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 5 - CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) - CUB CARE › Section 144-332-5-6 - INCOME STANDARD

Current through 2024-29, July 17, 2024
Household income for children
A. Age 0 up to age 1: Greater than 191% and
				  equal to or less than 208% of the Federal Poverty Level for a the family
				  size.
B. Age 1 up to age 6: greater
				  than 140% and equal to or less than 208% of the Federal Poverty Level for the
				  family size.
C. Age 6 up to age 19:
				  greater than 132% and equal to or less than 208% of the Federal Poverty Level
				  for the family size.
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 5 - CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) - CUB CARE › Section 144-332-5-7 - ELIGIBILITY BUDGETING PRINCIPLES

Current through 2024-29, July 17, 2024
Medicaid rules will be followed as identified in Part 2 and
					 Part 4 to determine the appropriate household and whose income will be
					 budgeted.
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 5 - CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) - CUB CARE › Section 144-332-5-8 - ELIGIBILITY PERIODS

Current through 2024-29, July 17, 2024
A. Coverage under
				  Cub Care is determined for a twelve-month enrollment period for all members of
				  a household, beginning with the month of application or, if ineligible for that
				  month, coverage starts in the following month. There is only one enrollment
				  period for a household.
B. Eligible
				  children may receive retroactive coverage of up to three months prior the
				  application month. The rules in Part 2, Section
				  13.4 apply.
C. The child remains eligible for the
				  12-month period without regard to changes in household income.
D. The individual must complete a renewal,
				  and be found eligible, in order for coverage to continue beyond the initial
				  twelve month enrollment period.
The individual will be sent a renewal notice at least 30
					 days before the 12-month enrollment period ends.
E. A child who has been covered by Cub Care
				  and whose household income exceeds 208% of the Federal Poverty Level at the end
				  of the 12-month enrollment period will be provided notice that their
				  application was transferred to the SBM and informed of the option to purchase
				  extended coverage through the Health Insurance Purchase Option (HIPO). Refer to
				  Chapter 335 Health Insurance Purchase Option (HIPO) in this manual. (10-144
				  C.M.R. Ch. 335)
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 5 - CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) - CUB CARE › Section 144-332-5-9 - NOTICES

Current through 2024-29, July 17, 2024
A.
Eligibility Notices
Individuals will be notified in writing as soon as
					 eligibility is determined. If some of the individuals applying for medical
					 coverage are eligible and some are not, the notice must specify who is or is
					 not eligible and the reasons for each individual's ineligibility.
Individuals whose eligibility begins after the month of
					 application must be sent a denial notice for the month(s) of
					 ineligibility.
When an individual is determined to be ineligible, the
					 notification will contain a statement that the application has been denied, the
					 specific reason(s) for the denial, the manual citations which support the
					 decisions, and an explanation of the individual's right to request a
					 hearing.
B.
Adverse
				  Action Notices
In situations when the intended action is to discontinue
					 eligibility or to reduce services, timely and adequate notice must be given to
					 the recipient. However, coverage will not be continued beyond the enrollment
					 period pending a hearing decision.
"Timely" means that the notice must be mailed 15 days
					 before the intended change would be effective (ten days for notice plus five
					 days for mail).
"Adequate" means a written notice which includes a
					 statement of the action the Department intends to take, the reasons for the
					 intended action, the regulations supporting such action, and an explanation of
					 the rights to request a hearing.
C.
Denials
If an application is denied for MAGI- Related Medicaid or
					 Cub Care, notification will be given that other coverage may be available if
					 the household has large medical bills or a child has a disabling condition. The
					 application will be transferred to the SBM.
D.
Closings
Before MaineCare or Cub Care coverage is ended or denied,
					 it must be determined that the individual is not eligible under any coverage
					 group.
If coverage under Cub Care is ended for a reason other than
					 that the enrollment period has ended, the individual will be given adequate and
					 timely notice.
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 5 - CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) - CUB CARE › Section 144-332-5-10 - ADMINISTRATIVE HEARINGS

Current through 2024-29, July 17, 2024
Rules regarding hearings are identified in Part 1, Section
					 7.
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 5.5 - CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) - CUB CARE › Section 144-332-5.5-5 - ASSETS

Current through 2024-29, July 17, 2024
There is no asset criteria for eligibility under Cub
					 Care.
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 5.5 - CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) - CUB CARE › Section 144-332-5.5-6 - INCOME STANDARD

Current through 2024-29, July 17, 2024
Household income must be greater than 157% and equal to or
					 less than 208% of the Federal Poverty Level (See Chart 6.5) for the family
					 size.
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 5.5 - CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) - CUB CARE › Section 144-332-5.5-7 - ELIGIBILITY BUDGETING PRINCIPLES

