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MaineCare
is a program offered by the Department of
Health and Human Services (DHHS). Young adults
ages 19 and 20 may be able to get free or low-cost
MaineCare coverage. Other people living in the
same household may be able to get MaineCare as
well, under different guidelines
What you'll
find on this page:
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What's covered?
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 "young
adult" child get MaineCare?
If
your household income is at or below the guidelines
listed below, the young adults in your household may
be able to enroll in MaineCare. Parents may be eligible
as well, under different eligibility guidelines. Unlike
minor children, young adults will also have to meet
an asset test. But, many assets will not count against
you. Click here
for a list of assets that do not count against the young
adult. If a young adult is not living with
a parent, they may be able to apply for MaineCare using
only their own income and assets. If you have questions,
or are unsure whether your young adult child qualifies,
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
If
a 19 or 20 year old is living with their parents, the
parents income and assets will count toward eligibility
unless they are pregnant. 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.
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2009/2010*
Monthly Income Guidelines for
Free MaineCare
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Family
Size
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Income
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1
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$1,354
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2
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$1,822
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3
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$2,289
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4
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$2,757
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5
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$3,224
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6
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$3,692
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For
each additional family member add:
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$468
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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 and children 19 and 20
years old, 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.
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Real property that is up for sale
- Loans
that must be repaid
- The
cash value of life insurance the family has
purchased
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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. If
you have questions, or are unsure whether you
qualify, call our HelpLine at 1-800-965-7476.
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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 year's 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?
If
your family is enrolled in MaineCare and your income
goes up, there is a free transitional program that can
extend parent and young adult coverage for up to 12
more months in some cases. Call the HelpLine at 1-800-965-7476
if you need assistance.
What if I already
have private insurance?
Young adults can have both private insurance and MaineCare.
Private insurance is always primary, and MaineCare is
secondary. Since MaineCare is very comprehensive coverage,
most people decide to drop their private insurance once
they are enrolled in MaineCare. Call the HelpLine at
1-800-965-7476 for more details.
Can I get old medical
bills paid?
Young adults who are eligible for MaineCare can get
old medical bills paid up to 3 months before the application.
To get back bills paid, you must have been eligible
for MaineCare at the time you incurred the bills. Please
call the HelpLine at 1-800-965-7476 if you have
questions about this process.
Are there other
programs if I am disabled?
Even if household income is over the limit for MaineCare,
some young adults may still qualify if they are disabled.
Certain deductions to income apply for disabled people.
And, young adults who are disabled but also are working
may qualify for MaineCare at much higher income levels.
Refer to the Disabled
or Elderly Adults section of this Online
Health Care Guide or call the HelpLine at 1-800-965-7476
for more information. Another helpful program is the
Children
with Special Health Needs, which is not a
"health coverage" program like MaineCare,
but it can help reduce or remove the cost of many health
services related to a young adult's disability. Call
the HelpLine at 1-800-965-7476 or call your local
DHHS office for more information about the Children
with Special Health Needs program.
What if my income
is too high to qualify for MaineCare?
A young adult who is over income for MaineCare should
be offered "Medically Needy" coverage, as
long as they are not over the asset
guidelines. 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.
