| ^ top | |
| < previous page | next page > |
 |
As of July 1, 2002, the Medicaid and Cub Care programs have a new name. It is Maine Care. This name change was required by the Maine Legislature. Maine Care continues to offer the same health care coverage for Maine residents that was offered by Medicaid and Cub Care. The only thing that changes is the name.
*Would be purchased only under the MR Waiver program
** very narrow eligibility
Maine Care provides health care coverage to Maine residents whose income and assets are within the Maine Care guidelines. The best way to find out if you and/or your family members are eligible for Maine Care is to fill out a simple two-page application. Maine Care benefits are different for different members depending on age, medical condition, or income level. Most people will get the Full Benefit package. If you do not know what benefit package you get, call Maine Care Member Services at 207 624-7539, Option 1 (Augusta area) or 1 800 321-5557, Option 1 (statewide) and they can help you.
To get a Maine Care application, you can go to your local Department of Human Services (DHS) office (see below for location nearest you) or call them using one of the numbers below. You can also get one by printing one from the Internet. Adults and children use the same form. When the form is completed, mail it back or bring it to the DHS office closest to you. These addresses and phone numbers are current as of (August 2002). Be sure to include with your application the proof of your income for the past 4 weeks. For example, send or bring to DHS a copy of your 4 most recent paycheck stubs if you are paid weekly. Eligibility is determined locally.
Remember that families must reapply for Maine Care every year (twelve months). DHS will send you the form. If you: 1. Return the form by the deadline stated in the letter; 2. Have paid any fees due; and, 3. Still meet the income and asset guidelines, then you remain covered.
| Department of Human
Services Portland Regional Office 161 Marginal Way Portland, ME 04101 Phone: 207-822-2000 Fax: 207 822-2310 TTY: 207 822-2293 Toll Free Phone: 800 482-7520
|
Department of Human Services
396 Griffin Road Bangor, ME 04401 Phone: 207 561-4100 Fax: 207 561-4493 TTY: 207 561-4403 Toll Free Phone: 800 432-7825 |
| Department of Human
Services 208 Graham Street Biddeford, ME 04005 Phone: 207 286-2400 Fax: 207 286-2546 TTY: 207 286-2402 Toll Free Phone: 800 322-1919
|
Department of Human
Services 88A South Street Calais, ME 04619 Phone: 207 454-9000 Fax: 207 454-9012 TTY: 207 454-3415 Toll Free Phone: 800 622-1400 |
| Department of Human
Services 890 Main St., Suite 208 Sanford, ME 04073 Phone: 207 490-5400 Fax: 207 490-5499 TTY: 207 490-5466 Toll Free Phone: 800 482-0790
|
Department of Human
Services 200 Main Street Lewiston, ME 04240 Phone: 207 795-4300 Fax: 207 795-4444 TTY: 207 795-4595 Toll Free Phone: 800 482-7517 |
| Department of Human
Services 360 Old County Road Rockland, ME 04841 Phone: 207 596-4200 Fax: 207 596-4331 TTY: 207 596-4201 Toll Free Phone: 800 432-7802
|
Department of Human
Services 17 Eastwood Lane Ellsworth, ME 04605 Phone: 207 667-1600 Fax: 207 667-5364 TTY: 207 667-1639 Toll Free Phone: 800 432-7823 |
| Department of Human
Services 13 Prescott Drive Machias, ME 04654 Phone: 207 255-2000 Fax: 207 255-2022 TTY: 207 255-6866 Toll Free Phone: 800 432-7846
|
Department of Human
Services 98 North Avenue Skowhegan, ME 04976 Phone: 207 474-4800 Fax: 207 474-4890 TTY: 207 474-4891 Toll Free Phone: 800 452-4602 |
| Department of Human
Services 137 Market Street Fort Kent, ME 04743-1447 Phone: 207 834-7900 Fax: 207 834-7780 TTY: 207 834-7702 Toll Free Phone: 800 432-7340
|
Department of Human
Services 11 High Street Houlton, ME 04730-2012 Phone: 207 532-5000 Fax: 207 532-5027 TTY: 207 532-5001 Toll Free Phone: 800 432-7338 |
| Department of Human
Services 219 Capitol Street Augusta, ME 04333 Phone: 207 624-8000 Fax: 207 624-8124 TTY: 207 624-8004 Toll Free Phone: 800 452-1926
|
Department of Human
Services 114 Corn Shop Lane Farmington, ME 04938 Phone: 207 778-8400 Fax: 207 778-8429 TTY: 207 778-8439 Toll Free Phone: 800 442-6382 |
| Department of Human
Services 14 Access Highway Caribou, ME 04736 Phone: 207 493-4000 Fax: 207 493-4004 TTY: 207 493-4034 Toll Free Phone: 800 432-7366
|
Department of Human