Current through 2024-29, July 17, 2024
In determining the appropriate household and whose income
					 will be budgeted, the rules of Medicaid will be followed as identified in Part
					 2 and Part 4.5.
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 6 - SUPPLEMENTAL SECURITY INCOME(SSI) - RELATED MEDICAID COVERAGE › Section 144-332-6-1 - SSI AND MEDICAID

Current through 2024-29, July 17, 2024
The Social Security Administration administers the SSI
					 Program which was established to meet the needs of aged, blind or disabled
					 individuals. The basic needs in the SSI Program are established for individuals
					 and couples by the Federal government.
Individuals who receive SSI or State Supplement payments,
					 or are eligible under Section 1619(b) of the
Social Security
					 Act
do not need to file a separate application for Medicaid. They are
					 automatically eligible for Medicaid unless they refuse to assign their rights
					 to medical payments (see Part 2, Section 6 ) for medical care or are ineligible
					 due to Medicaid Qualifying Trust rules (see Appendix H). Section 1619(b)
					 individuals are those who are considered disabled but their earned income
					 disqualifies them for an SSI payment. However, due to the use of a higher
					 income guideline by SSI, they continue to be carried as an open SSI case and
					 they are Medicaid eligible.
In general, the criteria in this section follows those used
					 by the Social Security Administration when determining the eligibility for
					 Supplemental Security Income (SSI) for individuals who are aged (at least age
					 65), blind or disabled. When the SSI office makes an eligibility decision based
					 on disability or blindness the decisions may not be overturned by the
					 Department unless new information is presented, or conditions change. In this
					 case, an independent decision of the individual's or couple's eligibility
					 Medicaid may be 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 6 - SUPPLEMENTAL SECURITY INCOME(SSI) - RELATED MEDICAID COVERAGE › Section 144-332-6-2 - SSI APPEALS OF DISABILITY DECISIONS

Current through 2024-29, July 17, 2024
If the Department of Health and Human Services has an open
					 Medicaid case in any category, except for temporary coverage, this coverage
					 will continue until a decision is reached on an SSI application or appeal
					 regarding disability or until other Medicaid eligibility criteria are not met.
					 The appeal must be filed in a timely manner according to SSI
					 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 › Part 6 - SUPPLEMENTAL SECURITY INCOME(SSI) - RELATED MEDICAID COVERAGE › Section 144-332-6-3 - RETROACTIVE MEDICAID BENEFITS FOR SSI RECIPIENTS

Current through 2024-29, July 17, 2024
An individual who has been determined by the Disability
					 Determination Services (DDS) to meet the disability criteria for receipt of SSI
					 also meets the disability criteria for SSI - Related Medicaid benefits for the
					 three months prior to application for SSI benefits. If there is an indication
					 that the onset of the disability was between the first day of the third prior
					 month and the application date eligibility begins with the first month of
					 disability. Unless there is information to the contrary, the individual's
					 statement of the onset may be accepted. If there is an indication that the
					 individual was not disabled on the first day of the third month prior to the
					 application for SSI, and if there is no information which would indicate the
					 date of the onset of disability, then the procedures outlined in Section 4.3 of
					 this Part must be followed. In determining retroactive Medicaid eligibility for
					 all SSI recipients (aged, blind or disabled) all eligibility factors must be
					 met. The best information available regarding income and assets should be
					 used.
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 7 - SSI - RELATED MEDICAID BUDGETING › Section 144-332-7-1 - TREATMENT OF SSI - RELATED ASSETS

Current through 2024-29, July 17, 2024
Assets, other than those excluded in Part 16, must be under
					 the following limits on any day of the month to be eligible for that
					 month.
Section 1.1
:
				  Categorically Needy Asset Limit
$2000 for a single individual, a married individual not
					 living with a spouse or a child.
$3000 for an individual living with an ineligible spouse or
					 an eligible couple.
Section
				  1.2
: Working Disabled Asset Limits
$8000 for a single individual, a married individual not
					 living with a spouse or a child.
$12,000 for an individual living with an ineligible spouse
					 or an eligible couple.
Section
				  1.3
: Deeming of Assets
When an eligible individual is living in the same household
					 with an ineligible spouse, or if the eligible individual is a child under age
					 18 residing in the same household with a parent, the assets of the spouse or
					 parent must be included in determining eligibility.
The assets of an ineligible spouse, or parent living with
					 the individual, are deemed to the individual and are combined with the
					 applicant's own assets.
Section
				  1.3.1
Exclusions to Deeming Process
The assets listed below are excluded in determining the
					 amount of the ineligible spouse's or ineligible parent's assets:
I. Assets excluded in Part 16 are also
				  excluded here.
II. Assets owned by
				  a stepparent.
III. Pension Funds
				  (and other retirement accounts) which belong to the ineligible spouse or
				  ineligible parent.
IV. Parent's
				  assets are not considered in determining eligibility for the "Katie Beckett"
				  coverage group.
V. If the asset is
				  only in the child's name, then it does not affect the parent's eligibility
				  since there is no deeming from child to parent.
VI. In determining eligibility for a child
				  some assets may be deducted for legal parents and the balance applied to the
				  child's asset limit. No assets are deducted for a stepparent.
The non-excluded assets of the parent in excess of $2000
					 (if the child is living with one legal parent) or $3000 (if the child is living
					 with both parents) are deemed to the child and combined with the child's own
					 non-excluded assets. The combined amount of deemed and own assets must be under
					 the $2000 limit.
Example
The legal parents of Joe have non-excluded assets that
					 total $4000. Joe has $200 of non-excluded assets of his own. We will deem $1000
					 of the parent's assets to Joe. Joe now has $1200 of countable assets which will
					 be applied against his $2000 asset limit.
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 7 - SSI - RELATED MEDICAID BUDGETING › Section 144-332-7-3 - SSI - RELATED BUDGETS FOR AN INDIVIDUAL/CHILD

