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MAIN
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A Joint Project of the Maine
Association of Interdependent Neighborhoods |
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Volume 9 No. 2 |
August 2005 |
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MAIN
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A Joint Project of the Maine
Association of Interdependent Neighborhoods |
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Volume 9 No. 2 |
August 2005 |
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Severe MaineCare Cuts to Childless Adults
(The “Noncategorical” Group)
Caused Mostly by a Cap on Federal DollarsWho are “noncategoricals” and why are their MaineCare services being reduced?
MaineCare members in the “noncategorical” group are adults (age 21-64) without minor children at home who are below the poverty level. MaineCare for this group is being severely cut. It is called the “noncategorical” group because they do not fit a traditional MaineCare category – they are not disabled, 65 or over, a parent with minor children at home or a child. People in this group are able to get MaineCare only through a “waiver” from the federal government. MAIN and MEJP worked hard for many years to convince state government to obtain a noncategorical waiver – and, in 2002, were successful in getting MaineCare coverage to this group for the first time. But to get that waiver, Maine had to agree to limit the amount of federal dollars it would spend over the 5 years of the waiver. If the total cost of services for everyone in the noncategorical group was greater than the federal cap allowed, then either the program would have to be cut or the state would be liable for 100% of any of the extra costs.
This year Maine’s Department of Health and Human Services (DHHS) realized that there were not enough dollars to continue full MaineCare coverage to everyone who was eligible in the noncategorical group. On March 1st, they froze enrollment in the program and put new applicants on a waiting list.
In October 2005, DHHS will severely cut the MaineCare benefits for this group. People in the noncategorical group will get a notice in September listing in detail what services will and will not be covered by MaineCare. Needed services such as laboratory services, medical imaging services, speech and hearing services, occupational therapy services, podiatric services, targeted case management services and many more are being cut entirely. Outpatient mental health services are being limited to 16 visits per calendar year. Fortunately many important services will continue to be covered, including: prescription drugs, physician services, hospital services, dental services, outpatient substance abuse services, family planning services and transportation services. Get more details.
I’m worried my services are being cut. Is there anything I can do?
Maybe! Only people who are in the “noncategorical group” and cannot fit into another MaineCare category should be affected by these cuts. So the first step is to see if you fit into another MaineCare category.
You may still get full MaineCare benefits if you are in one of these categories:
65 or over
Disabled (unable to work because of a physical and/or mental health problem)
Pregnant
A parent or caretaker relative of a child under the age of 19 who lives with you
Under 21 years old
Have breast or cervical cancer, or
Have HIV or AIDS
Also, if you were ever in AMHI and are a consent decree class member, you should get any service that is in your Individualized Support Plan (ISP). Contact your case worker if you need help with this.
If you think DHHS has you listed in the noncategorical group when you belong in a different group with full MaineCare benefits, contact your local DHHS office about switching MaineCare categories. If you think you may fit the disability category, but haven’t yet been determined disabled by either Social Security or DHHS, ask the DHHS case worker for the “disability determination” form, fill it out and send it to your local DHHS office. If you can’t afford the health service (like a lab test) needed to prove you are disabled, DHHS can pay for the service once you have filed the disability determination forms as part of their process for deciding whether you are disabled.
I provide health and/or social services to people and am worried they will lose needed MaineCare services. What can I do?
You can screen the clients that you see to be sure that they are not mistakenly in the noncategorical group. You can also help those who are likely to be considered disabled apply for a DHHS disability determination (see above).
MEJP has a written screening tool, with instructions, to help you decide whether a client should be in a different MaineCare category.
These will be difficult days for those whose health care is being cut. If you are being cut, feel free to call MEJP for help figuring out what to do. MAIN and MEJP are monitoring the cuts and the enrollment freeze to advocate for restoring services or letting people on the waiting list enroll the moment it becomes clear the money is there to pay for it.
How to Make Sure You Keep Your MaineCare Coverage
Enrollment in the noncategorical group is now frozen, so new people aren’t being enrolled. If you are enrolled in MaineCare in the noncategorical group now, it’s important that you fill out the annual review form (recertification) and get it in to DHHS on time. If you get your review form in on time and you are still eligible for non-categorical services, your MaineCare coverage will continue. Be sure to let your DHHS worker know if your address changes, so you will get the review form.
If your review form is more than 30 days late, your case will be closed and you will lose MaineCare coverage (unless you are eligible for another group). If this happens you will have to apply again to find out if your name can be put on the waiting list for noncategorical coverage.
