
0.70696
0.29304
64
0.69352
0.30648
65
0.67970
0.32030
66
0.66551
0.33449
67
0.65098
0.34902
68
0.63610
0.36390
69
0.62086
0.37914
70
0.60522
0.39478
71
0.58914
0.41086
72
0.57261
0.42739
73
0.55571
0.44429
74
0.53862
0.46138
75
0.52149
0.47851
76
0.50441
0.49559
77
0.48742
0.51258
78
0.47049
0.52951
79
0.45357
0.54643
80
0.43659
0.56341
81
0.41967
0.58033
82
0.40295
0.59705
83
0.38642
0.61358
84
0.36998
0.63002
85
0.35359
0.64641
86
0.33764
0.66236
87
0.32262
0.67738
88
0.30859
0.69141
89
0.29526
0.70474
90
0.28221
0.71779
91
0.26955
0.73045
92
0.25771
0.74229
93
0.24692
0.75308
94
0.23728
0.76272
95
0.22887
0.77113
96
0.22181
0.77819
97
0.21550
0.78450
98
0.21000
0.79000
99
0.20486
0.79514
100
0.19975
0.80025
101
0.19532
0.80468
102
0.19054
0.80946
103
0.18437
0.81563
104
0.17856
0.82144
105
0.16962
0.83038
Click to
				  view image
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-F

Current through 2024-29, July 17, 2024
STATE OF MAINE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
To: __________ Case No: ______________
____________________
CONSENT DECISION
On or about____________a hearing was requested on behalf of
(applicant)
_____ to appeal the allocation of spousal
				  assets.
Both (applicant & spouse)_____________and the Department
				  agree to the following:
(applicant)
________ resides in a
				  nursing facility and applied for Medicaid on ___________.
(applicant's spouse)
__________ is the community
				  spouse.
As indicated below,
(applicant's
				  spouse)
__________can keep $__________ of the couple's countable
				  assets effective ___________.
INCOME ALLOWANCE
$ ____________ Monthly mortgage/rent
+ ____________ Real estate taxes
+ ____________ Condo fees
+ ____________ Home owners insurance
+ ____________ Utility standard
$ ____________ Total shelter expenses
- ______
582.00
(30% of $1,939.00 -
				  Chart 4.4)
$ ____________ Excess Shelter Expense
+ _____
1,939.00
Minimum Monthly
				  Income Standard (Chart 4.4)
$ ____________ Monthly Income Allowance (may not exceed
				  $2841.00 - Chart 4.4)
- ____________ Community spouse's gross income
- ____________ Community spouse monthly income
				  allocation
= ____________ Deficit in meeting Monthly Income
				  Allowance
Average cost of an annuity to generate $__________ per month
				  income is $__________.
Dated _______________ Signed
(
				  Supervisor)
for the Department of Health and Human Services
Dated _______________ Signed ___________________
Institutionalized spouse or representative
Based upon the agreement between the parties, this CONSENT
				  DECISION to the hearing requested in this matter is the final agency action on
				  the appeal.
Dated_________________ Signed_____________________
Hearing Officer
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › 144-332-1 - ITEMS INCLUDED IN THE BASIC COST CHART

Current through 2024-29, July 17, 2024
Housing
: includes either a payment for rent or
				  home ownership costs (which include taxes, mortgage payments, insurance and
				  property maintenance), heating fuel, water, electricity, gas, refuse disposal,
				  household textiles such as sheets and towels, furniture and appliance
				  replacement, house wares, laundry and cleaning supplies, paper products,
				  services and telephone at the basic rate.
Food
: includes all food eaten at home, meals
				  eaten at work or school and snacks.
Clothing
: includes basic inner and outer
				  clothing, undergarments, footwear, dress and work clothing, cleaning and
				  pressing services and shoe repair.
Personal Care
: includes haircuts, hair dressing,
				  and such items as toothpaste, shaving cream, and shampoo.
Other Family Consumption
: includes newspapers,
				  magazines, entertainment expenses and allowances for participation in sports,
				  hobbies and other recreation.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › 144-332-2 - DEPENDENT ALLOCATIONS USING AFDC RELATED LIMITS

Current through 2024-29, July 17, 2024
The amounts below are used for income allocations for
				  dependents in Home and Community Based Waivers and dependents of nursing home
				  residents when there is no community spouse. They are based on the Full Need
				  Standard in the AFDC Program as of 8/96.
ADULTS INCLUDED
ADULTS NOT INCLUDED
Unit Size
Full Need
Full Need
1
262
154
2
412
295
3
553
437
4
695
579
5
837
721
6
979
863
7
1120
1005
8
1262
1146
Add $142 to Full Need for each additional
				  person.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › 144-332-4 - NURSING CARE LIMITS