Current through 2024-29, July 17, 2024
The following describes budgeting for:
* SSI or State Supplement for eligible individuals.
* Pickle, DAC, DWB for eligible individuals.
* Categorically Needy Medicaid for eligible
					 individuals.
* SSI, State Supplement and Categorically Needy Medicaid
					 for eligible children.
Note
: If an individual is over income or
					 assets under Categorically Needy, eligibility needs to be determined under
					 Medically Needy criteria (See Part 10).
Section
				  3.1
: Budget for SSI or State Supplement Payment
I. Combine all gross unearned
				  income.
II. Subtract the $20.00
				  Federal Disregard where applicable. The remainder is the net unearned
				  income.
III. Combine all gross
				  earned income.
IV. Subtract any
				  remainder of the $20.00 Federal Disregard not deducted from unearned
				  income.
V. Subtract any
				  Impairment-Related Work Expenses (IRWE) outlined in Appendix B.
VI. Subtract the earned income disregard of
				  $65.00.
VII. Divide the remaining
				  earned income by two. The remainder is net earned income.
VIII. Combine net earned and unearned income.
				  The remainder is total net income.
If total net income is below the appropriate SSI Income
					 Standard for one, based on living arrangement, the individual meets the income
					 criteria for an SSI payment.
If receiving SSI, the individual also gets a State
					 Supplement. If over income for SSI, s/he may be eligible for a State Supplement
					 only payment.
IX. Subtract
				  the State Disregard for one ($55.00), except for those in living arrangements
				  D, E, F, G, I (See Chart 3.6). The remainder is countable income.
If countable income is below the appropriate State
					 Supplement Income Standard for one, based on living arrangement, the individual
					 meets the income criteria for the State Supplement only payment (See Part 11
					 for more information on State Supplement 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 7 - SSI - RELATED MEDICAID BUDGETING › Section 144-332-7-4 - BUDGET FOR A COUPLE OR FOR AN ELIGIBLE INDIVIDUAL WITH AN INELIGIBLE SPOUSE

Current through 2024-29, July 17, 2024
The following describes budgeting for an eligible couple or
					 eligible individual with an ineligible spouse:
* SSI or State Supplement
* Pickle, DAC, DWB
* Categorically Needy Medicaid
* SSI, State Supplement and Categorically Needy
					 Medicaid
Note
: If over income or assets under
					 Categorically Needy, eligibility needs to be determined under Medically Needy
					 criteria (See Part 10).
In SSI - Related coverage groups, when one spouse is
					 receiving an SSI/State Supplement benefit, that spouse is included in the
					 assistance unit. The SSI/State Supplement payment is excluded income. All other
					 countable income of the SSI/State Supplement recipient is used to determine
					 eligibility for the assistance unit.
Example
Barb Van Marpel receives SSDI of $600 and SSI of $57.00.
					 Her husband Antonio, age 83, has retirement income of $300, monthly. Barb is
					 eligible for Medicaid because she receives SSI. Eligibility needs to be
					 determined for Antonio. The budget for his eligibility will use Barb's SSDI of
					 $600 and his retirement of $300. The budgeting process used is for an eligible
					 couple.
Section 4.1
: Budget for
				  SSI or State Supplement Payment
I.
Budget for an Eligible Couple
Follow the budgeting steps for an individual with the
					 following exceptions:
A. the income of
				  the couple is used
B. the State
				  Disregard for two is used in Step IX ($80.00).
C. Net income is compared to the SSI Income
				  Standard for two based on living arrangement.
D. If ineligible for SSI, countable income is
				  compared to the State Supplement Income Standard for two based on living
				  arrangement.
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 7 - SSI - RELATED MEDICAID BUDGETING › Section 144-332-7-5 - KATIE BECKETT COVERAGE

