Kids and Parents

For families with children 18 years old and younger

MaineCare is a program offered by the Department of Health and Human Services (DHHS). Families with children 18 years old and younger may be able to get free or low-cost MaineCare coverage. Families that qualify for free MaineCare do not have to pay any monthly premium. Families that qualify for low-cost MaineCare will have a small monthly premium. The premium is from $8 to $64 per month, depending on income level. What you'll find on this page: What's covered? Can my family get MaineCare? What are the income guidelines? What are the asset guidelines? How do I apply? Do I have to prove my citizenship and identity? What if my application is denied? What happens if my income goes up? What if I already have private insurance? Can I get old medical bills paid? Are there other program if my child is disabled? What if my income is too high for MaineCare?	...	Online Health Care Guide Helpful programs for the following groups of people: Kids and Parents Pregnant Women Young Adults Disabled or Elderly Adults Other Adults Other helpful programs for many groups of people: COBRA Dental DirigoChoice Hospital Programs Mental Health Prescription Drug Programs Private Insurance Substance Abuse Other Resources Getting Quality Health Care

What's covered?
Both Free MaineCare and Low-cost MaineCare offer the same great health benefits. MaineCare coverage is fairly comprehensive. It includes nearly all health services -- doctor's visits and treatment, hospital care, prescription drugs, physical therapy, mental health services, transportation to doctor's appointments and much more!

Can my family get MaineCare?
If your household income is at or below the guidelines listed below, your children can enroll in MaineCare. Parents will also have to meet an asset test. But, many assets will not count against you and assets will NOT affect your child's right to coverage or a pregnant woman's right to coverage. Click here for a list of assets that do not count against the parents. If you have questions, or are unsure whether you qualify, call our HelpLine at 1-800-965-7476. We can answer your questions, and you will receive helpful and friendly advice. This number is not a DHHS office, and no information will be given out without your consent. We can also help you fill out the application.

Income guidelines
For self-employed income, use your net income (after business expenses and taxes). For all other income types, use the gross amount (the amount before any taxes or expenses are taken out). Even if your income is above the levels listed you should apply anyway! Sometimes deductions to income can be made. If you have questions, or are unsure whether you qualify, call our HelpLine at 1-800-965-7476.

2009/2010* Monthly Income Guidelines for Low-Cost MaineCare Family Size Income 1 $1,805 2 $2,429 3 $3,052 4 $3,675 5 $4,299 6 $4,922 For each additional family member add: $624

2009/2010* Monthly Income Guidelines for Free MaineCare Family Size Income 1 $1,354 2 $1,822 3 $2,289 4 $2,757 5 $3,224 6 $3,692 For each additional family member add: $468

Note: Some money can be "disregarded" or ignored when applying. So even if you are a little over income guidelines listed above, you should apply anyway. If you are unsure, call our HelpLine at 1-800-965-7476.

*Income Guidelines are based on Federal Poverty Guidelines, which are calculated by a set formula every year. For the first time in the history of the Federal Poverty Guidelines, income limits for programs would have gone down for 2010. To avoid people losing coverage, the Obama Administration decided not to change the Federal Poverty Guidelines at all this year.

Asset guidelines
Assets do NOT count against children 18 years old and younger or pregnant women. For parents, many assets will NOT count against you. Families can own a home, land that the home sits on, cars and many other assets and still get MaineCare coverage!

Assets that do NOT count against you: The family’s home and surrounding lot Basic items used in day to day living, such as furniture, tools and equipment Two cars or trucks (the second vehicle must be necessary for employment, medical treatment, essential daily activities or modified for operation by a person with a disability or for the transportation of a person with a disability) Property used to produce income such as boats, trucks, machinery Money in a savings account, CD, pension plan, IRA – up to $8,000 for a single person; $12,000 for a family of two or more with minor children; $10,000 for an adult couple with no children in the home. Real property that is up for sale Loans that must be repaid The cash value of life insurance the family has purchased Up to $10,000 in a Family Development Account (FDA) that can be spent only for education, home repair, a car or truck needed for work or school, small business start up, health care, or to use for an emergency or other family need approved by DHHS Other less common assets listed in DHHS rules For assets not listed above: For children (18 and under) and pregnant women, MaineCare will not count any assets. For parents of children (18 and under), you are allowed to have $2,000 in addition to all of the assets that do NOT count against you which are listed above. If you have questions, or are unsure whether you qualify, call our HelpLine at 1-800-965-7476.

