10-144-332 Me. Code R. § 2-1
MaineCare is the name used by the State of Maine for programs that help individuals pay for health care costs. The Department's goal is to assist Maine residents in obtaining the benefits to which they are entitled. The programs are:
Medicaid (Title XIX of the Social Security Act). To be enrolled in Medicaid an individual must be both categorically and financially eligible. Each category has its own eligibility rules. Medicaid includes coverage for people living in the community or living in a long-term care facility.
Categorically Needy - This Medicaid category is made up of different mandatory and optional coverage groups covered within the state plan. An individual qualifies for Medicaid in this category if they meet the requirements of one of the Categorically Needy coverage groups.
Medically Needy - This Medicaid category provides coverage for individuals who meet the non- financial requirements of a Categorically Needy group but are financially ineligible. Coverage is gained by meeting a deductible.
Medicaid Waiver Groups - These are optional coverage groups approved by the Center for Medicare and Medicaid Services (CMS) under which an individual can become enrolled in Medicaid who might not otherwise be eligible. Examples are the Home and Community Based Waivers and the HIV Waiver.
Children's Health Insurance Program (CHIP), formerly known as Cub Care in Maine until 2024, is authorizing under Title XXI of the Social Security Act - This program provides coverage for children under the age of 19 within certain income limits. CHIP also provides coverage to pregnant individuals who are eligible for Medicaid but for their noncitizen status.
Medicare Savings Program (Buy-In) - This Medicaid category is a benefit for those who are entitled to Medicare Part A and who meet certain income criteria. Depending on income, the benefit is payment of Medicare Part B premium or payment of Medicare Part A and B premiums as well as coinsurance and deductibles.
The Office for Family Independence (OFI) also administers the following additional benefits under MaineCare:
Health Insurance Purchase Option (HIPO) - This program provides 18 months of extended health coverage to children under the age of 19 who are no longer eligible for MaineCare due to changes in income. (See 10-144 C.M.R. Ch. 335.)
Coverage for Noncitizens Under Age 21 - This state funded program provides coverage to individuals under the age of 21 who would be eligible for Medicaid but for their noncitizen status.
Low Cost Drugs for the Elderly and Disabled (DEL) - This state funded program assists elderly or disabled individuals with the cost of their medications. (See 10-144 C.M.R. Ch. 333.)
Maine Rx Plus - This state funded program assists Maine residents with the cost of their medications. Income guidelines are higher than under DEL and the benefit is less. (See 10-144 C.M.R. Ch. 334.)
State Supplement - This is a cash payment to SSI recipients, and individuals who would otherwise be eligible for SSI except for income or citizenship criteria. (See Part 11.)
Spousal Living Allowance - This is a cash payment to a spouse of a resident of a Residential Care Facility or Cost Reimbursed Boarding Home. The spouse must meet income and asset criteria. (See Part 12 Section 5.)
10-144 C.M.R. ch. 332, § 2-1