MaineCare, the Medicaid program in Maine, offers vital healthcare coverage to diverse individuals, including children, elderly adults, people with disabilities, and those with low incomes. It is a collaborative effort jointly funded by the federal government's Centers for Medicare & Medicaid Services (CMS) and the State of Maine.

Eligibility for MaineCare is based on several criteria, including income levels, age, family circumstances, and specific healthcare needs. The program extends its benefits to those financially constrained or medically needy. In addition, certain services, like nursing home care and in-home services, necessitate financial and medical eligibility, ensuring that the assistance is directed to those who need it most.

MaineCare offers various medically necessary services, but coverage depends on factors such as income, age, medical needs, and whether assistance is required for Activities of Daily Living (ADLs). Not all services are covered for every coverage group, and most services have specific limits or rules.

Here are some of the covered services under MaineCare:

1. Doctor Visits: Includes routine check-ups, specialist consultations, and other visits to a healthcare provider for medical care.
2. Prescription Medications: Covers the cost of prescribed drugs. There may be limitations on the types of medications covered.
3. Behavioral Health Services: Encompasses mental health and substance abuse treatment, including counseling, therapy, and psychiatric services.
4. Gender Affirming Care Services: Includes treatments such as hormone therapy and surgeries for transgender individuals to affirm their gender identity.
5. X-rays and Labs: Diagnostic services like X-rays, blood tests, and other laboratory tests used to diagnose and monitor health conditions.
6. Emergency and Hospital Visits: Covers care in emergencies and services received during a hospital stay.

Remember to verify with MaineCare whether a specific service is covered under your coverage group before seeking care.

The eligibility for MaineCare, Maine's Medicaid program, is primarily based on household size and monthly income before taxes. The income limits vary depending on the category of individuals in the household. Here's a summary:

Children and Young Adults (19-20 years):

• For a household of one, the income limit is $3,828 per month.
• For each additional family member, add $1,345 to the income limit.

Adults (21-64 years):

• For a household of one, the income limit is $1,733 per month.
• For each additional family member, add $597 to the income limit.

Pregnant Individuals:

• For a household of two, the income limit is $3,646 per month.
• For each additional family member (or expected baby), add $938 to the income limit.

Please note that these amounts are guidelines and may vary. You may still qualify for MaineCare even if your income is above these limits, as there are different coverage categories with their own income limits.

If you do not qualify for MaineCare, you might be eligible for financial help to pay for health insurance through the individual marketplace. More information is available at CoverME.gov.

To apply for MaineCare, which is Maine's Medicaid program, follow these steps:

Check eligibility

Review the MaineCare Eligibility Guidelines for income limits based on your household size at Health Care Assistance webpage.

Complete application

• Online: Visit My Maine Connection to check if you are eligible and apply for MaineCare online.
• By mail: Download an application from here and mail the completed form to 114 Corn Shop Lane, Farmington, ME 04938.
• By phone: Call 1-855-797-4357. For TTY users, dial 711.
• In-person: Find the nearest district office address at this link or use the Office Finder webpage at http://gateway.maine.gov/dhhs-apps/office_finder/index.asp.

For additional support

• Call MaineCare Member Services at 1-800-977-6740. For those who are deaf or hard of hearing and have a TTY machine, call Maine Relay 711.
• Contact the OFI eligibility office at 1-855-797-4357 if you need a MaineCare card, have questions about your eligibility, experience changes in household, insurance, or employment, or require an administrative hearing regarding MaineCare coverage.

Remember to contact the Office for Family Independence (OFI) if your circumstances change, such as moving, changing phone numbers, pregnancy, changes in household members, getting or losing other health insurance, employment changes, or if you want an administrative hearing when your MaineCare coverage ends.

MaineCare requires annual renewal to maintain coverage. Here’s a summary of the renewal process and important considerations:

Update Contact Information:

Keep your contact information up-to-date with the Office for Family Independence (OFI) to ensure you receive all necessary communication. Update your information on MyMaineConnection.gov or call the eligibility office at 1-855-797-4357.

Annual Renewal Form:

The eligibility office will send you a renewal form each year. Watch for an envelope with a blue block containing renewal information and instructions. It’s crucial to complete and return the renewal form promptly. Failing to do so could result in losing your MaineCare coverage.

Reporting Changes:

If there are changes in your circumstances, you should report them to the eligibility office within ten days. These changes can include:

• Change of address
• Changes in income or assets
• Acquiring or losing other health insurance, including Medicare
• Changes in household composition, such as someone moving in or out
• Changes in marital status

For any queries or to report changes, call the eligibility office at 1-855-797-4357. Chapter 10 of the MaineCare handbook also provides addresses and phone numbers for local DHHS offices.