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MaineCare
is a program offered by the Department of Health
and Human Services (DHHS). Pregnant women may
be able to get free MaineCare coverage, depending
on their household income. 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 I get MaineCare?
If
household income is at or below the guidelines listed
below, pregnant women can enroll in MaineCare. Assets
do NOT count against pregnant women, only household
income. A "household" includes a spouse and
other minor children. For unmarried parents who live
together, the father's income is not used in deciding
eligibility for the pregnant woman.
What if I am a
minor or a young adult?
When a young pregnant woman is under age 18 and
living with her parents, there are two ways that she
could qualify for MaineCare. In the first way, MaineCare
will include her parents and her parent’s income
to see if everyone in the household can get MaineCare.
If that doesn't work, the pregnant minor may still be
eligible! The second way is to only look at PART of
her parent's income, with the understanding that the
pregnant minor is the only one who will get coverage.
Once the baby is born, the grandparent's income does
not count when looking at the baby's eligibility even
if they are still in the same household. However, until
the mom turns 18 at least PART of her parent's income
will still count for her if she is in their household.
When
a young pregnant woman or parent is age 18 to 21
and living with her own parents, she is considered an
"independent child" and her parent's income
does not count against her or her children.
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.
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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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$2,429
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2
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$3,052
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3
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$3,675
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4
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$4,299
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5
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$4,922
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6
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$5,545
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For
each additional family member add:
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$624
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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 pregnant women.
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 is the fastest
way for me to enroll in MaineCare?
Pregnant
women can get a "presumptive eligibility"
determination by a medical provider who accepts MaineCare
patients. If that medical provider determines the pregnant
woman qualifies for MaineCare, her coverage and prenatal
care can start the day she goes to the provider's office
for services. But, she will still need to go through
a regular application process after that point!
The "presumptive eligibility" determination
only lasts through the last day of the month following
the month the determination is made.
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?
Once
you are enrolled in MaineCare as a pregnant woman, your
coverage will continue for at least 60 days after giving
birth, regardless of any income change. And, children
whose mothers received MaineCare at the time they were
born continue to be eligible for one year, regardless
of family income. After that point, your household may
still be eligible for some "transitional coverage,"
and the kids in the household can enroll in The Full
Cost Purchase Option (FCPO) once their automatic one
year coverage period has ended. The FCPO 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?
Pregnant women 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?
Pregnant women can get old medical bills paid up to
3 months before the application, as long as they 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?
A pregnant woman 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.
There are also other programs that can be helpful in
reducing the cost of health care services and prescriptions.
Check out the "Other
Helpful Programs for Many People" section
of this Online Health Care Guide or call the HelpLine
at 1-800-965-7476 for more information.