Current through 2024-29, July 17, 2024
Katie Beckett is a MaineCare coverage group for children
					 who are ineligible under a Family - Related or any other SSI - Related coverage
					 group and who:
I. are age 18 and under
				  (up to age 19);
II. reside in the
				  community (not in a medical institution);
III. meet the SSI/SSA criteria for
				  disability; and
IV. need in-patient
				  care provided by a hospital, nursing facility, psychiatric hospital, or an
				  ICF-MR. The cost of providing care outside the facility must not exceed the
				  annual cost of institutional care needed by the child as determined by the
				  Office of MaineCare Services.
V. If
				  a child covered under Katie Beckett no longer resides with the parent(s),
				  parental deeming under SSI - Related rules ends (See Section 2.2.3 of this
				  Part). The child may then be eligible as SSI - Related and may not need the
				  Katie Beckett coverage group.
Section
				  5.1
: Income and Assets
If the criteria in I - IV above are met, the income and
					 assets of the child only are considered in determining financial eligibility.
					 Parental income and assets are disregarded. There is no cost of care and there
					 is no penalty for transfer of resources.
I. The child's gross income as defined in SSI
				  - Related coverage must be less than or equal to the Categorical Nursing Care
				  Limit (see Chart 4.1). If income exceeds this amount, the individual is not
				  eligible.
II. The child's countable
				  assets as defined in Part 16 must be less than $2,000.
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 8 - MEDICARE SAVINGS PROGRAM [BUY-IN] › Section 144-332-8-1 - PROGRAM SCOPE

Current through 2024-29, July 17, 2024
The Medicare Savings Program (MSP), also known as the
					 Buy-In, provides qualified Medicare eligible individuals with Medicaid coverage
					 that pays for their Medicare premiums. The Department also provides additional
					 benefits for Qualified Medicare Beneficiaries (QMB), which are detailed
					 below.
The Social Security Administration (SSA) enrolls SSI
					 recipients for the Buy-In of Medicare Part B premiums. If the individual needs
					 assistance with payment of Medicare Part A premiums, DHHS enrolls the
					 individual in Qualified Medicare Beneficiaries (QMB). See Section 4.1 of 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 8 - MEDICARE SAVINGS PROGRAM [BUY-IN] › Section 144-332-8-2 - BASIC ELIGIBILITY REQUIREMENTS

Current through 2024-29, July 17, 2024
Individuals may be eligible for Buy-In if they meet the
					 criteria of one of the groups listed in Section
					 4 of this Part. If not open for or
					 applying for MaineCare, these individuals need to file an application for
					 Buy-In with the Department.
Individuals must meet the basic eligibility requirements
					 for SSI - Related MaineCare described in Part 6, except for individuals who
					 have been diagnosed with end stage renal disease (ESRD). Individuals with an
					 ESRD diagnosis do not need to meet the age or disability
					 requirements.
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 8 - MEDICARE SAVINGS PROGRAM [BUY-IN] › Section 144-332-8-3 - FINANCIAL ELIGIBILITY REQUIREMENTS

Current through 2024-29, July 17, 2024
SSI - Related Categorically Needy MaineCare budgeting rules
					 are used to determine Buy-In eligibility.
Buy-In is a separate benefit within Medicaid. As a result,
					 one spouse of an eligible couple can choose to be an ineligible spouse to give
					 Medicaid eligibility to the other, and at the same time the couple will both be
					 considered for Buy-In eligibility.
Example
Mr. and Mrs. Mazure apply for MaineCare. Both have
					 Medicare. Mr. Mazure has Social Security income of $920. Mrs. Mazure has Social
					 Security income of $600. Using SSI -Related Categorically Needy budgeting for
					 an eligible couple, both are eligible for Buy-In but over income for Medicaid.
					 Mrs. Mazure has to see a specialist, and Mr. Mazure does not. Mr. Mazure can
					 choose to be counted as an ineligible spouse for MaineCare. We then use the
					 exclusions to deeming found in Part 7, Section 2.2.2, resulting in Mrs. Mazure
					 being eligible for Medicaid, and both of them being eligible for Buy-In.
There is usually a delay between the time an individual is
					 eligible for the Buy-In and the time the Buy-In premium payment begins. During
					 this time, the individual continues to have premiums deducted from their Social
					 Security benefits (See Appendix A).
Section
				  3.1:
Individual Who Opted Out of Medicare
Individuals who are not automatically enrolled in Medicare
					 Part A or B, are not entitled to premium-free Medicare Part A (such as those
					 individuals over age 65 but who did not pay enough Medicare taxes), or who opt
					 out of Medicare Part A and/or B coverage when it is first offered, are
					 considered entitled to enroll in Medicare. These individuals are eligible to
					 apply for Buy-In. The Department will start their coverage without waiting for
					 open enrollment.
The Medicare Part A and/or B start date will be the
					 effective date of the Buy-in.
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 8 - MEDICARE SAVINGS PROGRAM [BUY-IN] › Section 144-332-8-4 - COVERAGE TIERS

