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The adopted rule removes the asset test for the Medicare Savings Program (MSP) based on a legislative change to 22 M.R.S. § 3174-LLL made by P.L. 2023, ch. 412.
In addition, the Department submitted and received approval from the Center for Medicaid and CHIP Services for a CHIP State Plan Amendment to establish a Health Services Initiative (HSI) to provide comprehensive coverage during the 12-month postpartum period for individuals whose newborns had been eligible as targeted low-income children under the from-conception-to-end-of-pregnancy (FCEP) option. The benefits provided during this postpartum period are identical to the benefits provided to pregnant individuals enrolled in MaineCare. The Department’s recently approved SPA is consistent with Social Security Act § 2105(a)(1)(D)(ii) and 42 C.F.R. § 457.10. The adopted rule changes increase access to health insurance coverage.
The adopted rule amends Part 2, Section 1, Cub Care, to “This program provides coverage for children under the age of 19 within certain income limits and different eligibility rules than Medicaid.”
Part 3, Section 4.2.1 and Section 4.3 are changed to allow Transitional MaineCare (TM) coverage to begin the month after the individual becomes ineligible for MAGI coverage. In addition, the Department proposes to change the examples in these sections to show that the 12 months of TM coverage begins the month after the MAGI coverage closes due to the report of increased earnings or increased alimony.
The adopted rule updates Part 3, Section 2.2(II) and Part 3, Section 4.1.1(IV) with pregnant individual replacing pregnant woman.
The adopted rule amends Part 2, Section 13.1(III) to include “Effective December 1, 2023, pregnant individuals who are found eligible for Children’s Health Insurance Program (CHIP), and enrolled in CHIP while pregnant, under Part 3, Section 2.3(III) are continuously eligible for 12 months beyond the date the pregnancy ends.”
Part 3, Section 2.3(III) is updated to “Effective December 1, 2023, pregnant individuals who are found eligible for the Children’s Health Insurance Program (CHIP), and enrolled in CHIP while pregnant, eligibility from conception to end of pregnancy extends 12 months beyond the month in which the pregnancy ends, regardless of any subsequent changes in household income.” In addition, the adopted rule updates the countable income section to state: “Countable income is equal to or less than 208% FPL.”
Part 8, Section 4 removes the asset test for all Medicare Savings Plan coverage types effective retroactive to January 1, 2024.
Retroactive rulemaking is permissible under 22 M.R.S. § 42(8) as these updates provide a benefit to recipients and applicants.
The Department determined it necessary to make non-substantial changes to the final rule to align the MaineCare Eligibility Manual with legislative changes to 22 M.R.S. §§ 2127 (2 & 6), 3173-K, and 3174-B(3), 3174-G(1B),(D &E), 3174-T, 3174-U, 3174-X(A), 3174-BB(1), 3174-NNN and 24 M.R.S. § 2332-A(2), 24-A MRSA §§ 2844(2) and 2849-B (3, C-1) made by P.L. 2024, Ch. 597, An Act to Correct Language Related to Medicaid Coverage for Children. Throughout the open Parts of this rule, CHIP replaces Cub Care. The final rule is consistent in substance with the rule that was proposed.
An additional non-substantial change was made to Part 2, Section 13.1(II) “It does not apply to those enrolled in Katie Beckett or those receiving coverage under Transitional MaineCare.” The adopted rule removed “enrolled in Katie Beckett or those” as individuals enrolled in Katie Beckett receive 12 months of continuous coverage consistent with Section 1902(e)(12) of the Act and 42 C.F.R. § 435.225. Further, Part 3, Section 2.3(III) removed “prenatal care and pregnancy related.” Covered services are detailed in 10-144 C.M.R. Ch. 101, § 106-3(B).
This rule will not have an adverse impact on municipalities or small businesses.
Statutory Authority: 22 M.R.S. §§ 42(1) and 8; 3174-G(1); 3174-FFF; and 3174-LLL
Effective Date: May 26, 2024
Adopted
Office: Office for Family Independence
Routine technical
Email: Adam.Hooper@maine.gov
Comment deadline:
Effective date:
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