MaineCare Rule #303A - Household Income Standard for Children and CHIP Changes

The adopted rule increased the Federal Poverty Level (FPL) to 300% from 208% of the FPL for all children. The adopted rule aligns the MaineCare Eligibility Manual with a legislative change to 22 M.R.S. § 3174-G(B) made by P.L. 2024 ch. 597, §5. The adopted rule is anticipated to increase access to health insurance coverage.

MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.

Attention Pharmacy Providers: Status of Restoration of Maine Point of Purchase System (MEPOPS) and Office Hours with MaineCare’s Pharmacy Team

The Office of MaineCare Services continues a phased recovery following the outage that occurred from February 21, 2024, through March 26, 2024, due to the national cyber security issue affecting Change Healthcare. 

Maine’s Children & Youth with Special Health Care Needs Webinar Learning Series: MaineCare in Education

This comprehensive webinar on September 3, 2024, from 3:30-4:30 PM, provides a basic overview of MaineCare services in schools. An explanation of MaineCare eligibility will include what school related services are available, who is eligible and how to access them. Trista Collins will cover Katie Beckett coverage and dispel some myths regarding MaineCare covered services. Participants will learn about MaineCare covered services in an Individual Education Plan (IEP) and how to utilize Private Duty Nursing (PDN) both at home and in the school setting.

Certified Community Behavioral Health Clinic (CCBHC) Certification Documentation Due September 6, 2024

On December 13, 2023, MaineCare noticed the opportunity for an initial cohort of prospective CCBHCs to submit provisional certification materials. The Department is now accepting final certification documentation from provisionally certified providers. The Department will review submissions for final approval and full certification status and participation in Maine’s CCBHC Demonstration program.

​Attention Section 65, Behavioral Health Services Providers: Temporary Claims Payment Delay

Attention Section 65 Providers, Section 65 claims are temporarily pending due to an error in Gainwell’s implementation of the January 1, 2024, COLA. Gainwell corrected the error. Affected claims will process in this week’s reimbursement payment cycle which will issue reimbursements on August 23, 2024.  

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