Current through 2024-29, July 17, 2024
Section 4.1:
Qualified Medicare Beneficiary (QMB)
I. Eligibility Requirements for QMB
A Qualified Medicare Beneficiary is an individual
					 who:
A. is entitled to Medicare Part A
				  or voluntarily enrolled in Medicare Part A;
B. has income equal to or less than 150% of
				  FPL; and
C. may have assets.
				  Effective January 1, 2024, there is no asset test.
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 9 - LIMITED BENEFIT GROUPS › Section 144-332-9-2 - BREAST AND CERVICAL CANCER

Current through 2024-29, July 17, 2024
Medicaid is provided to women who are under age 65 and
					 otherwise meet the eligibility guidelines set forth in DHHS Rules for the Maine
					 Breast and Cervical Health Program (MBCHP), 10-144, Chapter 707
et
					 seq
. MaineCare coverage is also available for women diagnosed with
					 breast or cervical cancer, or a pre-cancerous condition and who meet the
					 eligibility guidelines set forth in DHHS Rules relating to the Breast &
					 Cervical Cancer Prevention and Treatment Act (BCCPTA), 10-144 C. M. R. Ch. 708
et seq
.
Individuals are initially authorized coverage under these
					 groups based on data collected by the Maine Center for Disease Control and
					 Prevention (MCDC) and transferred electronically to the Office for Family
					 Independence (OFI). Coverage is continuous for one year or as long as the
					 individual is in need of treatment, whichever is longer. When eligibility under
					 these groups ends, the individual will be reviewed by OFI for continued
					 coverage under another MaineCare coverage group.
Basic Non-Financial eligibility requirements for getting
					 Medicaid coverage identified in Part 2 also apply to these groups. This
					 includes the rules on residency, citizenship, social security numbers, and
					 assignment of rights to medical payments.
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 9 - LIMITED BENEFIT GROUPS › Section 144-332-9-3 - NON-CATEGORICAL ELIGIBILITY

Current through 2024-29, July 17, 2024
(Repealed effective December 31, 2013, filing
					 2013-321)
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 9 - LIMITED BENEFIT GROUPS › Section 144-332-9-4 - LIMITED FAMILY PLANNING BENEFIT (LFPB)

Current through 2024-29, July 17, 2024
This coverage group is effective October 1, 2016.
The Limited Family Planning Benefit is a limited Medicaid
					 benefit that provides coverage to individuals, regardless of gender, for family
					 planning and related services.
Coverage is available only to individuals who have not been
					 determined otherwise eligible for any Categorically Needy or Medically Needy
					 coverage group. If an individual, who is eligible for this benefit, is
					 determined eligible for any Categorically Needy or Medically Needy coverage
					 group, they shall be moved to that coverage group. This change in coverage
					 includes individuals who newly meet a deductible.
If an individual, enrolled in a full coverage group,
					 becomes ineligible for that coverage (including someone who must meet a new
					 deductible), but is eligible for Family Planning benefits, that individual can
					 be enrolled in Family Planning coverage.
1.
Basic Eligibility Requirements
Basic Non-Financial eligibility requirements for receiving
					 MaineCare coverage identified in Part 2 apply to this group. This stipulation
					 includes meeting the requirements for residency, citizenship, social security
					 numbers, and assignment of rights to medical payments and support rights, as
					 well as applying for other benefits. The Limited Family Planning Benefit has no
					 gender or age requirements.
Pregnant individuals are not eligible for coverage under
					 this benefit.
A.
Assets
LFPB has no asset criteria.
B.
Income
Individual income must be equal to or less than 209% of the
					 Federal Poverty Level.
C.
Budgeting
MAGI-based budgeting rules for Medicaid are used to
					 determine countable income. The assistance unit only consists of the individual
					 applying 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 10 - MEDICALLY NEEDY ELIGIBILITY CRITERIA › Section 144-332-10-1 - MEDICALLY NEEDY COVERAGE GROUPS

