|
|
MAIN
|
 |
|
|
A Joint Project of the Maine
Association of Interdependent Neighborhoods |
|||
|
Volume 10 No. 1 |
March 2006 |
||
|
|
MAIN
|
|
|
|
A Joint Project of the Maine
Association of Interdependent Neighborhoods |
|||
|
Volume 10 No. 1 |
March 2006 |
||
Update!
MaineCare Non-categorical Program
The MaineCare program for “non-categoricals” has some good news following the cutbacks and shut down in 2005. In March 2005, enrollment in the MaineCare program for childless adults—the so-called “non-categoricals"—between the ages of 21 and 64 was shut down. On December 5, 2005, services for this group were severely cut back. Non-categorical MaineCare recipients continue to receive many of the major MaineCare services such as hospital, doctor’s visits, and prescription drugs. However mental health outpatient visits have been limited and other important services such as podiatry, occupational therapy, durable medical equipment, and targeted case management have been cut completely.
Since the time that the program was frozen, enrollment has dropped from a high of 24,925 in February 2005 to 12,850 in January 2006. Participants are moving off the program at an average rate of over 1,000 individuals per month. While some of those leaving this group have moved into other MaineCare coverage categories such as disability, 75% or 8,429 of these individuals have completely lost their MaineCare coverage. Currently there are over 7,700 people in this group on a waiting list for MaineCare benefits.
Enrollment Re-opens
In response to MAIN’s requests, the Department of Health and Human Services (DHHS) has recently agreed to re-open enrollment for this group of adults on a limited basis. The plan is to let as many people into the program each month who leave it—for example, if 1,000 people leave the program in February, then there will be room for 1,000 new members in March.
The Department will soon send a letter to the first group of people on the waiting list inviting them to apply for coverage on a first-come, first-serve basis. Some people have gotten discouraged by the size of the waiting list and have not signed up. This new development makes it important for anyone who wants coverage under this group to be sure to get onto the waiting list. If you are on the list, be sure to respond right away to any letter about enrollment that you get from DHHS.
Enrollment will stay at the January level (12,850 members) until at least June when the Department has agreed to assess whether additional people can be added. This program is under a spending cap set by the federal government. The Department must determine if there are enough funds to add new members without going over the federal spending limit. MEJP and MAIN will continue to monitor the Department’s actions. We will advocate to raise enrollment above current levels as quickly as possible.
Broaden Mental Health Services
Meanwhile, legislation that would make outpatient mental health services more accessible to this group has been introduced by Rep. Joe Brannigan (D. Portland). This bill, LD 1701, would allow members to exceed the 16-visit limit on outpatient mental health services when medically necessary. MAIN strongly supports this effort. Recently, staff from Maine Equal Justice met with two groups of people eligible for MaineCare non-catagorical coverage in Bangor and Portland. We asked them for advice about what we should be advocating for in this program. Most felt strongly that reopening the program was most important, but that restoring certain services was critical as well. Eliminating the limit on outpatient mental health services was a priority for both groups.
[NOTE: Appointments to manage medication are not counted in the 16-visit limit.]
We expect more changes in this program in the next months. We will keep MAIN Update readers posted as they develop.
Two IMPORTANT Pieces of Information on MaineCare Non-Categoricals
How you can get needed services
Some services for people receiving MaineCare through the non-categorical program were cut back in December, 2005.
The following services were cut, but will be covered in certain circumstances:
- Lab work, X-Rays and other imaging services: Non-Categoricals can still get these services, but only if the service is provided at a hospital in-patient or out-patient facility. (If the hospital contracts with an outside business for these services, then they may not be covered!)
- Diabetic Supplies: Insulin, lancets, lancet devices, alcohol swabs, testing strips (blood and urine), glucometers and syringes are all covered with a prescription.
- Hospice Services: If a Non-Categorical needs hospice services, they can call their eligibility worker to apply for MaineCare based upon disability. They should be immediately put on full MaineCare so they can get hospice and other needed services.
[SPECIAL NOTE: Mental health appointments to manage medication are not counted in the 16-visit limit on outpatient mental health services.]
How to prevent being dropped from MaineCare
If you are in the MaineCare program as a non-categorical, your eligibility needs to be recertified once a year. When you receive the recertification form in the mail, please fill it out and return it by the required date. If you miss the deadline, MaineCare will send you a letter saying that your benefits will end by a certain date. When you get this letter, call your eligibility worker, whose number is listed on the letter and tell her/him that you want to continue your MaineCare coverage and that you will send in your recertification form. Send in your recertification form IMMEDIATELY. If you do not respond to this letter, you will be dropped from MaineCare. To get MaineCare coverage again, you must call to asked to be placed on the non-categorical waiting list. There are currently 7700 people on the waiting list.
