Current Status

The MaineCare 1115 adult coverage waiver was approved in December, 2018. 

 

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Population Covered

Maine’s MaineCare 1115 waiver covers adults including parents (19-64) who make less than 105 percent of the federal poverty line, or about $12,000 per year for a single person. The waiver would also cover former foster youth, those receiving Transitional Medical Assistance and people with breast and cervical cancer or HIV up to 250 percent of the federal poverty level, about $30,000 per year for a single person in 2017.

Components 

Other Resources

Premiums

Maine is approved to charge premiums (not exceeding 5 percent of income) to non-pregnant, non-disabled adults enrollees with incomes above 50 percent of poverty, with premiums varying between $10 and $40 depending on income (Maine income eligibility goes up to 200% of poverty). Individuals can be disenrolled for non-payment and locked out of coverage for 90 days or until back premiums are paid, whichever is shorter. More info and advocacy strategies to combat premiums programs.

Cost-Sharing

The state’s request for a $10 copay for emergency room use that does not result in an inpatient admission was not approved.  More info and advocacy strategies to combat cost sharing.

Benefits

Maine received approval to waive retroactive eligibility coverage. Coverage and benefits  begin the month individuals submit an application.  (Note: Maine had requested that coverage not begin until after an enrollee makes an initial premium payment.)

Work and Community Engagement Requirement

The state’s request to make work a condition of eligibility for non-pregnant, non-disabled adults enrolled in MaineCare was approved. Members who must meet the work requirement may only receive up to three months of MaineCare coverage in a thirty-six month period without meeting the community engagement and work requirements; those who fail to comply with the community engagement and work requirements may be disenrolled. Disenrolled individuals must reapply and will have eligibility reinstated if they can demonstrate one month’s compliance with the program’s work requirements, or that they are eligible under a category not subject to the work requirement. Individuals can also be disenrolled and locked out of coverage for 90 days for failure to report a change in circumstances related to Medicaid eligibility or work requirement compliance. More info and advocacy strategies to combat work requirements.

Asset Test

Maine’s request to apply an asset test of $5,000 to populations who do not otherwise have an asset test as a part of their eligibility requirements was not approved.