Current through 2024-29, July 17, 2024
Chart 4.1 Categorically Needy Nursing Care Status
				  Income Limits
Maximum Federal Supplemental Security Income (SSI) payment
				  amounts for an eligible individual multiplied by 3.
This is used as the income limit for:
Categorically Needy Nursing Care Status
									Home and Community Based Waivers
									Katie Beckett coverage
									SSI - Related or Family - Related coverage group in a
					 hospital for thirty consecutive days
Chart 4.2 Maximum Waiver Allowances
The amounts below are used as the maximum spousal allowance
				  for Home and Community Based Waivers:
Maximum Federal Supplemental Security Income (SSI) payment
				  amounts for an eligible individual.
Chart 4.3 Average Nursing Care Private
				  Rate
The average nursing care private rate is the annual average
				  monthly cost for a private patient to receive nursing facility care in the
				  State of Maine as determined by the Department. This amount is used to
				  calculate penalty periods for disposing of assets for less than fair market
				  value on or after the look-back period.
$3917.00 eff. 8/1/1994
$6255.00 eff. 1/1/2006
$6778.00 eff. 1/1/2008
$7258.00 eff. 1/1/2009
$7667.00 eff. 9/1/2011
$8476.00 eff. 10/19/2014
Effective 6/1/2023 the average nursing care private rate is
				  calculated using the previous year's average rates as reported by nursing
				  facilities on their most recent MaineCare Cost Report provided to the Division
				  of Audit. To calculate the average nursing care private rate the Department
				  shall add the total of all reported nursing facility daily rates and divide
				  that sum by the total number of reported Nursing Facility rates. The average
				  daily rates is multiplied by 31 to establish the average nursing care private
				  rate. The average nursing care private rate is redetermined annually, with
				  effective dates of June 1st, and posted online at
https://www.maine.gov/dhhs/ofi/programs-services/health-care-assistance
.
Chart 4.4 Spousal Impoverishment
Community Spouse Asset Allowance
					 Maximum
$60,000 increased by the same percentage as the
					 percentage increase in the consumer price index for all urban consumers (all
					 items; U.S. city average) between September 1988 and the September before the
					 calendar year involved.
Minimum Monthly Income Standard
150% of the Federal Poverty Level for a household of
					 2.
Monthly Excess Shelter Standard
30% of the Minimum Monthly Income Standard
					 [above].
Maximum Monthly Income
					 Allocation
$1500 increased by the same percentage as the
					 percentage increase in the consumer price index for all urban consumers (all
					 items; U.S. city average) between September 1988 and the September before the
					 calendar year involved.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › 144-332-5 - PROTECTED INCOME LEVEL

Current through 2024-29, July 17, 2024
The following levels are effective 11/91:
Unit Size
Protected Income Level
1
$315
2
$341
3
$458
4
$575
5
$691
6
$808
7
$925
8
$1033
9
$1150
10
$1266
Add $116 for each additional person.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › 144-332-6 - FEE SCHEDULE FOR QDWI

Current through 2024-29, July 17, 2024
If Monthly Countable Income is
Monthly Payment Required Is This % of the
							 Current Medicare Part A Premium
150% FPL - 160% FPL
10%
160.01% - 170%
20%
170.01% - 180%
30%
180.01% - 190%
40%
190.01% - 200%
50%
Over 200%
Not Eligible
Countable income is determined using SSI - Related
				  rules.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › 144-332-6.5 - FEDERAL POVERTY LEVEL/MAGI 5% REDUCTION CALCULATION

Current through 2024-29, July 17, 2024
Chart 6.5 - Rule #273A - eff. 3/31/2014
Effective April 31, 2014
Maximum Income
Level for
							 Maine
100%
140%
156%
157%
160%
175%
191%
208%
209%
Family Size
1
$958
$1,341
$1,494
$1,504
$1,532
$1,676
$1,829
$1,992
$2,002
2
$1,293
$1,810
$2,017
$2,030
$2,068
$2,262
$2,469
$2,689
$2,702
3
$1,628
$2,539
$2,556
$3,109
$3,386
$3,402
4
$1,963
$3,062
$3,082
$3,749
$4,082
$4,102
5
$2,298
$3,585
$3,608
$4,389
$4,779
$4,802
6
$2,633
$4,107
$4,134
$5,029
$5,476
$5,502
7
$2,968
$4,630
$4,659
$5,668
$6,173
$6,203
8
$3,303
$5,152
$5,185
$6,308
$6,870
$6,903
Each
Additional
Person
$335
$523
$526
$640
$697
$701
Household Size
1
2
3
4
5
6
7
8
Each Additional Person
5%
$48
$65
$82
$99
$115
$132
$149
$166
5% of Base 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 › 144-332-7 - CUB CARE

