MaineCare Rule #304P - CHIP Coverage Group Change and Medicare Savings Program Change

Date posted:

Attachment(s):

10-144 C.M.R. Chapter 332; MaineCare Eligibility Manual - Parts 2, 3 and 8

MaineCare Rule #304P - CHIP Coverage Group Change and Medicare Savings Program Change

The purpose of the proposed rule would remove 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 proposed rule changes would increase access to health insurance coverage.

The Department proposes to amend 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 Department proposes to change pregnant woman to pregnant individual in Part 3, Section 2.2(II) and Part 3, Section 4.1.1(IV).

The Department proposes to amend 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) would be 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 Department proposes to change the countable income section to state: “Countable income is equal to or less than 208% FPL.”

Part 8, Section 4 would remove 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.

PUBLIC HEARING: No public hearing is scheduled.

COMMENT DEADLINE: Monday, April 8, 2024, at 5:00 p.m. E.T.

Written public comments may be submitted via the link at https://www.maine.gov/dhhs/about/rulemaking.

Office: Office for Family Independence

Comment deadline:

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