MaineCare Eligibility
Section 2: The Application Process

Contents

Contents of this page
2.1 How to apply
2.2 Citizenship and identity verification requirement
2.3 How long does it take for DHHS to review an application?
2.4 When will coverage start? Can back bills be paid?
2.5 Length of enrollment
2.6 Other rules about how long enrollment will last
2.7 Options for members when their income goes over the guidelines
(Transitional MaineCare and Health Insurance Premium Option)

Section 2: Application and Enrollment

2.1 How to apply

Applicants can get an application online or by:

• Calling the DHHS statewide toll-free number at 1-877-543-7669
• Visiting a local DHHS office.
• Calling the Consumers for Affordable Health Care HelpLine at 1-800-965-7476

If applicants prefer, they can also call their local DHHS office and apply over the phone.

Parents, children, 19- and 20-year-olds, and pregnant women use the same form to apply. The applicant should complete the form, then mail it or bring it to a local DHHS office. Be sure he or she includes proof of income for the past 4 weeks (for example, the four most recent weekly paycheck stubs, or, if self-employed, a copy of the most recent tax form).

Agencies can request bulk orders of applications (500 per box) by faxing the DHHS supply room at 626-5555. Be sure to include your mailing address, the application form you want (the green family MaineCare application), and the number of applications you would like to receive.

Note: Elderly, disabled and "non-cat" adults must use a different application form. Get online form.

Link to all DHHS online application forms

Section 2: Application and Enrollment

2.2 Citizenship and identity verification requirement

The citizenship and identity verification law requires many people applying for or already receiving MaineCare (or Medicaid in any state) to prove their citizenship and their identity. If applicants are unable to prove their citizenship and identity, they will be allowed to get MaineCare for up to ninety (90) days. If they are not able to prove their citizenship within the 90 days, then they may lose their MaineCare.

A person will only need to prove his or her citizenship and identity once (unless he or she moves to another state). This means that if someone leaves MaineCare, but later comes back on, his or her citizenship and identity has already been proven.

To prove citizenship and identity, applicants may list the social security numbers for each of the family members on the application. The Department of Health and Human Services will submit the numbers to the Social Security Administration (SSA) and if Social Security verifies citizenship and identity, then no further documents need to be submitted.

Other ways to prove citizenship and identity

In very few cases when a social security number is not available, certain documents may be used to prove citizenship and identity. Documents must be originals, or certified copies from the issuing agency. These include documents such as passports, birth certificates, driver's licenses, etc.

MaineCare Eligibility Specialists have the full list of documents.

Exemptions from the law

There are many people who are exempt from this new law (they do not have to show documents that prove their citizenship or their identity):

• People on Medicare
• People receiving Supplemental Security Income (SSI)
• People receiving Social Security Disability Insurance (SSDI)
• Legal immigrants
• Foster children
• Newborn children born to mother who has MaineCare at the time of the birth

These groups of people are exempt because they have already had to show documents that proved their citizenship/immigration status and identity to state or federal government officials.

Section 2: Application and Enrollment

2.3 How long does it take for DHHS to review an application?

Most often, DHHS will send a notice within 2 to 3 weeks after getting a MaineCare application. DHHS must make a decision within 45 calendar days from the date they get the application, if it is complete.

If DHHS does not determine eligibility within 45 calendar days due to their own delays, they must send the family a short-term medical card to use until they do decide. This occurs fairly often when DHHS reviews eligibility based upon disability. The family may begin using the short-term card on day 46 and continue to use it until DHHS makes a decision. If DHHS later denies eligibility for MaineCare, the family will not have to repay DHHS for services received while using the short-term card.

Section 2: Application and Enrollment

2.4 When will coverage start? Can back bills be paid?

Everyone covered in this guide except CHIP children (who pay a monthly premium) may be eligible to receive coverage for up to 3 months before the month DHHS received the application. If anyone in the family had medical bills in the 3 months prior to applying, encourage them to indicate that on their application (Box 10).

CHIP children (who pay a monthly premium), will receive coverage beginning on the first day of the month that DHHS received the application.

Tip: If DHHS indicates that it will not cover medical bills for the 3 months before application, the family may want to contact the Consumers for Affordable Health Care HelpLine (1-800-965-7476).

Section 2: Application and Enrollment

2.5 Length of enrollment

Here's the basic rule: Members must re-apply every year (12 months) for MaineCare. DHHS will send a renewal form. They will check to make sure the member still meets income and asset guidelines.

Members will remain covered if:

1. The form is returned by the deadline stated in the letter
2. Any additional information requested by DHHS has been provided
3. Any CHIP premiums already due have been paid
4. They still meet the income and asset guidelines

Important! Children age 18 and younger who are enrolled in MaineCare are entitled to a full 12 months of coverage, regardless of any change to family income or composition.

Section 2: Application and Enrollment

2.6 Other rules about how long enrollment will last

CHIP children (who pay a monthly premium)

Children eligible for CHIP coverage may continue receiving coverage until they turn 19 years old. As a 19- or 20-year-old, they may then be eligible for free coverage. DHHS will automatically check to see if they are eligible for MaineCare in the category of coverage for 19- and 20-year-olds, and, if so, coverage will continue seamlessly.

Section 2: Application and Enrollment

2.7 Options for members when their income goes over the guidelines

Transitional MaineCare when earned income goes up

If parents and their children are enrolled in free MaineCare and their income goes from below the amount in Column B to over the amount in Column C (i.e. from below 150% FPL to over 200% FPL) because of increased earnings, they will be eligible for MaineCare for up to 6 more months, no matter how much their income goes up. If the children are enrolled in CHIP MaineCare (they pay a monthly premium), the parents' MaineCare will not continue. The children's eligibility will continue until the end of their annual enrollment period.

Transitional MaineCare when child support goes up

If a parent and his or her children are enrolled in free MaineCare and their income goes over the amount in Column C (i.e. over 200% FPL) because of an increase in child support, they can continue to get MaineCare for 4 more months.

MaineCare coverage continues for most children

Children of parents getting these earned income transitional benefits will continue to get MaineCare until the transitional benefits end or until the end of family’s 12-month certification period, whichever is later.

*Note: If after the initial six months extension, parents or caretaker relatives have income between 150 - 200% FPL, they could be eligible for coverage under the expanded coverage group for caretaker relatives

For children only: the Health Insurance Premium Option

For more information on transitional benefits for parents leaving TANF due to an increase in earned income, go to What Happens to my Benefits When I Get a Job and Leave TANF?

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