Current through 2024-29, July 17, 2024
(Repealed by adoption filing 2023-123 effective August 15,
				  2023.)
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › 144-332-8 - CUB CARE

Current through 2024-29, July 17, 2024
Family Income as % of Federal Poverty Level
Monthly Premium for 1 Child
Monthly Premium for 2 or More Children
150.1% to 160%
$ 8
$16
160.1% to 170%
$16
$32
170.1% to 185%
$24
$48
185.1% to 200%
$32
$64
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › 144-332-8.5 - CUB CARE

Current through 2024-29, July 17, 2024
Family Income as % of Federal Poverty Level
Monthly Premium for 1 Child
Monthly Premium for 2 or More Children
157.1% to 166%
$ 8
$16
166.1% to 177%
$16
$32
177.1% to 192%
$24
$48
192.1% to 208%
$32
$64
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 333 - LOW COST DRUGS FOR THE ELDERLY AND DISABLED (DEL) › Section 144-333-1 - COVERED INDIVIDUALS

Current through 2024-29, July 17, 2024
I.
Age
Individuals must be age 62 or older
or
age
				  19 through age 61 and meet the disability criteria for SSI (Supplemental
				  Security Income under Title XVI of the
Social Security Act
).
				  See
MaineCare Eligibility Manual
, Ch. 332, Part 6, Section
				  5.1.
II.
Residence
Individuals must meet Medicaid criteria for residence (See
MaineCare Eligibility Manual
, Ch. 332, Part 2, Section
				  4).
III.
Citizenship
Individuals must meet Medicaid criteria for citizenship,
				  except they do not need to provide documentation of citizenship or identity
				  (See
MaineCare Eligibility Manual
, Ch.
				  3 32, Part 2, Section 3).
Certain individuals who do not meet the Medicaid citizenship
				  requirements may be eligible for DEL. They are:
A.
Undocumented alien
- aliens
				who do not have documentation of their citizenship status from the U.S.
				Citizenship and Immigration Services.
B.
Ineligible alien
- aliens
				legally admitted on a temporary basis. The following are examples of
				individuals who are ineligible aliens:
1.
				Foreign government representatives on official business and their families and
				employees;
2. Visitors for business
				or pleasure, including exchange visitors;
3. Aliens in travel status while traveling
				directly through the Unites States;
4. Crewmen on shore leave;
5. Treaty traders and investors and their
				families;
6. Foreign
				students;
7. International
				organization personnel and their families and servants;
8. Temporary workers, including agricultural
				contract workers;
9. Members of
				foreign press, radio, film or other information media and their families;
				or
10. Parolee in the U. S. under
				Section 212 (d)(5) for less than one year unless they are granted "temporary
				parolee status."
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 333 - LOW COST DRUGS FOR THE ELDERLY AND DISABLED (DEL) › Section 144-333-2 - APPLICATION PROCESS

Current through 2024-29, July 17, 2024
An application for DEL coverage is made by signing the
				  Agency's application form for DEL or MaineCare. The individual or anyone acting
				  on the individual's behalf may sign the application form. The applicant may
				  choose anyone to help in completing the form.
The date of application is the date the signed and dated
				  application form is received in any regional office of the Department of Health
				  and Human Services.
All signed applications will be acknowledged in writing. A
				  written decision of eligibility will be sent to the applicant.
Coverage starts the first day of the month of application or
				  the first day of the month an individual meets program requirements, whichever
				  is later.
A reapplication is any signed application form received after
				  the Adverse Action Notice Period. This includes review forms returned after
				  that period.
All applicants or reapplicants will be given information in
				  writing, or verbally if appropriate, about the following:
I. services covered under DEL;
II. the individual's rights, including
				hearings; and
III. responsibilities
				of recipients, including reporting changes.
Individuals who are enrolled in Medicaid and/or Medicare
				  Buy-In (MSP), who are eligible for Medicare Part D, are deemed to be eligible
				  for and enrolled in DEL. They do not need to file a separate application for
				  DEL.
Section 2.1.
Assets
Effective January 1, 2024 there is no asset test.
Section 2.2.
Income
Gross non-excluded income of the applicant and spouse is used
				  to determine eligibility. SSI - Related eligibility criteria is used to
				  determine what is income and what are income exclusions. Income exclusions
				  include the exclusions defined in the SSI - Related deeming process.
Gross monthly income must be equal to or less than 185% of
				  the Federal Poverty Level.
If the assistance unit spends at least 40% of its gross
				  monthly income on prescription drugs, the monthly income limit is increased by
				  25%.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 333 - LOW COST DRUGS FOR THE ELDERLY AND DISABLED (DEL) › Section 144-333-3 - CONTINUED ELIGIBILITY

