Medicaid FAQ Sheets

Table of Contents 

• What Is Medicaid?
• What Healthcare Does Medicaid Cover?
• How Much Does Medicaid Cost?
• How to Qualify for Medicaid in Maine
• How to Apply for Medicaid in Maine
• How to Make Changes to Your Application
• How to Check Your Application Status
• What Happens After You Apply for Medicaid?
• How to Appeal a Denial of Benefits
• What Happens to My Medicaid If I Move?
• Need More Help?
• View or Download Our Free Guide

What Is Medicaid?

Medicaid is a federal U.S. health insurance program that provides health coverage to millions of Americans. The program primarily covers low-income adults, children, pregnant women, elderly adults and people with disabilities.

Federal guidelines for the Medicaid program are established by the Centers for Medicare and Medicaid Services (CMS). Learn more about Medicaid at a national level on the CMS website here.

The Maine Medicaid program is administered by the Maine Office of MaineCare Services (OMS). Learn more about Medicaid in Maine on the Office of MaineCare Services website here.

What Healthcare Does MaineCare Cover?

Through Medicaid, people gain access to health care services that may not be affordable without it. Additionally, some programs and benefits include special protections—such as provider networks and payment methods—that help ensure services are accessible. Medicaid also provides preventive care and other services to help people stay healthy and avoid costlier care.

Medicaid covers medical and health care services such as:

• Doctors visits
• Vision and dental care
• Family planning services
• Preventive health education
• Hearing services
• Home healthcare
• Hospice and hospital care (inpatient and outpatient)
• Maternity services
• Mental healthcare
• Nurse midwife services
• Nursing home services
• Prescription drugs
• Renal dialysis
• Transplants
• Transportation services

*Additional services, such as nursing homes or personal care services, may be available to those who have special needs.

Medicaid does not cover the following types of medical services:

• Cosmetic procedures or surgeries
• Certain dental services like braces and gold caps
• Unnecessary hospital expenses, like TV rentals or meals for guests
• Infertility services or treatments
• Recreational therapy
• Experimental treatments, supplies, equipment or drugs
• Sitter services
• Any services not covered under the State Plan for Medical Assistance

Learn more about medical and health care services that are covered by Medicaid in Maine on the Office of MaineCare Services page here.

How Much Does MaineCare Cost?

Medicaid recipients in Maine may need to pay a monthly premium, which is a monthly fee for enrollment in the program. Premiums range from $8 to $64. Premium amounts are based on the recipient’s annual income.

Recipients may sometimes need to pay a small out-of-pocket cost for treatments, which are known as copayments. Copayment amounts depend on the recipient’s age, household income and what the state pays for the specific service. There is a limit to the amount you can pay in copayments each month.

Services that require copayments include the following:

• Accessing emergency transportation services or the hospital’s emergency department for non-emergency medical conditions
• Chiropractic services
• Occupational therapy
• Optometric services
• Outpatient hospital services
• Physical therapy
• Podiatry services
• Speech therapy
• *Physician office visits

*Copayments are required for physician, or doctor, office visits unless the visit is for a preventive wellness exam, immunizations, family planning, or for urgent care that is provided at an urgent care facility.

Each Medicaid participant through the Maine Office of MaineCare Services has their own individual health care plan. Some participants may be required to pay fees, and some recipients may not be required to pay fees, i.e., are exempt.

Medicaid participants who fall into one of the below categories are exempt from copayment fees:

• Those younger than 19 years of age in households with incomes less than or equal to 133 percent of the Federal Poverty Level (FPL)
• Those in households with incomes less than or equal to 100 percent of the FPL
• Those receiving pregnancy-related services
• Inpatients in a hospital, nursing facility, intermediate care facility for persons with intellectual disabilities (ICF/ID), or other medical institution
• Adult participants who receive services provided under a 1915(c) waiver
• Participants who have other healthcare coverage that is the primary payer for the services provided
• Participants receiving hospice care
• Children in foster care receiving aid or assistance under Title IV, Part B of the Social Security Act
• Participants receiving adoption or foster care assistance under Title IV, Part E of the Social Security Act, regardless of age
• Women eligible under the breast and cervical cancer eligibility group
• Native American and Alaskan Native participants

To learn more about Medicaid premiums, click here and review page 13. To learn more about Medicaid copayments, click here.

How to Qualify for MaineCare in Maine

To qualify for Medicaid in Maine, you must all of the following:

• Be a resident of Maine
• Be a U.S. citizen or have a qualifying immigration status
• Meet the Medicaid program’s income limits

Income limits vary depending on household size, medical status and other factors and are subject to change annually. Find the current Medicaid income limits based on household size in Maine on page 20 of the MaineCare Eligibility Guide here.

