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Health
care services covered by
f ull-benefit MaineCare include:
Doctors'
Visits:
Well-child check-ups Sick care
Specialist care, including surgery Prenatal care
Dental
Services:
Full coverage for children (with limits for adults)
Hospital
Care:
In-patient, outpatient, and emergency room
Long-Term
Care:
Coverage for care in a nursing home, assisted
living center, or other residential care. Services
may also be provided in the home.
Therapies:
Speech therapy
Physical therapy
Occupational therapy
Services:
-Shots
to prevent illness (immunizations)
-Prescription drugs
-Mental health services
-Lab tests and x-rays
-Ambulance services
-Family planning
-Interpreters
-Eye exams and eye glasses (with limits for adults)
-Substance abuse services
-Medical equipment and supplies
-Chiropractic care
-School-based health centers
-Transportation to medical and counseling appointments
-Hearing tests (with limits for adults) and hearing
aids (for children age 20 and younger)
Early
and Periodic Screening, Diagnosis and Treatment:
Federal
Medicaid law requires States to cover Early and
Periodic Screening, Diagnosis and Treatment (EPSDT)
services for children and adolescents under age
21. EPSDT covers four separate screening services-medical,
vision, hearing and dental-and includes immunizations,
laboratory tests (including lead blood tests),
and health education. Each type of screen must
be furnished at pre-set, periodic intervals (periodic
screens) and when a problem is suspected (interperiodic
screens).
The
treatment component of EPSDT must include any
necessary health care, diagnostic services, treatment,
and other measures, described in section 1396d(a)
of the Medicaid Act, to "correct or ameliorate"
physical and mental illnesses and conditions,
whether or not such services are covered for adults
in the state's Medicaid program. EPSDT also includes
outreach and informing to notify children and
their families of EPSDT and the importance of
preventative care, and to offer appointment scheduling
and transportation assistance, if needed.
If
a service that a child under age 21 needs is for
some reason not available under MaineCare, or
if the child requires more services than MaineCare
may cover, then the child's provider can file
with the Office of MaineCare Services, a request
for Prior Authorization for what is called "Optional
Treatment- EPSDT Services."
And
More…
This
is just a partial list of services covered by
full-benefit MaineCare. It is important to note
that all children with MaineCare receive the same
full-benefit coverage, whether their coverage
is through the CHIP program (the children whose
families pay a monthly premium) or through straight
Medicaid, which includes the Katie Beckett benefit.
For more information, call MaineCare Member Services
at 1-800-977-6740 (if you are deaf or hard of
hearing and have a TTY machine, call 1-800-977-6741).
Important
note about copayments: Except for small copayments,
doctors and other health care providers cannot
charge members in addition to the payments they
get from MaineCare. There are no copayments for
services provided to children. If a MaineCare
member cannot afford to pay a copayment, the provider
must still provide the service. The provider may
bill the member, but may not deny services in
the future due to non-payment of copayments.
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