Current through 2024-29, July 17, 2024
The eligibility period is based on the month the application
				  is received. Individuals enrolled in DEL have their eligibility reviewed every
				  twelve months (See
MaineCare Eligibility Manual
, Ch. 332, Part
				  2, Section 13).
Individuals must continue to meet the requirements defined in
				  Sections 1 and
				  2 of this rule. Once an individual
				  does not meet or comply with any of the requirements set forth in this rule,
				  that individual is ineligible for the DEL program.
Individuals must notify the Department within ten days when
				  they know, or should know, of a change to their circumstance that would
				  disqualify them from the program.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 333 - LOW COST DRUGS FOR THE ELDERLY AND DISABLED (DEL) › Section 144-333-4 - NOTICE OF ELIGIBILITY

Current through 2024-29, July 17, 2024
Individuals will be given written notice of eligibility for
				  this state funded program, based on MaineCare noticing rules (See
MaineCare Eligibility Manual
, Ch. 332, Part 2, Section
				  15).
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 333 - LOW COST DRUGS FOR THE ELDERLY AND DISABLED (DEL) › Section 144-333-5 - ADMINISTRATIVE HEARINGS

Current through 2024-29, July 17, 2024
Individuals have the right to request a hearing if they
				  disagree with action taken in regard to their eligibility (See 10-144, ch. 104,
				  Section 1, Sec.
				  1.15).
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 333 - LOW COST DRUGS FOR THE ELDERLY AND DISABLED (DEL) › Section 144-333-6 - GRANDFATHERED GROUP

Current through 2024-29, July 17, 2024
Certain individuals do not meet the current eligibility rules
				  for the DEL benefit but they were enrolled in the DEL benefit at one time from
				  8/1/98 to 7/31/99. These individuals are eligible for DEL as long as another
				  household member is currently enrolled in this benefit.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 334 - MAINE Rx PLUS › Section 144-334-1 - COVERED INDIVIDUALS

Current through 2024-29, July 17, 2024
An individual is covered if that person satisfies the
				  requirements of this section.
Individuals who are enrolled in Medicaid or for the HIV
				  Limited Benefit are not eligible for Maine Rx Plus.
I.
Residence
Individuals must meet Medicaid criteria for residence (Part
				  2, Section 4 ).
II.
Citizenship
Individuals must meet Medicaid criteria for citizenship
				  except they do not need to provide documentation of citizenship or identity
				  (see Part 2, Section 3 ).
Certain individuals who do not meet the Medicaid citizenship
				  requirements may be eligible for Maine Rx. They are:
A.
Undocumented alien
- aliens
				who do not have documentation of their citizenship status from BCIS.
B.
Ineligible alien
- aliens
				legally admitted on a temporary basis. The following are examples of
				individuals who are ineligible aliens:
1.
				Foreign government representatives on official business and their families and
				employees;
2. Visitors for business
				or pleasure, including exchange visitors;
3. Aliens in travel status while traveling
				directly through the United States;
4. Crewmen on shore leave;
5. Treaty traders and investors and their
				families;
6. Foreign
				students;
7. International
				organization personnel and their families and servants;
8. Temporary workers, including agricultural
				contract workers;
9. Members of
				foreign press, radio, film or other information media and their families;
				or
10. Parolee in the U. S. under
				Section 212(d)(5) for less than one year unless they are granted "temporary
				parolee status."
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 334 - MAINE Rx PLUS › Section 144-334-2 - APPLICATION PROCESS

