CHIP in Maine

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The Maine Children’s Health Insurance Program (CHIP) is part of the MaineCare program. Both CHIP and Medicaid enrollment are managed under MaineCare. However, CHIP is only for children, pregnant women and families with children who are not eligible for Medicaid. Even if adults in a family do not have Medicaid eligibility children can still apply for medical benefits provided by CHIP. “Is CHIP considered Medicaid?” and, “What is CHIP Medicaid?” are two of the many questions parents of children who need government health insurance have. Medicaid for children and CHIP are both funded from state and federal resources, but have different rules surrounding the two programs. To learn more about the two forms of MaineCare for children, read the sections below.

Maine’s Children’s Health Insurance Program Overview

All 50 states have a version of the CHIP program, which operates as government-provided health insurance for children. However, each state manages the requirements for enrollment in CHIP and Medicaid differently. So, the rules and regulations for how to apply for Medicaid and CHIP in one state will not necessarily be the same in Maine.

Once enrolled in Maine CHIP, a recipient is allowed to see whichever medical provider of his or her choosing, as long as that provider is in-network with the program. All those enrolled in MaineCare CHIP will have to pay small premiums for maintaining enrollment in the program. Some families will be responsible for paying copayments for certain services. However, the children’s Medicaid coverage program will pay for all the costs that recipients incur, and there are no premiums for that program.

Is CHIP considered Medicaid in Maine?

CHIP and Medicaid enrollment is very similar, but is not the same. CHIP is not considered Medicaid in Maine, but it is an extension of the Medicaid program. Both the Medicaid and CHIP programs are managed under the title MaineCare, but there are differences between the two programs. Medicaid ineligible children can be enrolled in CHIP, while Medicaid eligible children can qualify for Medicaid. Medicaid covers those who have very low monthly incomes, are disabled or are elderly. CHIP provides coverage for the children of families that earn too much for Medicaid.

Who is eligible for CHIP in Maine?

Since CHIP is not Medicaid, different types of applicants will be covered by CHIP in the state of Maine. Maine Children’s Health Insurance Program (CHIP) requires the following criteria for enrollment:

  • Applicants must be younger than 19 years old, be a pregnant woman or be in a family with children under 19
  • Applicants must be citizens of the U.S. or legal aliens
  • Applicants must meet income requirements provided by the program
  • Applicants must not have health insurance

Pregnant women applying for CHIP will have different requirements to adhere to, and their coverage will only last a short time after their pregnancies end. Income enrollment criteria will vary depending on household size. For example, a household with three people will have lower income requirements than those with six household members. Parents of newborns can apply for CHIP coverage very soon after the child is born. Both Medicaid eligible children and CHIP eligible children will have to prove their eligible by providing documents regarding their identities, incomes and citizenship statuses.

What Services Are Covered By CHIP in Maine?

When it comes to what is covered by CHIP Medicaid, applicants are encouraged to review the full list of services prior to applying for benefits. The following services are covered by CHIP Medicaid in Maine:

  • Check-ups
  • Doctor’s appointments
  • Hospital stays
  • Emergency services and transportation
  • Physical, occupational or speech therapies
  • Surgeries
  • Dental care

To review the full list of CHIP-covered services, download our free guide.

Children with Medicaid eligibility can be entitled to more services. All approved dental services are covered entirely for children and partially for adult CHIP enrollees. Those enrolled in CHIP may not have to pay for certain preventative health services like yearly check-ups. Once an applicant has applied for CHIP enrollment and is accepted into the program, he or she will receive more information on which treatments will be covered by CHIP. Note that CHIP coverage may not apply to services an enrollee received from an out-of-network provider. Only medically valid and necessary treatments may be covered, as alternative medicine will not be covered by MaineCare.

How to Apply For CHIP in Maine

Potential beneficiaries can apply for CHIP and Medicaid coverage online by logging in to an account from My Maine Connection. This account allows users to prescreen for benefits and apply for government assistance. Those applying for CHIP benefits with paper applications can mail the forms to their local Department of Health and Human Services offices, or appear with the forms in person. Teenagers applying for benefits may be responsible for filling out certain portions of the form. CHIP eligibility for children may only be fully determined once applying to the program is complete, since applications are reviewed individually.

Even though CHIP is not considered Medicaid, both programs require accurate information and documentation to apply. Lying on a benefits application is criminal offense, and can result in jail time.

Download our guide to review more information about CHIP coverage for children.