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Maine's Medical Assistance Programs:
Who's Covered and Who's Not

Group

Program

Income
Limit
1

Asset
Limit

Notes

Children 0- 18

Full-benefit
MaineCare

200% FPL
(federal poverty level)

None

Children with income up to 150% FPL are eligible for free MaineCare; infants under 1 with income up to 185% FLP are eligible for free MaineCare. Children between 150% and 200% FPL are eligible for low-cost MaineCare (with a premium from $8-$64 per month, per family). Children in higher-income families who have a serious medical condition are served under the Katie Beckett option. For the Katie Beckett option, only the income and assets of the child who has the disabling condition (not the parents' income or assets) are counted. There is an asset limit of $2,000 for the child for Katie Beckett coverage.
Health Insurance Premium Option allows families who lose coverage due to increased income to buy into MaineCare at a cost of $250 per month per child for 18 months.  More information

19- and 20-year-olds

Full-benefit
MaineCare

150% FPL

$20002
(Many assets are excluded.) 

Income of parents in the household is counted in some circumstances. 
More information

Parents with children age 18 and younger at home3

Full-benefit
MaineCare

200% FPL

$2,0002
(Many assets are excluded.)

Transitional coverage: If family income increases from under 150% to over 200% FPL due to earnings, an additional 6 months of coverage is available. These individuals are also eligible for transitional coverage for 4 months if the reason for the increase in income is child support. More information

Pregnant Women

Full-benefit
MaineCare

200% FPL

None

For the mother, coverage continues for 2 months beyond the month that pregnancy ends. Coverage will continue longer if the mother meets criteria above for parents. If the mother had full-benefit MaineCare when the baby was born, the baby will be covered by MaineCare for at least 1 year. More information

Disabled Adults and seniors age 65 and older

Full-benefit
MaineCare

100% FPL

$2,000 ($3,000 for a couple)2

Workers with disabilities: $8,000 ($12,000/couple)
(Many assets are excluded.)

Full-benefit MaineCare "wraps around" Medicare. It covers nearly all Medicare costs. Individuals who are enrolled in Medicare will need to be enrolled in a Medicare Part D prescription drug plan (PDP) and will get their drugs through Part D. Call the DHHS Pharmacy Help Desk at 1-866-796-2463 begin_of_the_skype_highlighting              1-866-796-2463      end_of_the_skype_highlighting for questions on Part D. More information on Part D (large .pdf file)
MaineCare Option for Workers with Disabilities: People with disabilities who work may be eligible for full-benefit MaineCare if their unearned income is under 100% FPL and their total income, including earnings, is under 250% of FPL. Some people may have to pay small monthly premiums.

Disabled Adults and seniors age 65 and older who have Medicare

Limited-benefit
MaineCare

185% FPL

None

Medicare Savings Program (MSP or "Buy In"): MaineCare will pay for the Medicare Part B premiums for those below 185% of the FPL. For those below 150% of FPL MaineCare will also pay the Part A and B deductibles, co-insurance/co-pays.
MSP's will have no Part D premium, deductible or "donut hole." Co-payments are limited. More information on MSP

"Non-Cats:" adults who do not fit into one of the "categories" for full-benefit MaineCare Partial-benefit
MaineCare
100% FPL $2,000 ($3,000 for couple)2
(Many assets are excluded.)
Adults age 21 to 64 who are not disabled and do not have minor children living at home may be eligible for MaineCare if their income is below 100% of FLP and they are under the asset limit. Covered services are limited. There is usually a waiting list for this program. Individuals will be moved off of the waiting list and onto the program as spaces become available.

Adults living in Nursing Homes

Full-benefit
MaineCare

Gross Income must be below the semi-private room rate of the nursing facility in which the person resides.

$2,000 ($3,000 for couple)2
(Many assets are excluded.)

The person will pay most of their income toward the cost of care in the nursing facility, unless they have a spouse at home. The Member will keep at least $40 per month for personal needs.

Adults medically eligible for a Nursing Facility but who are living at home through the Home and Community Based Waiver

Full-benefit
MaineCare

300% of the federal SSI Benefit Amount ($2022 in 2009)

$2,000 ($3,000 for couple)2
(Many assets are excluded.)

The person will be able to keep income equaling up to 125% of the Federal Poverty Level. All other income will be used to pay for the cost of care.

Adults living in residential care facilites oither than nursing facilities

Full-benefit
MaineCare

Countable Income must be below the private pay rate for the residential care facility.

$2,000 ($3,000 for couple)2
(Many assets are excluded.)

The person will pay most of their income toward the cost of care in the residential care facility. Member will generally keep about $70 per month for personal needs.