Current through 2024-29, July 17, 2024
An application is the request for Maine Rx Plus coverage made
				  by signing the Agency's application form for Maine Rx Plus or MaineCare. The
				  individual or anyone acting on the individual's behalf may sign the application
				  form. The applicant may choose anyone to help in completing the form.
The date of application is the date the signed and dated
				  application form is received in any regional office of the Department.
All signed applications will be acknowledged in writing. A
				  written decision of eligibility will be sent to the applicant.
Coverage starts the first day of the month of application or
				  the first day of the month an individual meets program requirements, whichever
				  is later.
A reapplication is any signed application form received after
				  the Adverse Action Notice Period. This includes review forms returned after
				  that period.
All applicants or re-applicants will be given information in
				  writing, or verbally if appropriate, about the following:
I. services covered under Maine Rx
				Plus;
II. the individual's rights,
				including hearings; and
III.
				responsibilities of recipients, including reporting changes.
Section 2.1: Assets
There are no asset criteria.
Section 2.2. Income
Non-excluded gross monthly income is countable for Maine
				  Rx.
If the individual meets the rule for a Family - Related
				  assistance unit, the Family - Related rules are used to determine what is
				  countable income and whose income to count. See Part 3 and 17.
If the individual meets the rules for the Non - Categorical
				  or SSI - Related assistance unit the SSI - Related rules are used to determine
				  what is countable income and whose income to count. See Parts 6 and 17.
If the individual meets the rules of more than one assistance
				  unit, the rules that are most advantageous to the individual are used.
Non-excluded gross monthly income must be equal to or less
				  than 350% of the Federal Poverty Level (See Chart 6) for the assistance
				  unit.
If income exceeds this amount coverage may be available if
				  the assistance unit meets a spend down requirement as determined by the Office
				  of MaineCare Services. The criteria are set forth in 10-144 CMR 104 §3.
Income exclusions used in Family - Related and SSI - Related
				  Medicaid are used for Maine Rx Plus. When income is fully or partially excluded
				  by one of the groups and not the other, the rule that is most beneficial to the
				  individual is used.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 334 - MAINE Rx PLUS › Section 144-334-3 - CONTINUED ELIGIBILITY

Current through 2024-29, July 17, 2024
Individuals enrolled in Maine Rx have their eligibility
				  reviewed every twenty-four months. Once determined to be eligible and enrolled
				  in the program, individuals are continuously eligible for twenty-four months
				  starting with the month of enrollment or the month of the most recent review
				  without regard to changes in income.
Individuals must continue to meet the requirements of
				  residency and citizenship as defined in this rule. Once an individual does not
				  comply with any of the requirements set forth in this rule, that individual is
				  ineligible for the Maine Rx program.
Individuals must notify the Department within ten days when
				  they know, or should know, of a change to their circumstance that would
				  disqualify them from the program.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 334 - MAINE Rx PLUS › Section 144-334-4 - NOTICE OF ELIGIBILITY

Current through 2024-29, July 17, 2024
Individuals will be given written notice of eligibility (See
				  Part 2, Section 15 ).
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 334 - MAINE Rx PLUS › Section 144-334-5 - ADMINISTRATIVE HEARINGS

Current through 2024-29, July 17, 2024
Individuals have the right to request a hearing if they
				  disagree with action taken in regard to their eligibility (See Part 1, Section
				  7 ).
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 335 - HEALTH INSURANCE PURCHASE OPTION › Section 144-335-1 - Eligibility Criteria

Current through 2024-29, July 17, 2024
								
									 A child enrolled in Cub Care whose family income at
					 the end of the child's enrollment period exceeded the maximum Cub Care income
					 limit in effect at the time of reapplication; or
									A child enrolled in MaineCare whose family income
					 exceeded the maximum MaineCare income limits and the maximum Cub Care limits at
					 the time of reapplication.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 335 - HEALTH INSURANCE PURCHASE OPTION › Section 144-335-2 - Eligibility Period

Current through 2024-29, July 17, 2024
Health coverage through the Health Insurance Purchase Option
				  may be purchased for a period of up to eighteen (18) continuous months.
The eligibility period begins the first month following the
				  last month of MaineCare or Cub Care coverage. Coverage may be purchased under
				  this option beginning with any month of the eligibility period. If application
				  for HIPO is made after the first month of eligibility, coverage may be
				  purchased retroactive to the first month of eligibility.
Example
: MaineCare coverage for DiDi Smith, 7
				  years old, ended April 30, 2010 because her family income exceeded the maximum
				  income limit at the time of the MaineCare review. DiDi is eligible for HIPO
				  effective May 1, 2010 through October 31, 2011. An application for HIPO
				  coverage was received on January 3, 2011 and retro coverage was not requested.
				  Didi is eligible for HIPO effective January 1, 2011 through October 31, 2011
				  (10 months) as long as premiums are paid timely as outlined in Section
				  5 below.
The eligibility period ends if an individual withdraws
				  voluntarily or is terminated for non-payment of premium. Individuals who
				  withdraw participation in HIPO or are terminated cannot re-enroll for the
				  remainder of the eligibility period.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 335 - HEALTH INSURANCE PURCHASE OPTION › Section 144-335-3 - Notice of HIPO

Current through 2024-29, July 17, 2024
Individuals will be informed of the availability of extended
				  health coverage through HIPO at the time they are given notice of ineligibility
				  at reapplication for Cub Care or termination of MaineCare due to excess income.
				  A second notice will be sent thirty (30) calendar days after the initial notice
				  to individuals who have not responded.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 335 - HEALTH INSURANCE PURCHASE OPTION › Section 144-335-4 - Application for Participation

