UPDATE: In 2020, Medicaid insurance rules and application steps have not been significantly modified.
What are the requirements for Medicaid in Maine? For applicants wondering who is eligible for Medicaid, exactly, there are several factors that come into play. First, Medicaid eligibility requirements include some basic legalities regarding a patient’s residency. Next are the Medicaid income requirements, which are crucial in determining how to qualify for Medicaid.
What are the Medicaid application guidelines for different patient groups when reviewing qualifications? Learn more about Medicaid requirements by downloading our comprehensive guide.
Who meets the requirements for Medicaid in Maine?
Medicaid eligibility requirements in Maine begin with reviewing the different types of patients who qualify for the different types of Medicaid insurance. Since Medicaid eligibility requirements vary from state to state, it is important to take into consideration the standards set forth by the Department of Health and Human Services in Maine. Medicaid benefits in Maine are dispersed under the MaineCare program.
The following types of patients are eligible for Medicaid:
- Children (who can apply for the Children’s Health Insurance Program or CHIP)
- Pregnant women and parents/relative caretakers
- Patients between the ages of 19 and 20
- Disabled adults, elderly patients age 65 and older and those eligible for the Medicare Savings Program
- Former Maine foster care children up to age 26
- Patients in need of waivers that are elderly, brain-injured and disabled, among other conditions
- Adults who qualify medically for nursing care and adults residing in residential care facilities
- HIV-positive adults and women with breast cancer or cervical cancer
- Those considered “medically needy” or patients who want to “spend down” when income is recorded as too high for full Medicaid benefits
- Adults in need of Maine RX Plus who do not qualify for Medicaid fully and disabled and/or elderly adults over age 62 that require low-cost drug plans
If applicants do not belong to one of the above Medicaid eligibility patient categories, it is likely they will not qualify for Medicaid, in terms of full coverage. However, as listed, there are several scenarios that allow patients to be eligible for Medicaid on partial levels. Download our helpful guide to learn about the different requirements for Medicaid.
What Are the Requirements for Medicaid in Maine?
What are the Medicaid application guidelines specific to applicants living in Maine? Although Medicaid eligibility items tend to vary depending on the state, there are some mandatory Medicaid qualifications that are required across the board.
How to qualify for Medicaid revolves strongly around legal presence in both the state of Maine and the United States. Patients seeking Medicaid benefits eligibility must comply with the federally enforced requirements for Medicaid prior to taking Medicaid income requirements into consideration. The basic Medicaid eligibility requirements in Maine state that applicants must be and/or have:
Residents of Maine – In order to reap the Medicaid benefits of MaineCare, applicants must be full-time residents living within the Maine state borders. Potential Medicaid beneficiaries will be asked to provide proof of Maine residency to qualify for Medicaid. Typical proof of residency documents includes a valid driver’s license or state ID card, along with recent utility bills and official mail.
U.S. citizens – Candidates looking for Medicaid benefits eligibility must be able to prove United States citizenship in order to be accepted into MaineCare. For those that are not U.S. citizens, documentation proving legal presence in the country is also accepted when it comes to qualifying for Medicaid in Maine. Without citizenship or legal status documents handy, applicants are not legally granted Medicaid eligibility.
Registered Social Security Numbers – The purpose of an applicant’s Social Security Number as it relates to Medicaid benefits in Maine is that, first and foremost, it confirms income eligibility. Registered Social Security Numbers come into play because tax forms and reported income determine Medicaid benefits eligibility in ME. In addition, since Medicaid benefits are partially funded by the federal government, Social Security Numbers are used to track beneficiaries and their Medicaid coverage.
Keep in mind that the above Medicaid requirements apply to every member of a household who intends to become a Medicaid beneficiary in Maine. If an applicant plans to request Medicaid for a spouse or any children living in the home, all of the above requirements for Medicaid must be met in order for multiple family members to be eligible for Medicaid in Maine.
What Are the Medicaid Income Requirements in Maine?
Since Medicaid benefits are given to low-income families, children and individual patients, Medicaid income requirements are of utmost importance when it comes to qualifying for MaineCare. Income requirements for Medicaid are determined by the Modified Adjusted Gross Income calculator. This Medicaid eligibility tool takes into consideration the current Federal Poverty Levels (FPL) as they relate to certain patient groups.
The Medicaid income requirements compare household sizes with the FPLs in order to determine a figure for each patient category, depending on his or her family earnings. Financial requirements for Medicaid in Maine are outlined below.
Children who want to qualify for Medicaid through CHIP or MaineCare must reside in households that earn no more than 213 percent of the FPL, while 19- and 20-year-olds can report earnings no higher than 161 percent of the FPL. For former foster children in Maine, there are no Medicaid income requirements to meet. Parents, guardians and relative caretakers are eligible for Medicaid when earning no more than 105 percent of the FPL. However, pregnant women have a threshold set at 214 percent of the FPL.
Disabled adults and elderly patients age 65 and older meet Medicaid qualifications if earning no more than 175 of the FPL. Those seeking waivers related to home- and community-based care and other conditions, along with patients who are eligible for nursing care can earn up to 300 percent of the FPL to qualify for Medicaid.
And finally, women who are seeking treatment due to breast cancer or cervical cancer, along with HIV-positive adults can earn no more than 250 percent of the FPL to meet the requirements for Medicaid.