MaineCare For Childless Adults
(The "Noncategorical" Group)

Who are "noncategoricals"?

MaineCare members in the "noncategoricals" group are adults (age 21-64) with no minor children at home. Your countable income must be below the poverty level.

Family Size	Total Income (before deductions)
1	$10,400
2	$14,000
3	$17,600
4	$21,200
5	$24,800
6	$28,400
7	$32,000
8	$35,600
For each additional person add	$3,600

It is called the "noncategoricals" group because these people do not fit into a traditional MaineCare group; they are not disabled, 65 or over, a parent with minor children at home or a child.

Why do they sometimes put people on a waiting list for this program?

People in this group are able to get MaineCare only through a "waiver" from the federal government. 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 limit, then either the program would have to be cut or the state would be liable for 100% of any of the extra costs.

Do people in the noncategorical group get the same services as everyone else who gets MaineCare?

No. Most medical services are covered. However, some services are not covered or there are limits on the service. Here is a list of some of the limited or non-covered services.

• laboratory services (covered if provided in a hospital)
• medical imaging services (covered if provided in a hospital)
• speech and hearing services
• occupational therapy services
• podiatric services
• targeted case management services
• outpatient mental health services (limited to 24 visits per calendar year)
• durable medical equipment (oxygen and insulin pumps are covered)

What can I do if I need services that are not covered in this group?

You may still get full MaineCare benefits if you fit into another MaineCare group. The first step is to see if you fit into one of these groups:

• 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

Get chart of all covered groups, the basic financial eligibility requirements and coverage for each.
Get more details about MaineCare for all groups.

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 groups.

If you think you may fit the disability category, but have not 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.

I provide health and/or social services to people in the noncategorical group. How can I help them get the services that they need?

You can screen the people 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 person should be in a different MaineCare category.

How to make sure that you keep your MaineCare coverage

If you are in the MaineCare 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 may have to apply again to find out if your name can be put on the waiting list for noncategorical coverage.