Current through 2024-29, July 17, 2024
Individuals who request to participate in this option will be
				  sent information about the program and an agreement form to complete.
The child's responsible party is required to sign the
				  agreement which specifies terms & conditions of participation, and for whom
				  coverage will be purchased. Terms & Conditions include the monthly premium
				  amount, due dates, and termination of coverage if a payment is not received
				  timely.
The Department will verify the child's eligibility period and
				  provide return payment vouchers for each month of coverage requested to
				  purchase.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 335 - HEALTH INSURANCE PURCHASE OPTION › Section 144-335-5 - Premium Payment

Current through 2024-29, July 17, 2024
The monthly premium amount is determined annually by the
				  Office of MaineCare Services as outlined in the Maine State Services Manual,
				  10-144 CMR Chapter 104, Section
				  5.
The premium for the first month of coverage is due before the
				  end of the month. Subsequent premiums are due on the first
				  (1st) day of each month of coverage.
Premiums may be paid monthly or for multiple months at a
				  time.
A premium must be paid for an entire month; partial payments
				  will not be accepted.
Premiums that are not received by the due date are considered
				  overdue, and coverage will end effective the next month, unless there is good
				  cause. Good cause exists if premiums are not paid by the due date because of
				  the following reasons:
Mail delay; or
									 Illness of the covered child's responsible adult;
					 or
									 Unanticipated emergency beyond the control of the
					 responsible adult.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 335 - HEALTH INSURANCE PURCHASE OPTION › Section 144-335-6 - Notice of Termination and Right to a Hearing

Current through 2024-29, July 17, 2024
Individuals who are terminated from participation in HIPO
				  will be notified in accordance with Part 5, Section 9 of the MaineCare
				  Eligibility Manual,
				  1 0-144 CMR Chapter 332 and the Right
				  to a Hearing is as outlined in the Maine State Services Manual, 10-144 CMR
				  Chapter 104, Section1, Administrative Policies and
				  Procedures.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 336 - TRANSFER OF ASSET PENALTY FOR STATE-FUNDED ASSISTANCE IN RESIDENTIAL CARE › Section 144-336-1 - DEFINITION OF THE LOOK BACK PERIOD

Current through 2024-29, July 17, 2024
The period of time that the Department uses to determine
				  whether a penalty for improper transfer of assets will be imposed is called the
				  "look back period."
The look back period is on or after sixty months prior to the
				  first day of the month in which the individual resides in a Residential Care
				  Facility, Cost Reimbursed Boarding Home, or Adult Family Care Home and applies
				  for State-Funded Assistance.
If the individual has had multiple periods of residing in one
				  of the above facilities and/or applications for State-Funded Assistance, the
				  look back period starts sixty months prior to the first day of the month in
				  which the individual first resides in one of the facilities above and applies
				  for State-Funded Assistance.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 336 - TRANSFER OF ASSET PENALTY FOR STATE-FUNDED ASSISTANCE IN RESIDENTIAL CARE › Section 144-336-2 - DEFINITION OF INDIVIDUAL

Current through 2024-29, July 17, 2024
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 336 - TRANSFER OF ASSET PENALTY FOR STATE-FUNDED ASSISTANCE IN RESIDENTIAL CARE › Section 144-336-3 - DEFINITION OF ASSETS SUBJECT TO TRANSFER

Current through 2024-29, July 17, 2024
For transfer purposes, an asset includes all income and
				  resources of the individual and the individual's spouse. This includes any
				  income or resources which the individual or the individual's spouse is entitled
				  to but does not receive because of action or lack of action by the individual
				  as defined above, including but not limited to renouncing an inheritance or
				  failing to exercise a spousal share in a challenge to a will.
To determine the effect that the transfer has on eligibility,
				  several questions must be answered:
I.
				What was transferred?
II. Who was
				the transfer made to?
III. When was
				the transfer made?
IV. What did the
				individual or individual's spouse receive in exchange?
V. Why was the transfer made?
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 336 - TRANSFER OF ASSET PENALTY FOR STATE-FUNDED ASSISTANCE IN RESIDENTIAL CARE › Section 144-336-4 - EXEMPT TRANSFERS

