MaineCare Eligibility
Section 5: Seniors, Adults with Disabilities, and the "non-Cats"

Contents

Contents of this page
5.1 MaineCare coverage: Non-Family categories
5.2 Income: what counts for MaineCare in senior, disability & non-cat categories?
5.3 Deductions from income: Senior & Disability Categories
5.4 Asset rules
5.5 When will coverage start? Can back bills be paid?
5.6 Options for members when their income goes over the guidelines
5.7 Managed care: How it works

Section 5: MaineCare Eligibility and Benefits for Seniors, Adults with Disabilities, and the "Non-Cats"

You have just learned the basics of MaineCare eligibility and coverage benefits for children, their parents, 19- and 20-year-olds, and pregnant women. MaineCare also provides coverage to:

• Seniors age 65 and older
• Adults with disabilities
• “Non-cats,” or non-categorical adults. These are adults who do not fit into any of the other coverage categories of MaineCare. In other words, they are age 21 to 64, they do not have dependent children living with them, and they do not have documented disabilities.

MaineCare coverage for seniors, people with disabilities, and the non-cats has some important differences. Building from your knowledge of how MaineCare works for children, their parents, 19- and 20-year-olds, and pregnant women, this section is designed to outline the major eligibility and coverage differences for seniors, people with disabilities, and the non-cats. This information is intended to supplement information already provided in the earlier sections of this guide.

5.1 MaineCare coverage: Non-Family categories

Refer back to Section 1.1 MaineCare Coverage Categories

* Benefit packages are outlined in the MaineCare Member Handbook.

It is important to note that the non-cats (adults age 21-64 without dependent children and without documented disabilities) do not receive full-benefit MaineCare. There are limits on the types of services they can receive, and there can also be limits on the number of times a service can be accessed. Also, there is often a wait list to get onto MaineCare as a non-cat. There are not wait lists for the other covered groups we have talked about in this guide (nor for seniors or adults with disabilities).

Section 5: MaineCare Eligibility and Benefits for Seniors, Adults with Disabilities, and the "Non-Cats"

5.2 Income: what counts for MaineCare in senior, disability & non-cat categories?

Refer back to Section 1.2 What counts as income for MaineCare?

Difference: For seniors and people with disabilities, any child support received does not count as income for the parent.

What does not count as income?
Addition: Cost of Living Adjustments (COLAs) associated with Social Security retirement benefits or Social Security Disability Insurance (SSDI) benefits do not count as income if the person currently has MaineCare (or has had MaineCare in the past 3 months). However, COLAs associated with Veterans Affairs (VA) benefits do count as income.

Section 5: MaineCare Eligibility and Benefits for Seniors, Adults with Disabilities, and the "Non-Cats"

5.3 Deductions from income: Senior & Disability Categories

Refer back to Section 1.3 Deductions from Income

Difference: To figure out income eligibility for MaineCare based upon being age 65 or older or disabled, there are several deductions that can be made (deductions must be made in order listed below):

1. The federal disregard of $20 first from any unearned income and then the rest from earned income of an individual’s or couple’s gross income (unless the only income received is from a need-based source, like a Veteran’s pension, or all in-kind donations)
2. $65 of any earned income
3. 50% of any remaining earned income
4. The state disregard of $55 from an individual’s remaining countable income, or $80 from a couple’s remaining countable income
5. The Cost of Living Adjustment (COLA) associated with Social Security retirement benefits and/or Social Security Disability Insurance (SSDI) benefits (if people are already on MaineCare, or if they have received MaineCare within the past 3 months)
6. Wages of dependent children
7. TANF cash benefits
8. If the elderly or disabled person has a spouse or dependent children, additional deductions may be allowed.

Difference: MaineCare with an ineligible spouse. For someone who is a senior, disabled, or a non-cat and who is living with his or her spouse, the income limit can be higher if only one spouse signs up for MaineCare. As a general rule, if the couple is $337 or less over income, check with an Eligibility Specialist regarding MaineCare with an ineligible spouse. This eligibility option disregards $337 from the ineligible spouse’s income (for the seniors and disabled, this is in addition to the seven deductions listed above. For non-cats, there are no other deductions). It also may be possible for spouses to alternate eligibility, switching their eligibility status with one another as often as once per month.

Difference: There are no deductions for non-cats for their income eligibility (except for the MaineCare with an ineligible spouse option).

Section 5: MaineCare Eligibility and Benefits for Seniors, Adults with Disabilities, and the "Non-Cats"

5.4 Asset rules

Refer back to Section 1.4 Asset Rules

Difference: A senior or disabled couple, or a senior or disabled individual with a child(ren), have a $3,000 asset limit. Remember that many assets are not counted in the asset limit (for example, $8,000 in savings is excluded).

