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Maine Medicaid Eligibility Qualifications

The Maine government offers Medicaid under the name "MaineCare." MaineCare is available as full-benefit, partial-benefit and limited-benefit coverage dependent upon income levels and medical criteria. Maine determines qualifying income levels for each group of MaineCare eligible individuals based on the Federal Poverty Level (FPL). The FPL is reevaluated periodically and sets poverty levels based on annual income. As of 2010, the FPL was income below $10,830 for a single person and $22,050 for a family of four (slightly higher levels apply in Alaska and Hawaii).

  1. Children

    • According to Maine Equal Justice Partners, children from age 1 to 18 with income up to 150 percent of the FPL are eligible for free MaineCare. The limit is 185 percent of the FPL for children under age 1. Children with 150 percent to 200 percent of the FPL are eligible for MaineCare with a low premium. The Katie Beckett option is available for higher-income families with a child who has a serious medical condition. This option counts only the child's personal income and assets, not those of the family.

    Parents with Children

    • Parents with children 18 and younger living at home qualify for full-benefit MaineCare with income levels at or below 200 percent of the FPL. MaineCare offers special extended coverage for families whose income increases from below 150 percent to above 200 percent of the FPL because of earnings, and transitional coverage for families whose income increased because of child support.

    Pregnant Women

    • MaineCare offers full benefits for pregnant women with income levels at or below 200 percent of the FPL. According to Maine Equal Justice Partners, the coverage continues for 2 months after the month when the pregnancy ends or longer if the mother qualifies for MaineCare under the category for parents with children.

    Disabled Adults and Seniors 65 and Older

    • Disabled adults and seniors age 65 and older qualify for full-benefit MaineCare to supplement Medicare with income levels of 100 percent or lower of the FPL and limited-benefit MaineCare to pay some Medicare premiums for those with income levels below 185 percent of the FPL.

    Maine Rx Plus

    • People with incomes at or above 350 percent of the FPL qualify for the Maine Rx Plus program if out-of-pocket medical expenses are more than 15 percent of the family income or out-of-pocket prescription drug costs are more than 5 percent of the family income. The program offers discounted brand name and generic drugs and covers drugs on the MaineCare "preferred drug list."

    Medically Needy

    • According to Maine Equal Justice Partners, people with "catastrophic" health-care expenses who are in one of the qualifiable groups, such as disabled, older or pregnant women, but whose income is above the eligibility limits qualify for full-benefit MaineCare after meeting a large deductible. The deductible is determined by income level and the person must have already incurred medical bills.

    Other Categories

    • Adults living in nursing homes or residential facilities, or those receiving health care at home, may qualify for different levels of MaineCare benefits. The benefits for people in nursing homes and residential facilities go primarily to the cost of the facility.

      Adults who do not fit into one of the eligible categories for MaineCare, whose income is below 100 percent of the FPL and who have assets valued at less than $2,000 may qualify for partial benefits. People will be placed on a waiting list for benefits, as the services are limited.

      Women between the ages of 40 and 64 who have no insurance and have been diagnosed with breast or cervical cancer may qualify for MaineCare.

      MaineCare offers a limited number of individuals with HIV drug coverage and partial benefits.

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