MaineCare Managed Care Assistance Program

In the last several years, the State of Maine has created managed care programs to serve many of those who receive MaineCare. Most parents and children that are enrolled in MaineCare are now required to join the state-run managed care plan called Maine PrimeCare. While these managed care plans offer a variety of benefits to consumers and providers, it also create a new set of rules, procedures, rights and responsibilities for consumers to learn. How do I use this service?

Our MaineCare Managed Care Assistance Project was created to help consumers navigate this new system in order to get the health care they need. Our toll-free HelpLine (1-800-965-7476) is here to assist consumers in resolving any problems with PrimeCare. The HelpLine is staffed by knowledgeable and friendly advocates that can help consumers resolve complaints, fix mistakes, and understand their rights.

Some specific issues that the Health Care Helpline can help consumers with include (but are not limited to):

• getting an exemption from participating in PrimeCare (if there is good cause)
• understanding and participating effectively in the appeals ("fair hearing") process.
• filing complaints with appropriate private or governmental organizations in the event that a client is mistreated
• finding MaineCare providers when all other resources have been exhausted
• problems with the referral process
• incorrect or improper billing to MaineCare or Cub Care participants
• referring consumers to non-profit or government agencies when appropriate.

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