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MaineCare (Maine Medicaid Program)

MaineCare is the name for the state of Maine Medicaid program. MaineCare provides no and low-cost health insurance to low-income Maine residents.

Click below to learn more about ME Medicaid:

MaineCare Benefits

Your MaineCare benefit package will depend on your age, income, and medical needs. You will automatically be assigned a benefits package based on your eligibility and your application; it can change if your income and needs change. The packages are separated into three categories:

  • Full Benefits (kids, young adults, parents/caretakers, pregnant women, former foster care kids, aged, blind, disabled, spend-down, home and community-based waiver recipients)
  • Limited Benefits (special benefit waiver recipients, some pregnant women, undocumented residents)
  • Long Term Care Benefits (residents of nursing facilities or residential care facilities)

On the most basic level, MaineCare covers medically necessary services. While “medically necessary” is broad, it really depends on what you need. Your doctor can submit requests for authorization if you need something that Medicaid doesn’t usually cover. That doesn’t mean that it is guaranteed to be approved, but as long as your doctor can prove that it is medically necessary, you have a good shot. For example, doctor visits, hospital stays, prescriptions, and X-rays are typically covered, but acupuncture, cosmetic surgery, and health club memberships are not.

View the 2019 MaineCare handbook for more information.

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Cub Care Maine for Kids

Cub Care is the name of the children’s Medicaid insurance program in the state of Maine. It includes comprehensive coverage for services like doctor visits, hospital care, immunizations, prescriptions, surgeries, tests, and even school-based services. Most families will not have to pay anything for this coverage, but some families with higher incomes will be asked to pay anywhere from $8 to $62 per month. There may be some small copayments for certain services. Eligibility is based on total household income, and your application will not be processed until the state receives your proof of income.

MaineCare Eligibility

MaineCare eligible groups include:

  • Low-income people between the ages of 21 and 64 who are not eligible for Medicare
  • Low-income parents or caretakers with a child under 18 in the household
  • Low-income kids under 21
  • Low-income people under 26 who aged out of the foster care system
  • Low-income disabled people
  • Low-income people over the age of 65

Medicaid eligibility is mostly based on your household income, but some kinds of income don’t count - so it’s a good idea to apply even if your income is a bit higher than the numbers in our chart below. Assets are only considered for those over the age of 65. Assets do NOT include your home and land, less than two cars, machinery used for income, checking or savings accounts, IRAs, pensions, loans, or life insurance.

MaineCare Eligibility | Medicare Plan Finder

Disability Determination

Wondering if your disability qualifies you for benefits? Not all disabilities result in Medicaid approval even if they result in other Social Security benefits. By definition, disability means that you are unable to perform substantial work that you can be compensated for due to either a physical or mental impairment. That impairment must be expected to last for at least 12 months. To prove that you are disabled, you have to be able to prove that you are not able to work for a reasonable amount of time and earn a reasonable living.

If you have questions or want to appeal your disability determination, you can call the Disability Determination Services office at 207-377-9500 or visit their office at 1705 Route 202, Winthrop, ME 04364. You can also visit your local Social Security office.

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MaineCare Application

Ready to apply for MaineCare? To apply for Medicaid in Maine, you should start by gathering your legal documents. For your application, you will need proof of citizenship and identity, income documentation, proof of property ownership, health insurance cards, proof of liquid assets, and other relevant documents.

You can apply online, by mail, by fax, or in person. To apply my mail, complete the application and mail it to:

Office for Family Independence

State of Maine - DHHS

114 Corn Shop Lane

Farmington, ME 04938

You can also fax your application to 1-207-778-8429. If you’d prefer to get assistance with some of the questions or would prefer to apply in person, you can take your application to your district’s Department of Health and Human Services office from 8 am to 5 pm Monday through Friday. You can also apply online by visiting My Maine Connection.

MaineCare Portal (My Maine Connection)

The online MaineCare Portal, called My Maine Connection, does more than just allow you to apply for Medicaid online. You can also use it to complete an eligibility prescreening test, submit changes to your income, and review your benefit history. My Maine Connection is for all state benefits, so you can apply for more than just Medicaid (food supplements, child care, cash assistance, etc.)

How to get Both Medicare and Medicaid in Maine

You may be eligible for Medicare if you are either:

  • Over 65,
  • Diagnosed with ALS,
  • Diagnosed with ESRD, or
  • Receiving SSDI (for at least 24 months)

If you qualify for both Medicare and Medicaid, you may qualify for a Dual-Eligible Special Needs Plan (DSNP). DSNPs are types of Medicare Advantage plans that can incorporate Medicare and Medicaid benefits for ultimate coordinated care with a reasonable price tag. For help selecting a Special Needs Plan, call us at 833-438-3676 or send us a message.

Turning 65 Checklist | Medicare Plan Finder

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