10-144 C.M.R. Ch. 332; MaineCare Eligibility Manual - Part 2; MC Rule #308A - Eligibility and Verification Changes

Date posted:

Attachment(s):

The adopted rule updates the MaineCare Eligibility Manual, Part 2, Basic Eligibility Criteria, consistent with the Centers for Medicaid and Medicare Services’ “2023 Streamlining Medicare Savings Program Enrollment” final rule (89 FR 22780). The adopted rule removes the requirement that applicants apply for other benefits as a condition of MaineCare eligibility. Additionally, the adopted rule removes the limit on the number of reasonable opportunity periods for individuals verifying their citizenship and immigration status.

The adopted rule effectuates the following changes to Part 2, Basic Eligibility Criteria:

  • Section 3.1, (III)(B) removes “not” from “A reasonable opportunity period will not be provided on subsequent applications submitted by or on behalf of the applicant or household members.”
  • Section 3.4, (H) capitalizes Batterer(s).
  • Section 10, “APPLICATION FOR MEDICARE” replaces “APPLICATION FOR OTHER BENEFITS”
  • Section 10 removes “Individuals must apply for other benefits to which they may be entitled. This includes applying for the benefit and providing the Department with necessary information to determine eligibility.”
  • Section 10 removes I. “Other benefits include but are not limited to, Social Security, Railroad Retirement, Veteran’s Pension/Compensation, Worker’s Compensation, and Unemployment Insurance. This provision does not apply to SSI, State Supplement, TANF cash benefits and other Federal, State, local or private programs which make payments based on need.”
  • Section 10 removes V. “The Department will not require an individual:”
  • Section 10 removes V.A. “To file for other benefits when applying for them would result in no additional benefits which affects the individual’s eligibility.”
  • Section 10 updates V.B. “To pursue a claim for other program benefits through the appeals process.”
  • Section 10 removes V.C. “Who is not applying for or covered by Medicaid to pursue a claim for other program benefits, for example, an ineligible spouse, parent or child.”

Changes were made to the adopted rule as a result of public comment and intended to provide clarity and reduce confusion. The adopted rule is consistent in substance with the rule was proposed.

Section 10: Application for Medicare:

  • The title of Section 10 is changed to “Requirement to Apply for Medicare”
  • I. and II. add “through the Social Security Administration,”

The adopted rule changes are effective retroactive to June 1, 2024. Retroactive rulemaking is permissible under 22 M.R.S. § 42(8) as these updates provide a benefit to recipients and applicants.

This rule will not have an adverse impact on municipalities or small businesses.

Statutory Authority: 22 M.R.S. §§ 42(1) and (8); 3174

Effective Date: October 22, 2023

Office: Office for Family Independence

Comment deadline:

Effective date:

Comments for this rule have been closed.