Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › Part 2 - BASIC ELIGIBILITY CRITERIA › Section 144-332-2-12 - CLIENT AND DEPARTMENT RESPONSIBILITIES

Current through 2024-29, July 17, 2024
Section
				  12.1:
Verification of Eligibility Factors
The individual or the individual's authorized
					 representative is responsible for verifying information for all persons in the
					 household whose circumstances affect the eligibility determination. If this
					 information is not provided and cannot be verified electronically by the
					 Department, or electronic verification is inconsistent with the individual's
					 attestation, the Department will notify the individual or the authorized
					 representative what items require resolution. If, following this notice,
					 verifications are not received, the Department is not able to determine
					 eligibility and a denial or closure notice will be issued. It is the
					 responsibility of the Department to assist the individual in establishing
					 eligibility for MaineCare.
Verification of information needed to determine eligibility
					 must be requested initially from the individual. If information is requested
					 from other sources (with the exception of public records) the individual must
					 be informed. If collateral contacts are necessary to determine eligibility and
					 the individual does not give consent, denial or closure must occur because the
					 Department is unable to determine eligibility.
Section 12.2:
Reporting
				  Responsibilities
It is the responsibility of the individual to report
					 changes of income, assets, household composition and any other change in
					 circumstances which affect eligibility for MaineCare. Such change is to be
					 reported within ten days from occurrence. For income purposes, "occurrence"
					 will be considered the date the increased income was received. For all other
					 purposes, "occurrence" will be considered the date the change took place.
					 Applicants and recipients are informed of reporting responsibilities in the
					 notice of eligibility.
Eligibility will be recalculated within 30 days of the
					 receipt of new information which may affect the level of MaineCare coverage or
					 cause ineligibility.
Section
				  12.3:
Temporary Coverage
Temporary Coverage is medical coverage that is authorized
					 because an application has not been processed, by no fault of the applicant or
					 their representative, and an eligibility decision has not been issued, within
					 forty-five days of the application date. As described in Section 3.3 of this
					 part, Temporary Coverage will not be granted following the 90-day reasonable
					 opportunity period.
Section 12.3.1:
45-Day Processing Standard
The applicant must be sent a notice of eligibility no later
					 than 45 days after the date of application. The 45-day processing standard is
					 the result of the settlement of a court case,
Polk, et al. v.
					 Longley
. The consent decree stated that all applications must be acted
					 upon and a decision made as quickly as possible.
I. Temporary Coverage is authorized when:
A. a decision is not made within 45 days. The
				  Department must authorize temporary coverage. This provides medical coverage
				  from day 46 until a final decision is made on the application.
B. it is necessary to obtain medical reports
				  from physicians, hospitals, or other medical sources and such medical
				  information is not requested from all necessary sources within five days after
				  the date of application. If the reports are not received within 15 days of the
				  first request, a second request must be sent. The applicant is to be notified
				  whenever a second request is made to inform the individual that the necessary
				  medical reports have not been received.