Additional assets that do not count (for any MaineCare applicant/member):

• Prepaid burial contracts or mortuary trusts
• Burial spaces
• Up to $1,500 set aside in a separate account for burial expenses (including equity in burial contracts)

Section 5: MaineCare Eligibility and Benefits for Seniors, Adults with Disabilities, and the "Non-Cats"

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

Refer back to Section 2.4 When will coverage start? Can back bills be paid?

Difference: Non-cats will receive coverage beginning on the first day of the month that DHHS received the application, unless there is a waiting list. In the event of closed enrollment, a waiting list will be established, allowing applicants to submit an application. The application will be date stamped when received at DHHS and filed by date. Upon re-opening of enrollment for this group, DHHS will notify applicants in the order in which the applications were received. Coverage will begin on the first day of the month that notification is made to the applicant, as long as they still meet the eligibility requirements. There is no retroactive coverage. Back bills cannot be paid.

Section 5: MaineCare Eligibility and Benefits for Seniors, Adults with Disabilities, and the "Non-Cats"

5.6 Options for members when their income goes over the guidelines

Refer back to Section 2.7 Options for members when their income goes over the guidelines

Addition: MaineCare Option for Workers with Disabilities

The MaineCare Option for Workers with Disabilities (sometimes called the Working Disabled Benefit or the Medicaid Buy-In) allows members to earn more and still keep their MaineCare benefits. For this benefit, he or she only needs to meet the Social Security Administration (SSA) medical standard, not the work-related standard, of a disability.

An individual may qualify for this MaineCare Option if he or she:

• Meets the Social Security guidelines for a disability, and
• Has earnings, usually from a job, and
• Meets each of the following financial guidelines:

If the individual is single:

• Unearned income: monthly income from retirement, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), or other income that is not wages from a job must be $903 (100% of the federal poverty level [FPL]) or less after deductions. (Not all income is counted—income could be as high as $978 per month.)
• Wages from a job, added to the income that is not from a job, must be $2,257 (250% FPL) or less after deductions. (Not all income is counted; income could be as high as $4,709 per month, if all income is from work.)
• Assets are $8,000 or less. (Not all assets are counted. For example, your home, car(s), and up to $8,000 in savings are not counted.)

If the individual is married:

• Monthly income from retirement, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), or other income that is not wages from a job must be $1,215 (100% FPL) or less after deductions. (Not all income is counted—income could be as high as $1,315 per month.)
• Wages from a job, added to the income that is not from a job, must be $3,036 (250% FPL) or less after deductions. (Not all income is counted—income could be as high as $6,317 per month, if all income is from work.)
• Assets are $12,000 or less. (Not all assets are counted. For example, your home, car[s], and up to $12,000 in savings are not counted.)

If someone meets the three guidelines listed above, he or she may be eligible for MaineCare. Even if income is above these amounts, he or she may still be able to get MaineCare. Not all income is counted. Contact your local Department of Health and Human Services (DHHS) office and request to fill out an application for the MaineCare Option for Workers with Disabilities.

What will it cost?

If monthly countable income is over 150% FPL, the individual will need to pay a monthly premium for his or her benefits (either $10 or $20 per month, depending on income). If married and both spouses are eligible for this benefit, they will need to pay just one premium, based on their combined income. People will not have to pay the premium if they are responsible for paying their Medicare Part B premium.

Get more details from DHHS Office of Elder Services

• Home and Community Benefit for the Elderly or Adults with Disabilities
• Nursing Home Benefit
  

In order to receive MaineCare coverage for nursing home care or equivalent care at home, an individual must need the level of medical care given in a nursing home. There are other MaineCare programs that offer different levels of care in the home, depending on an individual's needs. He or she must also meet income and asset limits, although the income limits are higher than for full-benefit MaineCare. Also, if the individual has a spouse, much of the spouse's income will be disregarded. To learn more about these benefits, contact your local Area Agency on Aging, or call: 1-877-ELDERS1 (1-877-353-3771).

Section 5: MaineCare Eligibility and Benefits for Seniors, Adults with Disabilities, and the "Non-Cats"

5.7 Managed care: How it works

Refer back to Section 3.1 How managed care works

As of October 2008, elderly, disabled and non-categorical MaineCare members will also be enrolled in Managed Care, following the same rules. However, they can't enroll in managed care if they:

• Live in a nursing or ICF-MR (Intermediate Care Facility for people with Mental Retardation)
• Have Medicare
• Have other health insurance
• Will be eligible for MaineCare for less than 3 months
• Are in the MaineCare Member Restriction Plan

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