Elderly and Disabled Adults

MaineCare is a program offered by the Department of Health and Human Services (DHHS). People 65 years or older and disabled people may be able to get free MaineCare coverage, depending on their household income and assets. What you'll find on this page: What's covered? Can I get MaineCare? What are the income guidelines? What if I'm working? 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 or Medicare? Can I get old medical bills paid? 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?
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 I get MaineCare?
If household income is at or below the guidelines listed below, you may be able to get MaineCare. A "household" includes a spouse and minor children. Even if you do not receive Social Security benefits, you can still apply for MaineCare in the "disabled" category. MaineCare's Medical Review Team will contact you and your health care provider to make their own decision about your disability. And, if you are working as well as receiving Social Security payments, you could be eligible under the Working Disabled Benefit.

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.

What if I'm working?
If you are disabled and income from a job puts you over the income guidelines for MaineCare, you may still be able to get coverage through the "Working Disabled" program. Your Social Security check still cannot be over the guidelines for regular MaineCare, but income from a job can go up to the amount listed below, on the right. Call the HelpLine at 1-800-965-7476 and they will help you figure out if you qualify.

2009/2010* Monthly Income Guidelines for Free MaineCare Family Size Income 1 $903 2 $1,215 3 $1,526 4 $1,838 5 $2,150 6 $2,461 For each additional family member add: $312

2009/2010* Monthly Income Guidelines for "Working Disabled" MaineCare Family Size Income 1 $2,257 2 $3,036 3 $3,815 4 $4,594 5 $5,373 6 $6,153 For each additional family member add: $780

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
Many assets will NOT count against you. You can have savings and retirement, 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; $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: Single people are allowed to have $2,000, plus all of the assets that do NOT count against you (listed above). Couples are allowed to have $3,000, plus all of the assets that do NOT count against you (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 you or other household members are 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?
Your MaineCare coverage will be given to you for 12 months. After 12 months, your case will be reviewed to see if you still qualify for coverage. During that 12 month period, if you income or assets change significantly, you are supposed to contact DHHS and let them know. If this change means that you are no longer eligible for MaineCare, DHHS will look to see if you qualify for other programs. Call the HelpLine at 1-800-965-7476 for more information or if you need assistance.

What if I already have private insurance or Medicare?
Elderly and disabled adults can have private insurance, Medicare, or Supplemental Insurance AND MaineCare. Medicare or private insurance is always primary, and MaineCare is secondary. Since MaineCare is very comprehensive coverage and can "wrap around" Medicare, most people decide to drop their private insurance or Supplemental 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?
You can get old medical bills paid up to 3 months before the application, as long as you were eligible at that time. Please call the HelpLine at 1-800-965-7476 if you have questions about this process.

What if my income is too high to qualify for MaineCare?

• An elderly or disabled adult who is over income for MaineCare should 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.
• People eligible for Medicare may qualify for a MaineCare Savings Program, to help with health care and prescriptions costs not covered by Medicare.
• 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.