Learn what documents you can submit to prove your citizenship and identity on page 42 of the MaineCare Eligibility Guide here.

Find further information on Maine Medicaid eligibility here.

How to Apply for MaineCare in Maine

To apply for Medicaid in Maine, complete the following three steps:

1. Review the application requirements and gather documentation related to your health, medical condition and household. 

Learn what documents you need on page 2 of the application here.

2. Choose how you are going to apply, whether online, by mail, email, fax or in person.

To apply for Medicaid online, click here to access the Maine Benefits Portal.

To apply for Medicaid by mail, click here to access the application form, fill it out, and mail it with the necessary documents to:

Office for Family Independence
114 Corn Shop Lane
Farmington, ME 04938

To apply for Medicaid by email, click here to access the application form, fill it out, and send it with scans of the necessary documents to Farmington.DHHS@Maine.gov.

To apply for Medicaid by fax, click here to access the application form, fill it out, and fax it with the necessary documents to (207) 778-8429.

To apply for Medicaid in person, click here to find your nearest District Office.

3. Submit your application and complete the Medicaid interview. 

If you apply in person, you will complete an interview at the time of your application submission to verify your eligibility for the program.

If you apply online, by mail, by fax or by email, you will complete the interview over the phone.

If you have questions about the application process or require assistance, call the Maine Office of MaineCare Services’ toll-free customer service number at (855) 797-4357.

Or, contact your nearest local Maine District Office. Find contact information for local field offices in Maine here or refer to the list below.

How to Make Changes to Your Application

Maine Medicaid recipients must report changes that can influence their eligibility status, including:

• Income changes
• A new address
• A change in their child care provider
• Family changes (new baby, new household resident, death, etc.)
• Changes to working hours
• Marital status changes
• Changes to medical expenses
• Insurance changes
• A withdrawal of an application

You can update your information in the following ways:

• Online here
• By phone at (855) 797-4357 
• In person at a local District Office. Find contact information for local field offices here.

How to Check Your Application Status

You can check the status of your application in the following ways:

• By logging into your account through the Maine Benefit Portal here
• By calling the toll-free customer service number at (855) 797-4357

What Happens After You Apply for MaineCare?

The Maine Office of MaineCare Services will review your application to verify if you are eligible for Medicaid. In some cases, the state may ask for additional information before approving your application. Maine will mail applicants a letter detailing if their Medicaid application was approved or denied.

It takes approximately 45 days to process a Medicaid application. If you are approved, you will receive a Medicaid identification card within 2 weeks of when you receive your approval notification.

How to Appeal a Denial of Benefits

Medicaid applications will be denied when applicants do not meet the eligibility requirements. Also, beneficiaries can have their benefits terminated or reduced if their eligibility status changes while they are enrolled.

If your Medicaid application is denied or the amount of your benefits is reduced, you have the right to file an appeal. You must send a written appeal request within 30 days of when you receive notice of the denial or benefits reduction.

You can submit your written appeal request in the following ways:

• By mail to:

MaineCare Hearings Coordinator
Division of HealthCare Management
MaineCare Services
11 State House Station
Augusta, ME 04333-11

• By phone at (800) 977-6740
• By email to MaineCareMember@molinahealthcare.com

The Maine Office of MaineCare Services will review your claim and may ask for additional information or evidence of your eligibility.

If you are granted a hearing, you will receive a notice with the date, time and location of the hearing. Learn more about the appeal process in the MaineCare Member Handbook here on page 20.

What Happens to My Medicaid If I Move?

Maine Medicaid recipients must report changes that can influence their eligibility status, including relocating to a new address.

If you move to a new residence within Maine, you can update your address in the following ways:

• Online here
• By phone at (855) 797-4357 
• In person at a local District Office. Find contact information for local field offices here.

Note: Medicaid benefits do not transfer. If you move to a new state, you must reapply for Medicaid in your new location. If you have further questions about moving with Medicaid, visit the national Medicaid Contact Us here.

Need More Help?

For help with a Medicaid application, or for any further questions about the Medicaid program, contact the Maine Office of MaineCare Services by phone at (800) 977-6740. You can also call the Office for Family Independence at (855) 797-4357.

You can also visit or call a local District Office for further assistance. Find your nearest District Office location and contact information here.

View or Download Our Free Guide

While we are not affiliated with the government in any way, our private company engaged writers to research the Medicaid program and compiled a guide and these answers to frequently asked questions. Our goal is to help you get the benefits that you need by providing useful information on the process.

Our free Medicaid Guide is filled with helpful information about how to apply, program eligibility and how to get in touch with local offices. You can view or download our free guide here.

Last Updated: September 21, 2022