There are free and low-cost health coverage options that ensure children and young adults under age 21 can get the important care they need to stay healthy.
Types of Health Coverage for Children
MaineCare
MaineCare provides free health insurance, other health benefits, and assistance to childen and young adults under age 21 who meet income guidelines or disability criteria.
Apply to MaineCare now!
As of October 1, 2023, eligibility guidelines have changed! For example, children and young adults under 21 in families may be eligible if they earn an annual salary of:
- $59,000 for a family of two, or
- $90,000 for a family of four.
If you think your child or young adult could be eligible, apply to MaineCare now. Apply online at MyMaineConnection.gov or go to the Department's Office of Family Independence page for more options. Applications for MaineCare are processed by the Office for Family Independence.
For more information about MaineCare coverage for children, please see the following documents:
Katie Beckett
Children under age 19, with serious health conditions who are over the income level for free MaineCare, may get MaineCare coverage through the Katie Beckett program. Children enrolled in Katie Beckett pay a low-cost premium for health coverage. For more information about the Katie Beckett program, please see the following documents:
Health Insurance Purchase Option
If a child under age 19 loses MaineCare coverage because family income goes up, you can buy MaineCare coverage for up to 18 months or until your child turns 19, whichever comes first. For more information, call the Office for Family Independence at 1-855-797-4357. Ask about the “Full Cost Purchase Option for Children Under 19 Years of Age.”
Newborn Coverage
After your baby is born, call the Office for Family Independence as soon as possible to add your baby MaineCare. If you do not add your baby to MaineCare right away, you may get a bill from the hospital. If you had full MaineCare coverage when your baby was born, the baby can have MaineCare coverage until their first birthday even if your income changes.
- Coverage and Services
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Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program
Children and young adults who are under age 21 who have MaineCare are part of the EPSDT program. EPSDT is designed to assure children and young adults receive early detection and treatment to address health problems as soon as possible. MaineCare's EPSDT program can pay for medically necessary services or equipment that are not normally covered by MaineCare, if they are medically necessary to prevent illness or improve a condition.
EPSDT can cover a wide range of medically necessary preventive, dental, developmental, behavioral health, and specialty services.
For more information, please see the EPSDT Member Fact Sheet.
Please visit our Covered Services & Benefits webpage for more information.
- Children's Behavioral Health Services
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Children's Behavioral Health Services CBHS is a support provided by the Office of Child and Family Services (OCFS) that helps Maine children, youth, and families find mental and behavioral health services. While CBHS does not directly provide these services, it helps connect children under 21 to needed care.
Please visit the Children's Behavioral Health webpage on OCFS's website for more information.
- Health Homes for Chronic Conditions
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If your child has chronic health conditions, they may be eligible to participate in a Health Home, Behavioral Health Home, or Opioid Health Home. Health Homes work with your child’s Primary Care Provider (PCP) to manage their chronic health conditions. Please visit the Primary Care and Your Health webpage for more Health Home information.
- MaineCare for Students
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There are three ways MaineCare covers medical services when a member is at school:
MaineCare’s School-Based Services Program
This program covers medically necessary services listed in the member’s Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) when provided by a school-based provider.
School Health Clinics
There are some school districts that run school health clinics. School health clinics are different from one school district to another. They can provide a range of services from preventive care to acute care. When students who are MaineCare members get services through these clinics, MaineCare will pay for the medically necessary services that are not listed in the IEP or IFSP. Please contact your school health clinic for a list of services that may be offered in your district.
Provider Discretion
There are MaineCare providers who use space in a school to provide medical services to students when the service is not listed in the IEP or IFSP. The student may get services at the school instead of the provider’s office and these services are not considered school-based service because the referral was not made based on services listed in the IEP or IFSP.
See the MaineCare Member Handbook (PDF) for more detail about MaineCare services provided in a school setting. For all questions regarding school-based services, please contact MaineCare’s State Medicaid Educational Liaison by email or call (207) 624-4094.
Examples of school-based services include, but are not limited to:
- Children's Behavioral Health Day Treatment (Section 65)
- Speech therapy
- Physical therapy
- Occupational therapy
- Nursing services
- Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations (Section 28)
- Specialized transportation
MaineCare will pay for any medically necessary services that are not listed in the IEP or IFSP, or are in addition to services listed.