Current through 2024-29, July 17, 2024
Section 1.1:
Eligible Medically Needy Groups
The Medically Needy coverage groups are available to
					 individuals who meet the categorical criteria of a Medical coverage but are
					 ineligible because of excess income. Individuals eligible for the Medically
					 Needy coverage groups include:
I.
				  Persons who are aged, blind, or disabled (as defined in Part 6, Section 4
				  )
II. Children under age
				  21
III. Pregnant Women
IV. Parent/Caretaker Relatives (as defined in
				  Part 3, Section 2.2 )
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 10 - MEDICALLY NEEDY ELIGIBILITY CRITERIA › Section 144-332-10-2 - MEDICALLY NEEDY ELIGIBILITY PERIOD

Current through 2024-29, July 17, 2024
Section 2.1:
The Prospective Period
The Medically Needy eligibility period is the time period
					 during which the individual or family is assigned a deductible. This time
					 period begins the first day of the month the individual first applied for
					 Medicaid (See Part 2 Section 11 ), or the first day of the month after the date
					 Medicaid ended because of excess income. The time period lasts six consecutive
					 months.
An applicant may choose to withdraw their application for
					 the month of submission and start the Medically Needy period for the following
					 month, which would alter the retroactive period. (See 2.2 below.)
The six-month deductible period is shorted if:
I. The individual will turn age 21 in less
				  than six months;
II. The individual
				  dies;
III. The individual becomes
				  eligible for categorical coverage; or
IV. The individual voluntarily withdraws from
				  the 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 10 - MEDICALLY NEEDY ELIGIBILITY CRITERIA › Section 144-332-10-3 - FINANCIAL ELIGIBILITY REQUIREMENTS

Current through 2024-29, July 17, 2024
Section 3.1:
Medically Needy Assets
Assets must be under the following limits on at least one
					 day of the month to be eligible for that month.
For SSI - Related coverage groups:
$2000 for an individual not married or not living with a
					 spouse, including an individual who is a child.
$3000 for an eligible couple or an individual living with
					 an ineligible spouse There is no asset limit for MAGI-based coverage
					 groups.
Section 3.2:
Medically Needy Income
Treatment of income varies depending on whether the person
					 is receiving Medically Needy coverage in an SSI-Related or MAGI-based coverage
					 group.
I. For SSI-Related
				  groups
,
budgeting rules in Part 7 are used to determine countable
				  income.
II. For MAGI-based groups,
				  budgeting rules in Part 4 are used to determine the assistance unit and
				  countable income, except that income of a non-responsible relative is not
				  counted when determining the deductible. A responsible relative is defined as a
				  spouse or a biological or adoptive parent of a child under age 19.
The countable income is compared to the Protected Income
					 Level (PIL). The PIL is based on family size and can be found in Chart 5. When
					 the individual or family's net countable income is above the PIL a deductible
					 must be met. Due to differences in income counting methodology applicable to
					 categorically needy and Medically Needy coverage groups, an individual may be
					 ineligible for coverage in a categorically needy coverage group but have
					 countable income under the PIL for Medically Needy coverage. An individual in
					 this situation receives Medically Needy coverage without first having to incur
					 any medical costs.
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 10 - MEDICALLY NEEDY ELIGIBILITY CRITERIA › Section 144-332-10-4 - DEDUCTIBLE PROCESS

Current through 2024-29, July 17, 2024
Individuals who are ineligible under Categorically Needy
					 and whose income is above the appropriate Protected Income Level (PIL) are not
					 eligible for Medicaid until they meet a deductible. The deductible is met by
					 applying incurred costs for necessary medical services to the deductible
					 amount.
Section 4.1:
Calculating
				  the deductible amount
I. Determine the
				  countable income.
II. Subtract the
				  PIL for the appropriate assistance unit size (See Chart 5) from the countable
				  income.
III. Multiply the result by
				  the number of months in the eligibility period (usually six months).
The result is the deductible amount the individual or
					 family must meet by applying incurred medical costs before coverage can
					 begin.
The deductible amount must be reviewed prior to opening
					 coverage. When changes occur that impact Medically Needy eligibility (e.g.
					 changes in income or household composition), eligibility is redetermined and
					 the deductible amount is recalculated. If the Medically Needy period ends or
					 the deductible amount increases, the Eligibility Specialist must give the
					 individual timely and adequate notice of the change. (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 332 - MAINECARE ELIGIBILITY MANUAL › Part 10 - MEDICALLY NEEDY ELIGIBILITY CRITERIA › Section 144-332-10-5 - APPLICABLE MEDICAL COSTS

