MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter II, Section 94, EPSDT

Date posted:


Notice of Agency Rule-making Proposal

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage.  This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes.  The MaineCare Benefits Manual is available on-line at the Secretary of State’s website

Below, please find a MaineCare Notice of Agency Rule-making Proposal. You can access the complete rule at


AGENCY:  Department of Health and Human Services, MaineCare Services, Division of Policy

CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Chapter II, Section 94, EPSDT



In order to codify telehealth visits allowable during the Public Health Emergency, to add the service of immunization counseling, and to add eligibility for MaineCare to pregnant individuals of any age who but for their immigration status would be eligible for MaineCare, this proposed rulemaking seeks to make the following changes:

Addition of well-child visit: In response to the COVID-19 pandemic, on May 13, 2020, the Department emergency adopted MaineCare Benefits Manual, Ch. I, Section 5, COVID-19 Public Health Emergency Services, which allowed members to receive a second well-child visit when an initial visit was completed via telehealth. This proposed rule codifies that extra visit allowed during the public health emergency in Section 94.06-1. 

Immunizations: The proposed rule adds coverage for immunization counseling in Section 94.04-4.

Eligibility: In Section 94.02-02, the proposed rule adds eligibility for EPSDT services. In accordance with the MaineCare Eligibility Manual, 10-144 Ch. 332 Part 3, Section 2.3, III, Coverage for Pregnant Individuals for the Health of Unborn Children, a pregnant individual of any age who is eligible for Medicaid but for noncitizen status and is covered under MaineCare’s Children’s Health Insurance Program (CHIP) is eligible for the services described in this Section. 

Changes to the rule also include minor technical changes such as replacing the outdated Bright Futures periodicity schedule with the website address for the most updated schedule, instructing providers to use the EP modifier when billing, and replacing a telephone number with the name of the office.

See for rules and related rulemaking documents.

STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173

PUBLIC HEARING: December 8, 2023, at 2 p.m.

The Department will hold a combined in-person and remote (via Zoom) public hearing.

Location: State Office Building, Conference Rooms A and B, 109 Capitol Street, Augusta, ME.

Zoom Meeting link:

Some devices may require downloading a free app from Zoom prior to joining the public hearing event. The Department requests that any individual requiring special arrangements to attend the hearing in person contact the agency person listed below 5 days in advance of the hearing.

Meeting ID: 868 5079 0395 

DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on December 18, 2023.

AGENCY CONTACT PERSON:    Jeannette Sedgwick, Comprehensive Health Planner II

AGENCY NAME:                           MaineCare Services

ADDRESS:                                      109 Capitol Street, 11 State House Station

                                                         Augusta, Maine  04333-0011


TELEPHONE:                                 207-624-4086  FAX: (207) 287-6106

                                                         TTY: 711 (Deaf or Hard of Hearing)

IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.



Office: MaineCare Services

Routine technical


Comment deadline:

Status message

Comments for this rule have been closed.