|
|
MAIN
|
 |
|
|
A Joint Project of the Maine
Association of Interdependent Neighborhoods |
|||
|
Volume 10 No. 2 |
June 2006 |
||
|
|
MAIN
|
|
|
|
A Joint Project of the Maine
Association of Interdependent Neighborhoods |
|||
|
Volume 10 No. 2 |
June 2006 |
||
Good News for MaineCare Non-Categoricals!
The “non-categorical” MaineCare program serves non-disabled childless adults between the ages of 21 and 64 who are living below the poverty level. The federal government put a limit (“cap”) on the amount of money that can be spent to provide services to this group. Because of the cap, enrollment of non-categorical participants was frozen in March 2005 and services were cut back in December 2005. Here’s the good news: People who have been on a waiting list are going to be able to enroll and some of the services that were cut are going to be covered again.
Increasing Enrollment
This spring, over 10,000 people were on the non-categorical waiting list. MAIN and MEJP asked the Department of Health and Human Services (DHHS) to re-open MaineCare enrollment for this group. DHHS agreed and amended their budget request to the Legislature so they could increase enrollment. The Legislature agreed to this request. Over the last few weeks, the DHHS sent letters to the first 3,000 people on the waiting list inviting them to apply for coverage on a first come, first serve basis. After July 1st enrollment will be opened to everyone who is still on the waiting list.
If you are on the waiting list and get a letter that says you can enroll, you need to apply within 30 days. Be sure to send in your form right away. If you didn’t put your name on the waiting list, you can put it on now. If you call and sign up for the list, you may be able to get coverage a little earlier than if you wait until DHHS opens enrollment again.
Hopefully, by late summer enrollment will be opened to people who are not on the waiting list now. This will be on a “first-come first-served” basis. For the next year, DHHS will monitor enrollment and costs carefully to make sure we stay under the cap set by the federal government. While enrollment in this program will always be limited by the federal cap, the good news is that thousands more people who are eligible for the non-categorical program will soon have access to critical health care services through MaineCare.
Some Services Added
The Department is also adding back a few services that had been cut for non-categorical participants in MaineCare. Starting in October, non-categorical participants will be able to get these services:
- Podiatry;
- Oxygen;
- Insulin pumps;
- Ambulance services; and
- Laboratory services from any MaineCare provider.
Thanks to LD 1701, legislation introduced by Rep. Joe Brannigan (D. Portland) and supported by MAIN, the limit on mental health services will be increased from 16 to 24 visits a year starting in October. For non-categorical participants to get these 24 visits, their mental health providers will need to ask for prior authorization from DHHS.
More Time to Send in Review Forms
LD 1701 also provides some protection for non-categorical participants who have good reason for not returning their annual review forms on time. Starting in September, these participants will be able to return their review forms within 30 days after their termination date. Individuals, who show that they have a good reason for not returning the forms on time, will be placed at the top of the waiting list rather than having to reapply to the program and being placed at the bottom of the list.
Hundreds of people leave the non-categorical program each month. We believe that many of these people are falling off the program because they do not send their review form in on time.
The MaineCare program requires every recipient to renew their eligibility once a year. MaineCare recipients receive a letter telling them that it’s time to recertify. They are asked to return a form before the end of the month to tell DHHS about any changes in income or other important changes. If the recipient does not mail the form to DHHS, they receive a second notice telling them that their MaineCare will be terminated at the end of that month. Recipients can stay on the program if they send in the materials before the end of that month, and are still eligible.
Starting in September, non-categorical MaineCare participants and individuals on the waiting list who don’t get their review forms in on time may be able to send in their forms within the next 30 days. If you get a final notice telling you that your MaineCare is ending because you didn’t send in your review form, be sure to call your worker and tell him/her if you have “good cause” for not sending it in. “Good Cause” example: You never received the notice because of homelessness or because you moved recently.
If you have good cause and get your review form in within the next 30-day period you will be placed at the top of the program’s waiting list. If there isn’t a waiting list anymore, you will be able to stay on MaineCare. This change will certainly help many people, but will not help everyone who misses the deadline for filing their review form. So, please try to return you form right away!
We hope that these changes to the noncategorical MaineCare program will help more people get the health care services that they need.