Women who have breast or cervical cancer (or pre-cancerous condition)

Full-benefit
MaineCare

250% FPL

None

Women must be without insurance; age 40-64; have a positive screening for breast or cervical cancer at an approved screener. For more information: 1-800-350-5180 begin_of_the_skype_highlighting              1-800-350-5180      end_of_the_skype_highlighting.
HIV-positive adults MaineCare
drug coverage and other limited benefits
250% FPL None Individual must be HIV-positive (with or without diagnosis of AIDS); coverage includes prescriptions and physician and hospital services; there are some limitations on services; co-pays are higher ($10 per prescription and per office visit) than for full-benefit MaineCare; there is a limit on the number of individuals who can participate in the program.
"Medically Needy" or "Spend Down:" persons whose income is too high for full benefit MaineCare Full-benefit MaineCare, after a large deductible is met None $2,000 ($3,000 for some couples)2
(Many assets are excluded.)
The Medically Needy benefit helps people with catastrophic health care expenses; participants must be in a coverable group (65 or older, disabled, 20 or younger, pregnant, or the parent of a minor child); the deductible amount depends on income level; medical bills and other costs associated with medical care must have been incurred, but don’t need to have been paid; certification is usually for 6 months. Old medical bills which you still owe can be used towards your deductible. More information

Disabled adults and seniors 62 and older

Low Cost Drugs for the Elderly and Disabled (DEL)

185% FPL (income limit is increased by 25% if drug costs are high.)

None

DEL covers:

  1. 80% of generic drugs costs (member pays 20% and small co-pay);

  2. 80% of drug costs for 14 specific health problems (member pays 20% and small co-pay);

  3. A small discount off the retail cost of many other medications;

  4. A catastrophic drug benefit covers 80% of the cost of most needed drugs after the person incurs $1,000 out-of-pocket using their DEL card (member pays 20% and small co-pay).

Some drugs will require prior authorization. Most individuals who are also enrolled in Medicare will need to be enrolled in a Medicare Part D Prescription Drug Plan (PDP) and will get their drugs through Part D. Call the DHHS Pharmacy Help Desk at 1-866-796-2463 begin_of_the_skype_highlighting              1-866-796-2463      end_of_the_skype_highlighting for questions on Part D.

Persons who do not qualify for full-benefit MaineCare Maine Rx Plus 350% FPL (see notes) None People over 350% of poverty will be eligible if they have out-of-pocket prescription drug expenses exceeding 5% of the family's income or out-of-pocket medical expenses exceeding 15% of the family's income. Drugs listed as "preferred" on the MaineCare preferred drug list are covered; savings will be approximately 15% on covered brand name drugs and 60% on generic drugs.

1For most MaineCare benefits, some income does not count towards these limits.

2Asset rules now exempt $8,000 for an individual and $12,000 for a household of 2 or more in certain savings, including retirement savings!

3DHHS Rule covers parents with an 18-year-old who will finish high school by age 19.


Federal Poverty Levels

IMPORTANT NOTE:  For most MaineCare benefits, some income does not count toward these limits. Poverty levels are adjusted annually according to the Consumer Price Index.

Annual Income

Household

Size 

100% 150% 170% 185% 200% 250% 350%
1 $10,830 $16,245 $18,411 $20,036 $21,660 $27,075 $37,905
2 $14,570 $21,855 $24,769 $26,955 $29,140 $36,425 $50,995
3 $18,310 $27,465 $31,127 $33,874 $36,620 $45,775 $64,085
4 $22,050 $33,075 $37,485 $40,793 $44,100 $55,125 $77,175
5 $25,790 $38,685 $43,843 $47,712 $51,580 $64,475 $90,265
6 $29,530 $44,295 $50,201 $54,631 $59,060 $73,825 $103,355
Each additional person $3,740 $5,610 $6,358 $6,919 $7,480 $9,350 $13,090

Monthly Income

Household

Size 

100% 150% 170% 185% 200% 250% 350%
1 $903 $1,354 $1,535 $1,670 $1,805 $2,257 $3,159
2 $1,215 $1,822 $2,065 $2,247 $2,429 $3,036 $4,250
3 $1,526 $2,289 $2,594 $2,823 $3,052 $3,815 $5,341
4 $1,838 $2,757 $3,124 $3,400 $3,675 $4,594 $6,432
5 $2,150 $3,224 $3,654 $3,976 $4,299 $5,373 $7,523
6 $2,461 $3,692 $4,184 $4,553 $4,922 $6,153 $8,613
Each additional person $312 $468 $530 $577 $624 $780 $1,091

Disclaimer

Maine Equal Justice Partners
February 2010

We are providing this information as a public service. We try to make it accurate as of the date indicated for each client education page. Sometimes the law changes. We cannot guarantee or promise that this information is always up-to-date and correct. Feel free to contact us to find out if there have been any changes since the date of the information provided.

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 Copyright 2010 Maine Equal Justice, 126 Sewall Street, Augusta ME 04330
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