Services 137 Market St. Fort Kent, ME 04743 Phone: 207 834-7900 Fax: 207 834-7780 TTY: 207 834-7702 Toll Free Phone: 800 432-7340 |
| Department of Human
Services 243 Main St., Suite 6 So. Paris, ME 04281 Phone: 207 744-1200 Fax: 207 743-8735 TTY: 207 744-1224 Toll Free Phone: 888 593-9775 |
If an individual has a question about eligibility, s/he should contact the local DHS office of the Bureau of Family Independence (BFI) (see list at beginning of this section). If a Maine Care member has a question about benefits or services, call Maine Care member services at 207 624-7539, Option 1 (Augusta area) or 1 800 321-5557, Option 1 (statewide) and they can help you.
Maine Care is an entitlement program. This means that services cannot be refused because of budget limitations and that once an individual is determined to be eligible for a specific Maine Care benefit package, s/ he is eligible for all services provided in that specific benefit package. Maine Care benefit packages are different depending on the member's age, medical condition, or income level. Most members get the Full Benefits package. Some members will only get the Prescription Drug Benefit package or one of the other benefit packages (e.g., Medicare Buy-In).
For children 0 to 21 who are Maine Care members, Prevention, Health Promotion, and Optional Services formerly referred to in Maine as EPSDT (Early, Periodic, Screening, Diagnosis and Treatment Program) must be offered.
The Omnibus Budget Reconciliation Act of 1989 (OBRA 89) requires that all Maine Care reimbursable services must be available to eligible children if they are "medically necessary to correct or ameliorate defects (and physical and mental illnesses and conditions) discovered by the screening services, whether or not such services are covered under the state plan." Services must be covered under federal regulations governing the Maine Care Program and be prior-authorized by the Bureau of Medical Services.
OBRA 89 abolishes the concept of limiting services based on an arbitrary number of visits. Services must be provided in an amount, duration and scope to reasonably achieve goals of treatment.
The Bureau of Family Independence (BFI) workers use a number of eligibility options to determine if a person can be covered in a benefit package. One of the more commonly referred to "eligibility options" is known as the Katie Beckett option. This option provides Maine Care eligibility to children under the age of 19 who have a severe medical condition or a severe disability. In determining eligibility, the parents' income and resources are not counted in the financial eligibility determination.
In order to be found eligible, the individual's medical condition or disability must be such that s/ he would otherwise require institutional care (i.e., hospital, psychiatric facility, or nursing facility). The cost of care, however, must be equal to or less than the cost of institutional care. If a child is found eligible, s/he receives the Full Benefits package. For more complete information check with the regional DHS office closest to your home.
The actual words Assistive Technology (AT) do not appear in any current Maine Care policy. If a Maine Care member requires medically necessary AT, s/he should refer to Maine Care policies for prosthetics, orthotics or durable medical equipment. Any purchase of Durable Medical Equipment (DME) under Maine Care must demonstrate medical necessity and meet ALL of the following four criteria:
- Equipment can withstand repeated use;
- Primarily used to serve a medical purpose and is medically necessary and reasonable for the treatment of the member's illness or injury or to improve an altered body function;
- Is not generally useful to a person in the absence of illness or injury; and
- Appropriate for use in the home and is in safe and reasonably good condition and suitable for its intended use.
If your request for Primary Care Services (PCS), prosthetics, orthotics or durable medical equipment is denied and if you disagree with the decision made by the Department of Human Services, you have 60 days from the date of the DHS decision to appeal. If you want legal advice or help, call Covering Kids and Teens Help line staff at 1 800 965-7476 (voice or TTY). Help line staff will refer you to free legal advice.