Current through 2024-29, July 17, 2024
The following may be transferred without penalty.
I. The individual's home, if it is
				transferred to:
A. the individual's child, if
				the child is under the age of 21 or does or would meet SSI criteria of total
				and permanent disability or blindness.
B. a sibling of the individual, if the
				sibling has an equity interest in the home and was residing in the home for at
				least one year immediately before the date of the individual's admission to a
				Residential Care Facility, Cost Reimbursed Boarding Home or Adult Family Care
				Home.
Example
:
A brother and sister have joint ownership of a home in which
				  they both lived for the last five years prior to the brother's admission to a
				  Residential Care Facility, Cost Reimbursed Boarding Home or Adult Family Care
				  Home.
The brother may transfer his interest in the home to his
				  sister without penalty.
A penalty would be established if:
1. the sister was not a joint owner or had no
				equity interest in the home, or
2.
				the sister had not lived in the home for at least one year immediately before
				the brother moved to one of the above facilities.
C. a child of the individual, if the child is
				over the age of 21 and does not meet the SSI criteria of total and permanent
				disability or blindness, and the child was residing in the home for at least
				two years immediately before the individual's admission to one of the above
				facilities and was providing care which enabled the individual to live at home
				rather than in one of the above facilities for this time.
D. the individual's spouse.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 336 - TRANSFER OF ASSET PENALTY FOR STATE-FUNDED ASSISTANCE IN RESIDENTIAL CARE › Section 144-336-6 - DISPROVING THE PRESUMED TRANSFER

Current through 2024-29, July 17, 2024
Any transfer of assets by the individual within the look back
				  period will be presumed to have been made for the purpose of becoming or
				  remaining eligible for State-Funded Assistance, unless the individual furnishes
				  clear and convincing evidence that the transaction was for some other purpose
				  and that there was no intent at the time to apply for State-Funded Assistance
				  within the foreseeable future. It is the Department's responsibility to
				  demonstrate that a transfer took place and to establish the date of the
				  transfer. It is the individual's responsibility to prove that the transfer took
				  place for reasons other than to gain eligibility for State-Funded
				  Assistance.
If the individual wants to disprove the presumption that the
				  transfer was made to get help with State-Funded Assistance, the burden of proof
				  rests with the individual. The individual must demonstrate that the transfer
				  was specifically and solely for some other purpose than to receive State-Funded
				  Assistance. Statements and evidence to disprove the transfer must be contained
				  in the individual's record.
The statement should cover, but not necessarily be limited to
				  the individual's:
I. purpose for
				transferring the asset;
II.
				attempts to dispose of the asset for Fair Market Value;
III. reasons for accepting less than the Fair
				Market Value for the asset;
IV.
				plans for and ability to provide financial support after the
				transfer;
V. relationship, if any,
				to the persons to whom the asset was transferred; and
VI. belief that the Fair Market Value was
				received.
In addition to the individual having to prove that the
				  transfer was made specifically and solely for a purpose other than to get
				  State-Funded Assistance, other factors to be considered include:
I. a sudden onset of a disability or
				blindness after the asset was transferred;
II. the diagnosis of a previously undetected
				disabling condition after the transfer occurred;
III. unexpected loss of other assets
				following the transfer;
IV.
				unexpected loss of income after the transfer occurs; or
V. court ordered transfers.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 336 - TRANSFER OF ASSET PENALTY FOR STATE-FUNDED ASSISTANCE IN RESIDENTIAL CARE › Section 144-336-8 - ESTABLISHING A PENALTY

Current through 2024-29, July 17, 2024
Once it has been established that a transfer of assets for
				  less than Fair Market Value occurred within the look back period, the penalty
				  period must be determined.
Any penalty imposed under this Chapter will apply only to
				  State-Funded Assistance. No penalty under this Chapter will be applied to other
				  state services or Medicaid services for which the individual qualifies.
There are three different methods of calculating the penalty
				  period as follows.
I. If there has
				been only one transfer during the look back period:
A. Determine the date that each transfer
				occurred.
B. Determine the amount
				of the transfer.
C. Divide the
				amount of the transfer by the average monthly private rate for a semi-private
				room for a nursing facility at the time of application (see Chapter 332,
				Charts, Chart 4.3). This determines the number of whole months of ineligibility
				based on the transfer.
D. When the
				value of the transfer is less than the average monthly private rate for a
				semi-private room for a nursing facility in (see Chapter 332, Charts, Chart
				4.3), or the penalty calculation includes a partial month, the partial month
				shall be counted and implemented as a period of ineligibility using the
				following method:
1. After determining the
				amount of transfer and dividing that amount by the average monthly private rate
				for a semiprivate room for a nursing facility, impose a period of ineligibility
				for the whole months.
2. Convert
				the remaining partial month into a dollar amount by multiplying the number of
				whole months by the monthly private rate used in the calculation above, and
				subtracting that figure from the total amount of the transfer.
3. This remainder is added to the cost of
				care for the first month of eligibility after imposing the penalty period.
Example
:
If the monthly private rate is $6,000 and the transfer amount
				  is $56,400, this would result in a transfer penalty of 9.4 months. To determine
				  the remainder amount, you would take $6,000 X 9 months = $54,000. $56,400 -
				  $54,000 = $2,400. You would add $2,400 to the cost of care for one month. If
				  the penalty period begins March 1st, it would end November 30th. $2,400 would
				  be added to the cost of care for December.
In an instance where the penalty period is less than a full
				  month, the partial month penalty will be added to the cost of care in the first
				  month a cost of care is due.
Example
:
The individual enters a Residential Care Facility on November
				  27th. There is a partial month transfer penalty of $3000. A cost of care will
				  be due beginning with the month of December. The $3000 partial month transfer
				  penalty will be added to the December cost of care.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 336 - TRANSFER OF ASSET PENALTY FOR STATE-FUNDED ASSISTANCE IN RESIDENTIAL CARE › Section 144-336-9 - HARDSHIP WAIVERS

