C.M.R. 10, 144, ch. 104, § 144-104-3, subsec. 144-104-3.03
Any person whose family income is less than or equal to 350% of the federal poverty level is eligible for the Maine Rx Plus Benefit. This is referred to as "financial eligibility." Applicants will remain eligible for one year beginning on the date determined eligible and must reapply annually.
In addition, any person who incurs unreimbursed expenses for prescription drugs equaling 5% or more of family income, or who incurs unreimbursed expenses for all medical care equaling 15% or more of family income, is eligible for the remainder of the eligibility period. This is referred to as "spend down eligibility."
The Department will use the following processes to determine eligibility:
The Office of Integrated Access and Support (OIAS) will determine family income as set forth at 10-144 C.M.R. Chapter 332, MaineCare Eligibility Manual. If the family income as determined by BFI is equal to or less than 350% of the federal poverty level, the applicant is financially eligible for Maine Rx Plus Benefits.
If applicants do not meet financial eligibility as determined by OIAS, they may request that the Department consider eligible expenses incurred by the household during the six months prior to application. This six-month period is the medical spend down eligibility period. The Department will use income information prorated for this time period to determine the percentage of expenses incurred during the medical spend down eligibility period. If the applicant's unreimbursed expenses for prescription drugs are equal to 5% or more of family income, or unreimbursed expenses for medical care are equal to 15% or more of family income, the applicant is eligible for Maine Rx Plus on the basis of the spend down.
To be considered for spend down eligibility applicants must submit receipts or bills for unreimbursed prescription drug expenses and/or medical expenses to the Maine Rx Plus Spend Down, Department of Health and Human Services, 11 State House Station, Augusta Maine, 04333-0011. Applicants may submit a signed statement of incurredexpenses for those expenses for which a receipt has been lost. If found eligible due to medical spend down, applicants will remain eligible for one year from the date application is made.
All documented, unreimbursed medical and prescription drug expenses incurred by the applicant or family member shall be considered in the spend down determination, except the following:
The Department will notify applicants within 30 days of receipt of documented prescription and medical expenses whether or not they are eligible for Maine Rx Plus.
C.M.R. 10, 144, ch. 104, § 144-104-3, subsec. 144-104-3.03