Current through 2024-29, July 17, 2024
Medical costs are applied in the following order:
I. Verified medical insurance premiums,
				  including Medicare.
Note
: Indemnity insurance premiums are not
					 allowed. These are policies that pay for length of stay or a condition (such as
					 cancer) but not for a specific service.
II. Verified actual costs incurred during the
				  eligibility period for medical or remedial care costs not covered under
				  Medicaid such as eyeglasses, dental services and hearing aides for individuals
				  over age 21.
III. Medical costs
				  incurred during the eligibility period by individuals who are part of the
				  assistance unit but not eligible for coverage (such as an ineligible spouse or
				  deeming parent in an SSI - Related unit or the parents of an individual whose
				  eligibility is based on being under age 21).
IV. The unpaid balance on a loan taken out to
				  pay for an old medical bill which was incurred prior to the eligibility period
				  provided:
A. The proceeds of the loan were
				  used to pay the medical bill. Only the amount of the loan actually used to pay
				  the old medical bill may be deducted. Any portion used for another purpose may
				  not be deducted.
B. Neither the
				  medical bill nor the unpaid balance of the loan was previously applied against
				  another deductible.
C. Only the
				  principal part of the unpaid balance may be used in the deductible - not the
				  interest.
This provision allows the individual to use the liability
					 to the lender in place of the liability to the provider.
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 10 - MEDICALLY NEEDY ELIGIBILITY CRITERIA › Section 144-332-10-7 - VERIFICATION OF MEDICAL COSTS

Current through 2024-29, July 17, 2024
All costs applied to the deductible must be verified. For
					 each item, with the exception of transportation costs, the applicant must
					 provide a dated bill or receipt showing the name of the provider, date of
					 service, type of service, costs and any insurance payments. If the applicant
					 does not provide an appropriate bill or receipt, the cost cannot be
					 applied.
For transportation, the individual's record must show the
					 reason the cost was incurred, the place visited and the date. A receipt is
					 required if the applicant paid someone else for the transportation. If the
					 applicant's car was used, the actual cost of gas and oil may be calculated or a
					 mileage cost allowed (using current allowance authorized by State Employees
					 Contract). The individual should be given the opportunity to choose whichever
					 option they prefer.
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 11 - STATE SUPPLEMENT › Section 144-332-11-1 - NON-FINANCIAL CRITERIA

Current through 2024-29, July 17, 2024
When determining eligibility for the State Supplement only,
					 the individual must comply with Medicaid rules for assignment of rights (See
					 Part 2, Section 6 ) and residency (See Part 2, Section 4 ).
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 11 - STATE SUPPLEMENT › Section 144-332-11-2 - INDIVIDUALS INELIGIBLE FOR SSI DUE TO THE 8/96 CITIZENSHIP RULES

Current through 2024-29, July 17, 2024
When individuals have been denied SSI due to the 8/96
					 citizenship rules they may be eligible for a State Supplement payment. Upon
					 application to the Department they must meet all other eligibility criteria in
					 this section. This excludes individuals eligible for emergency services
					 only.
State Supplement budgeting rules, found in Part 7, Section
					 2, are used to determine countable income. The payment is the difference
					 between countable income and the maximum SSI payment plus the State Supplement
					 amount for the living arrangement.
Example:
Barb Doyle is a 70 year old individual who is not eligible
					 for SSI due to 8/96 citizenship rules. She is receiving a pension of $300 and
					 lives in the community.
Her countable income is:
$ 300
Pension
- $20
Federal Disregard
- $ 55
__________
State Disregard
$ 225
Countable Income
Her payment amount is:
$ 674
Max SSI payment level (eff. 1/09)
+ $ 10
________
State Supplement payment level
$ 684
- $ 225
_____________
Countable Income
$ 459
Payment Amount
If we know the individual is not eligible for SSI due to
					 citizenship rules described above, there is no need for a separate SSI
					 eligibility 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 11 - STATE SUPPLEMENT › Section 144-332-11-3 - SUBSTANTIAL GAINFUL ACTIVITY (SGA)

Current through 2024-29, July 17, 2024
"Substantial Gainful Activity" (SGA) is full or part time
					 work that involves physical or mental activities which are usually done for pay
					 or profit, although there may not be a profit.
Applicants who have average monthly earnings of more than
					 $980 a month are considered to be engaging in SGA. (see Appendix B for
					 calculation of this application pretest).
Applicants who are determined to be engaged in Substantial
					 Gainful Activity are not eligible for State Supplement.
Applicants who have stopped work in the month of
					 application do not have to meet the SGA test. Any income from the terminated
					 employment is countable income.
Recipients who are working must continue to meet the
					 definition of disability.
The following are examples of activities that would not be
					 considered Substantial Gainful Activity:
I. A job is made for an individual out of
				  sympathy or compassion, or which can be performed only because others provide
				  more assistance or supervision than would be characteristic of a bona fide
				  employment situation or a market for the goods or services is created more out
				  of sympathy than intrinsic value received.
II. A job that is part of occupational
				  therapy prescribed and supervised by a physician.
III. An activity which is in the nature of a
				  hobby and does not provide a bona fide job opportunity from the standpoint of
				  genuine economic demand and remuneration.
IV. Activity which is part of an active
				  Vocational Rehabilitation program constituting training and supervised by a
				  rehabilitation 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 11 - STATE SUPPLEMENT › Section 144-332-11-4 - MONTH OF FIRST PAYMENT

