10- 144 C.M.R. ch. 332, § 1-1
The Maine Department of Health and Human Services is responsible for administering the MaineCare Program in compliance with Federal and State statutes and administrative policies. It is also responsible for state funded assistance programs found within this manual. Within the Department, the Office for Family Independence (OFI) establishes and applies written policies and procedures for taking applications and determining eligibility for assistance, consistent with the objectives of the Program. It also respects the rights of individuals under the United States Constitution, the Social Security Act, Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act and all other relevant provisions of Federal and State laws which do not result in practices that violate the individual's privacy or personal dignity. The Department further holds any policies or procedures developed at the regional level to be consistent.
Title VI of the Civil Rights Act of 1964 and the Americans with Disabilities Act states that no person shall be excluded from participation, be denied benefits, or be subjected to discrimination on the grounds of race, color, national origin, sex, gender orientation, religion or disability under any program or activity receiving federal financial assistance. Therefore, the programs of the Department, like every program or activity receiving financial assistance from the Federal Department of Health and Human Services, must be operated in compliance with the law.
In accordance with the Americans with Disabilities Act, no qualified individual with a disability will, by reason of such disability, be subjected to discrimination; or be excluded from participation or be denied the benefits of the services, programs or activities of the Maine Department of Health and Human Services.
"Assistance unit" means the individuals whose need the department considers when determining whether an applicant or recipient is eligible for program benefits.
An "Administrative Hearing" (Hearing) is a hearing between a participant and the Department that is less formal than a proceeding in traditional courtroom, but there still is an authority presiding and testimony and evidence are presented by both sides. A Hearings Officer or the Commissioner of the Department will oversee the Administrative Hearing by hearing both sides and review the action taken by the Department. The purpose of the Administrative Hearing is to ensure that Federal and State rules have been applied correctly. A hearing decision will be made in writing and provided to the participant and the Department within the timelines allotted in the Appendix.
Federally Facilitated Marketplace: The federally facilitated marketplace (FFM) is a website established and operated by the US federal government to facilitate the purchase of health insurance in accordance with the Patient Protection and Affordable Care Act.
"Intentional Program Violation" means that a recipient, applicant, or any other individual in the "Assistance Unit" has intentionally misrepresented facts (including, but not limited to such facts as living arrangement, income, or assets) in order to receive MaineCare, and the recipient, applicant, or any other individual in the Assistance Unit would not have been eligible for MaineCare if the Department had been notified of the correct facts, or of a material change in facts. This includes, but is not limited to:
"Overpayment" means program benefits that exceed the amount of program benefits, if any, for which an individual or assistance unit is actually eligible when the department or a court has determined that the benefits were provided as a result of an Intentional Program Violation by the individual.
"Program benefits" means payments for medical services or durable medical equipment and supplies, and/or the durable medical equipment and supplies, reimbursed by the department under the MaineCare program established pursuant to 22 MSRA ch. 855.
10- 144 C.M.R. ch. 332, § 1-1