Current through 2024-29, July 17, 2024
The Department may waive a transfer penalty under this
				  Chapter where the transfer penalty would impose an undue hardship on the
				  penalized individual. It is the responsibility of the individual to prove the
				  claim of undue hardship.
I. Determine
				if undue hardship exists. An undue hardship exists if this denial would:
A. deprive the individual of medical care
				such that the individual's health or life would be threatened; or
B. deprive the individual of food, clothing,
				shelter, or other needs of life.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 351 - Maine Child Support Enforcement Manual › Chapter 1 - PRELIMINARY STATEMENT › Section 144-351-1-1 - AUTHORITY AND INTENTION TO ESTABLISH RULES

Current through 2024-29, July 17, 2024
In accordance with and pursuant to the authority conferred
					 by
					 22 M.R.S.
					 §42(1), the
Maine Administrative Procedure Act
and
					 19-A M.R.S. §2251
et seq.
, the Maine Department of Health and Human Services
					 herewith establishes its rules with respect to the activities of the Division
					 of Support Enforcement.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 351 - Maine Child Support Enforcement Manual › Chapter 1 - PRELIMINARY STATEMENT › Section 144-351-1-2 - TITLE OF RULES

Current through 2024-29, July 17, 2024
These rules may be referred to and cited as the "Maine
					 Child Support Enforcement Manual," the "Support Enforcement Manual," or the
					 "Manual."
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 351 - Maine Child Support Enforcement Manual › Chapter 1 - PRELIMINARY STATEMENT › Section 144-351-1-3 - PRELIMINARY STATEMENT AS INTEGRAL PART OF MANUAL

Current through 2024-29, July 17, 2024
This chapter is an integral part of the
					 Manual.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 351 - Maine Child Support Enforcement Manual › Chapter 1 - PRELIMINARY STATEMENT › Section 144-351-1-4 - MANUAL BINDING ON DEPARTMENTAL EMPLOYEES

Current through 2024-29, July 17, 2024
The Manual is binding on all employees of the
					 Department.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 351 - Maine Child Support Enforcement Manual › Chapter 1 - PRELIMINARY STATEMENT › Section 144-351-1-5 - PURPOSES OF ESTABLISHMENT OF RULES

Current through 2024-29, July 17, 2024
These rules are promulgated for the following
					 purposes:
A. To implement Federal
				  statutes, regulations and action transmittals of the Office of Child Support
				  Enforcement (OCSE), U.S. Department of Health and Human Services, that are
				  applicable to the activities of the Division of Support Enforcement.
B. To implement the Statutes of the State of
				  Maine, inclusive of the
Maine Rules of Civil Procedure
, and
				  the
Maine Administrative Procedure Act
, to the extent they are
				  applicable to the activities of the Division.
C. To establish rules of practice governing
				  the conduct of adjudicatory proceedings of the Division, in accordance with and
				  as authorized by the
Maine Administrative Procedure Act
(
				  5 M.R.S.
				  §8051 ).
D. To establish the Department's rules for
				  its employees who are engaged in any of the activities to which the Manual is
				  applicable.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 351 - Maine Child Support Enforcement Manual › Chapter 1 - PRELIMINARY STATEMENT › Section 144-351-1-6 - DISCLAIMER OF WAIVER

Current through 2024-29, July 17, 2024
The absence of a reference herein to a power of or a
					 remedy available to the Division by virtue of any federal or State statute,
					 regulation or rule, or to a support-establishment/enforcement/collection
					 procedure or mechanism permitted under federal or State law, regulation or
					 rule, or under OCSE action transmittals, shall not operate as a waiver of any
					 such power or of the use of any such remedy, procedure, or
					 mechanism.