Maine Medicaid Definition
Medicaid in Maine is called MaineCare. It is administered by the State of Maine Department of Health and Human Services (DHHS).
Medicaid is a jointly funded federal and state health care program for low-income individuals of any age. While there are several different Medicaid coverage groups, the focus of this page is eligibility for elderly Maine residents, aged 65 and over. Specifically, long term care is covered. In addition to nursing home care and assisted living services, MaineCare pays for non-medical services and supports to help frail seniors remain living at home.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Maine seniors may be eligible. These programs have medical (functional) and financial eligibility requirements, although the exact requirements differ, as do the programs’ benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Maine offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services – These are not entitlement programs; There are a limited number of participants. Intended to delay nursing home admissions, benefits are provided at home, adult day care, or in assisted living. More on Waivers.
3) Regular Medicaid / Aged Blind and Disabled – This is an entitlement program; Meeting the eligibility requirements guarantees one will receive benefits. Various long-term care services, such as personal care assistance or adult day care, may be available.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a MaineCare / ME Medicaid program. Alternatively, taking the Medicaid Eligibility Test can prove helpful. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Maine. More.
|2022 Maine Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,523 / month*||$10,000†||Nursing Home||$2,523 / month per spouse*||$15,000 if sharing a room / $20,000 ($10,000 each) if in separate rooms or facilities†||Nursing Home||$2,523 / month for applicant*||$10,000 for applicant & $137,400 for non-applicant†||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,523 / month‡||$10,000†||Nursing Home||$2,523 / month per spouse‡||$15,000†||Nursing Home||$2,523 / month for applicant‡||$10,000 for applicant & $137,400 for non-applicant†||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,133 / month||$10,000†||Help with ADLs||$1,526 / month||$15,000†||Help with ADLs||$1,526 / month||$15,000†||Help with ADLs|
†While the asset limit is technically $2,000 for an individual and $3,000 for a couple, Maine allows an extra exemption of $8,000 in savings for an individual and $12,000 for a couple.
‡ Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.
What Defines “Income”
Any income that a Medicaid applicant receives is counted. This can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. An exception exists for Covid-19 stimulus checks and Holocaust restitution payments. They do not count as income, and therefore, do not impact Medicaid eligibility.
When only one spouse of a married couple applies for nursing home Medicaid or a Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the income eligibility of their spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is a spousal impoverishment rule and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid spousal impoverishment. The MMMNA is $2,288.75 (effective 7/1/22 – 6/30/23). If a non-applicant’s monthly income falls under $2,288.75, income can be transferred from their applicant spouse, bringing their income up to this level.
In Maine, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $686.63 / month (effective 7/1/22 – 6/30/23). However, in 2022, in no case can a spousal income allowance put a non-applicant’s income over $3,435 / month. This is the Maximum Monthly Maintenance Needs Allowance. Learn more about how the spousal income allowance is calculated.
Income is counted differently when only one spouse applies for Regular Medicaid / Aged Blind and Disabled; The income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. For more information on how Medicaid counts income, click here.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, IRAs, credit union, savings, and checking accounts, and real estate in which one does not reside. There are also many assets that Medicaid considers to be exempt (non-countable). Exemptions include personal belongings, household furnishings, two automobiles (one must be needed for a specific purpose, such as transportation to medical appointments), irrevocable burial trusts, and generally one’s primary home. For home exemption, the Medicaid applicant must live in their home or have intent to return, and in 2022, their home equity interest must not be more than $955,000. Equity interest is the amount of the home’s value owned by the applicant. If a non-applicant spouse lives in the home, it is automatically exempt.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, the non-applicant spouse of a nursing home Medicaid or Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). This is a spousal impoverishment provision, and in 2022, allows the community spouse (the non-applicant spouse) to retain up to $137,400 of the couple’s assets, as shown in the chart above.
Maine has a 5-year Medicaid Look-Back Period that immediately precedes the date of one’s Medicaid application. This is a period in which Medicaid checks to ensure no assets were transferred for less than fair market value. This includes assets that were gifted. If this rule has been violated, the Medicaid agency assumes it was done to become asset eligible and a penalty period of Medicaid ineligibility for long-term care will be calculated.
Qualifying When Over the Limits
For elderly Maine residents (65+) who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – Also called a Spend-Down Program, this program allows seniors who are over Medicaid’s income limit to still become eligible for Medicaid by spending the majority of their income on medical expenses. This may include Medicare premiums, eyeglasses, dental services, and doctor visits. In 2022, the medically needy income limit (MNIL), also called a protected income level in ME, is $315 / month for an individual and $341 / month for a couple. The “spend down” amount, which can be thought of as a deductible, is the difference between one’s monthly income and the MNIL. In ME, it is calculated for a 6-month period. Once the “spend down” is met, one will be Medicaid eligible for the remainder of the period. The medically needy asset limit is $2,000 for an individual and $3,000 for a couple.
2) Asset Spend Down – Persons who have assets over MaineCare’s limit can become asset eligible by spending down extra assets on non-countable ones. Examples include paying for home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. Remember, assets cannot be gifted or sold under fair market value, as doing so violates Medicaid’s look back rule. It is recommended one keep documentation of how assets were spent as proof the look back rule was not violated.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s estate recovery program. Read more or connect with a Medicaid planner.
Specific Maine Medicaid Programs
MaineCare covers the cost of nursing home care for all state residents who require the level of care provided in a nursing home and are financially eligible for the program. ME Medicaid also offers Medicaid programs for seniors who require nursing facility level of care or have slightly lesser care requirements and do not want to live in a nursing home. These programs provide care at home or “in the community”.
1) Elderly and Adults with Disabilities Medicaid Waiver – This program pays for home care, home modifications, personal emergency response systems, and other supportive services that allows nursing home-qualified persons to live in their homes.
2) Consumer Directed Attendant Services – Beneficiaries can receive assistance with their activities of daily living (attendant care) in their homes. Beneficiaries are also given the option to “consumer direct” their care provider. Stated another way, beneficiaries can choose their care provider and can even hire family members to provide care.
How to Apply for Maine Medicaid
MaineCare eligibility is determined by Maine’s Department of Health and Human Services’ (DHHS) Office for Family Independence (OFI). Persons can apply for Medicaid benefits online at My Maine Connection or in person at their district OFI office. Click here to find the office nearest you. Alternatively, applications can be downloaded here. There are separate applications for Regular Medicaid (MaineCare Application) and Nursing Home Medicaid / HCBS Medicaid Waivers (Application for Long Term Care MaineCare). Completed applications can be dropped off at one’s local DHHS OFI office or submitted by fax or mail. The appropriate fax number and mailing address can be found on the application.
Before submitting a Medicaid application, it is vital that Maine seniors be certain that all eligibility requirements, as discussed above, are met. If one does not meet the income and / or asset limit(s), or are unsure if the eligibility criteria is met, Medicaid planning is strongly suggested. The Medicaid application process can be complicated, and if not done correctly, can result in a denial or delay of benefits. For more information on applying for long-term care Medicaid, click here.