Current through 2024-29, July 17, 2024
I. For those living
				  alone/with others or residing in a Flat Rate Boarding Homes or Adult Foster
				  Homes, the State Supplement benefit starts the month following the month of
				  application or the month of eligibility, whichever is later.
For example, if an individual applies for and is eligible
					 for SSI in 3/08, the first month for which the SSI and State Supplement
					 benefits are authorized will be 4/08.
II. For Cost Reimbursed Boarding Homes, Adult
				  Family Care Homes and Residential Care Facilities, the State Supplement benefit
				  will be effective the month following the month a decision is made.
For example, if the State Supplement is being authorized on
					 June 2nd, July will be the first month a check is issued.
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 11 - STATE SUPPLEMENT › Section 144-332-11-6 - CHANGES IN LIVING ARRANGEMENT

Current through 2024-29, July 17, 2024
If an individual is receiving a State Supplement in one
					 living arrangement and moves to a different arrangement, any increase in
					 benefit will be made effective the month the individual is in the new living
					 arrangement up to three months retroactive to the month the move is reported to
					 the Department.
Any decrease in benefits will be given timely notice of
					 adverse action.
For example, the individual moves from a Cost Reimbursed
					 Boarding Home to his own home and reports this on 7/2. The August State
					 Supplement payment will be reduced to $10.00. If this had been reported on
					 7/22, the September payment would be reduced to $10.00.
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 11 - STATE SUPPLEMENT › Section 144-332-11-7 - SSI CLOSINGS

Current through 2024-29, July 17, 2024
When the individual is receiving a State Supplement and SSI
					 and the SSI is subsequently closed, the State Supplement payment will be ended
					 unless the individual is eligible for a State Supplement only payment or the
					 SSI closing is timely appealed with SSI and the individual meets all other
					 eligibility 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 › Part 11 - STATE SUPPLEMENT › Section 144-332-11-8 - REPRESENTATIVE PAYEE

Current through 2024-29, July 17, 2024
A Representative Payee for an SSI or SSA payment may be
					 used for the State Supplement check.
If not receiving an SSI or SSA benefit, the State
					 Supplement check may be received by other than the individual if that person is
					 the individual's legal guardian, conservator or has power of
					 attorney.
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 11 - STATE SUPPLEMENT › Section 144-332-11-9 - LOST, STOLEN, DESTROYED, OR RETURNED CHECKS

Current through 2024-29, July 17, 2024
When an individual reports a check has been lost, stolen or
					 destroyed prior to cashing, the agency has the responsibility to replace it. In
					 the instances when there is reason to believe there has either been a forgery
					 or duplicate checks have been received and cashed by the recipient, the
					 following procedures have been established.
I.
Forgeries
When the photocopy of the original check is sent to the OFI
					 office, staff must meet face-to-face with the individual or Representative
					 Payee to determine whether or not the signature is theirs. If the individual or
					 Representative Payee states it is not, then a Forgery Affidavit will be
					 completed (SWIM-052) and the original sent to FIR with a copy to Division of
					 Financial and Personnel Services and a copy for the record. This initiates an
					 investigation to determine who cashed the check.
If the individual or Representative Payee agrees that the
					 signature on the original check is theirs, OFI staff may refer for
					 fraud.
II.
Replacing
				  a Check
When a household presents a damaged check, which a bank
					 refuses to cash, the worker will take the following steps:
A. Complete a SWIM-050 (Stop
				  Payment).
B. Complete a SWIM-051
				  (Application for a Duplicate Check).
C. Void the damaged check.
D. Forward the original forms and the damaged
				  check to the Division of Financial and Personnel Services. A copy is retained
				  for the record.
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 11 - STATE SUPPLEMENT › Section 144-332-11-10 - EBT METHOD OF PAYMENT; PERMISSIBLE USE

Current through 2024-29, July 17, 2024
When expended using an Electronic Benefits Transfer (EBT)
					 card, State Supplement benefits are subject to the same purchase restrictions
					 as those described in
					 22 M.R.S.
					 §3763(11) and
					 10-144 C.M.R. 331, Ch. VI,
					 governing Temporary Assistance for Needy Families (TANF) benefits. These
					 restrictions do not apply to federal SSI benefits. When the recipient chooses
					 to have funds distributed to them as direct deposit or check, State Supplement
					 benefits are not subject to the above purchase restrictions.