How do I apply?
There is a simple, two-page application that is easy to fill out and can be mailed to DHHS. You do not have to go to a DHHS office to apply. If it takes DHHS more than 45 days to make a decision, you may be able to get temporary coverage at no charge, until they make their decision. To get an application or for more information, call the HelpLine at 1-800-965-7476, or use the printable application available on the DHHS web site. You need to mail or drop off your completed application at the local DHHS office. [See complete listing of DHHS offices with addresses and phone numbers]. When you apply, you will need to send pay stubs or other proof to document your last four weeks of income. If you are self-employed you will have to send in your last years tax return including Schedule C - or more current records (a ledger) if your income has changed much from the year before.

Do I have to prove my citizenship and identity?
Yes. The federal government has required that all states now screen applicants for citizenship and identity. Non-citizens will not be reported or prosecuted, but they will only qualify for emergency services through MaineCare. Please call the HelpLine at 1-800-965-7476 if you have questions about this process and what kinds of documents your family will need to prove citizenship and identity. This number is not a DHHS office, and no information will be given out without your consent. We can help you fill out the application.

What if my application is denied?
Mistakes can be made. If you feel your household is eligible but your application is denied, you have the right to appeal the decision. Call the HelpLine at 1-800-965-7476 if you need assistance. Or, you can call your local DHHS office and ask for a Fair Hearing. It is always a good idea to make your appeal in writing as well, and send it in. [See complete listing of DHHS offices with addresses and phone numbers].

What happens if my income goes up?
For children under 18, coverage will continue for 12 months even if your income goes up. If your family is enrolled in free MaineCare and your income goes up, there is a free transitional program that can extend your coverage for up to 12 more months in some cases. If your family is enrolled in low-cost MaineCare, the parents may still be eligible for some transitional coverage, and the kids in the household can enroll in the Health Insurance Purchase Option (HIPO) once the 12 month coverage period has ended. HIPO is available for 18 months and currently costs $100 per month per child. Your MaineCare caseworker may not know about this program. You can call Third Party Liability at 1-800-572-3839 for more information, or call the HelpLine at 1-800-965-7476 if you need assistance.

What if I already have private insurance?
The answer depends on whether you are eligible for MaineCare Free or Low-cost Care. The best course is usually to keep the private insurance if you can, and simply apply for MaineCare and see what happens. A small number of children that have recently been covered by a private plan may have to wait to get coverage, even if the family is below the income guidelines. Call the HelpLine at 1-800-965-7476 for more details. Do not drop your child's private insurance without first checking with the HelpLine or your local DHHS office.

Can I get old medical bills paid?
People eligible for Free MaineCare can get old medical bills paid up to 3 months before the application. People eligible for Low-cost MaineCare can get old medical bills paid back to the first of the month of application. To get back bills paid, you must have been eligible for MaineCare at that time. Please call the HelpLine at 1-800-965-7476 if you have questions about this process.

Are there other programs if my child is disabled?
Even if household income is over the limit for MaineCare, children with severe disabilities may qualify for full MaineCare coverage through the Katie Beckett Program. This option offers all standard MaineCare services including hospital, nursing or intermediate care for many children who are considered disabled under the Social Security program. Another helpful program is the Children with Special Health Needs Program, which is not a "health coverage" program like Katie Beckett, but it can help reduce or remove the cost of many health services related to your child's disability. Call the HelpLine at 1-800-965-7476 or call your local DHHS office for more information about Katie Beckett or the Children with Special Health Needs Program.

What if my income is too high to qualify for MaineCare?
Any child who is over income for MaineCare should be offered "Medically Needy" coverage. Any parent who is over income but within the asset guidelines should also be offered "Medically Needy" coverage. This is also called the "Spend Down" or "Deductible" program. There is usually a very high deductible over a six-month period, but this can be a helpful safety net in case of large hospital or other medical bills. Information about your "Deductible" amount should be at the end of your denial letter for MaineCare. There are also other programs that can be helpful in reducing the cost of health care services and prescriptions. Check out the "Other Helpful Program for Many People" section of this Online Health Care Guide or call the HelpLine at 1-800-965-7476 for more information.