This article is a collection of the best answers to Maine Medicaid’s most frequently asked questions.
Medicaid is a government-sponsored healthcare program for low-income families and individuals who fulfill specific income and resource requirements. Only the aged, blind, or disabled can access resources within the defined restrictions.
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Table of Contents
What is the Maine Medicaid Program?
MaineCare (formerly known as Medicaid) is a federal program that aids low-income people. MaineCare specifically can assist eligible Maine residents with their medical expenses. Medicaid offers eligible low-income individuals accessible or affordable health insurance.
Who is eligible for the Maine Medicaid Program?
You must be a resident of the state of Maine, a national or citizen of the United States, a permanent resident, or a legal alien in need of health care or insurance help, and have a low income to qualify for MaineCare. You also need to fit one of the following criteria:
- Being pregnant
- Being in charge of a child under 18
- Being blind
- Having a family member with a disability, or
- Age 65 or older is required
You must fall under one of the following thresholds for household income (before taxes) in order to qualify:
Annual Household Income Limits (before taxes)
| Household Size* | Maximum Income Level (Per Year) |
| 1 | $18,075 |
| 2 | $24,353 |
| 3 | $30,630 |
| 4 | $36,908 |
| 5 | $43,186 |
| 6 | $49,463 |
| 7 | $55,741 |
| 8 | $62,018 |
For households with more than eight members, add $6,277 per additional member.
How do I contact Medicaid in Maine?
Visit Maine.gov to learn more about MaineCare and print an application.
You can contact MaineCare toll-free at 1-207-624-4168 with any questions.
What are the Medicaid plans in Maine?
Maine has launched several programs centered on value-based purchasing in recent years.
A multi-payer Patient Centered Medical Home (PCMH) Pilot Programme was launched in Maine in 2010 to reward better results and increase payments to primary care providers for care coordination.
Community Care Teams (CCTs) that are provider-based and care continuum for high-risk members across one or more practices were added to Maine’s PCMH program in 2012.
Early in 2013, Maine launched a State Medicaid Home Program to offer improved care management to people with multiple chronic conditions or one debilitating disease at risk for the other.
This program is built on the success of PCMHs and CCTs. In late 2013, the state intended to broaden the health home program scope to include those requiring behavioral health care.
In terms of managing care for Medicaid users in the PCCM, PCMH, & health homes programs, Maine enters into direct contracts with primary care doctors and CCTs.
In addition to the standard Medicaid fee-for-service reimbursement, primary care practitioners are given a monthly per-member practice management charge.
PCMHs, health homes, & CCTs are paid case management fees per month each month by Medicaid and other payers participating in multi-payer collaborative initiatives.
What if a person’s income is too high to qualify for regular Medicaid benefits?
Maine may grant a Medicaid spend-down for old, blind, and disabled people who don’t meet the criteria.
If you require Medicaid coverage and your income exceeds the state’s Medicaid income limits. To qualify for Medicaid, you can use this program to subtract a portion of your medical costs from your income.
If your medical costs significantly reduce your usable payment, you can qualify for a Medicaid spend-down.
What is covered by Maine Medicaid?
Based on your coverage group—which is decided by your income, age, medical needs, or whether you require assistance with daily living—MaineCare pays for medically essential services (ADLs).
The following are some instances of services that might be covered:
- Seeing a doctor
- Medications on prescription
- Services for behavioral health
- Labs and X-rays
- Hospital and emergency room visits
Can I have both Maine Medicaid and Medicare?
Those 65 and over are eligible for Medicare and Medicaid. You are eligible to receive benefits if you meet all other Medicaid eligibility standards and are under the age of 65.
Maine Medicaid Waivers?
They do not have to pay a copayment; when a member is:
- Under 21 years old;
- Pregnant;
- Held by the state
- Placed under government supervision
- Native American participants who qualify for Contract Health funding
- Services or Tribal Union of Indian Health Services
- Residing in one of the facilities listed below and funding a portion of their care:
- The hospital (inpatient)·
- A facility for skilled nursing
- A nursing home
Medicaid Eligibility
What is the highest income limit for Maine Medicaid?
The highest income limit for Maine Medicaid is approximately $18,075 for an individual. Roughly $24,353 for a family of two (or higher depending on family size).
What documents do I need to apply for Medicaid?
The following can be requested of you by your Medicaid office:
- Evidence of birthdate (e.g., birth certificate)
- Documents that can be used as proof of legitimate residency or citizenship in the US include a passport, driver’s license, birth certificate, green card, and job authorization card.
- A list of all sources of income, legal and illicit (e.g., paycheck stubs, retirement benefits, Supplemental Security Income)
- Evidence of sources (e.g., bank or stock statements, life insurance policies, property)
- Proof of residence (e.g., rent receipt, landlord statement, deed)
- The Medicare card as well as any insurance cards (you can also provide a copy of the insurance policy)
What is the best Medicaid in Maine?
In Maine, all plans receive the same services. There isn’t a single optimum method for the entire state; residents must choose the best strategy for their particular county.
You will receive the same care and assistance regardless of your chosen plan.
Where do I find the letter showing the reason(s) for denial or discontinuance from Maine Medicaid?
You can check your Kansas Medicaid health information status by visiting MaineCare Health PAS Online Portal.
Where can I upload the documents for Maine Medicaid?
To upload the documents visit MaineCare Online Portal.
