Maine DHHS releases data on MaineCare eligibility reviews

July 28, 2023

Today, the Maine Department of Health and Human Services (DHHS) is releasing the first data related to the end of the MaineCare (Medicaid) continuous coverage requirement, known for short as “unwinding.” In March 2020, as part of the response to the COVID-19 pandemic, the federal government temporarily waived eligibility reviews for people enrolled in state Medicaid programs. This helped prevent people with Medicaid from losing their health coverage during the pandemic, even if their circumstances impacting eligibility changed during that period. Congress has now directed all states, including Maine, to resume reviewing the eligibility of Medicaid members to determine if they are still eligible.

MaineCare began these reviews or “redeterminations” of the more than 400,000 MaineCare members in April of 2023. Not everyone will be renewed at once – members’ renewals will continue over the next year primarily based on when they signed up or were last renewed. All MaineCare households must complete the renewal process to see if they are still eligible, and all states must disenroll individuals no longer eligible for coverage.

This release covers the first two months of redeterminations as reported to the federal Centers for Medicare and Medicaid Services (CMS), reflecting MaineCare members who were due for renewal in May and June. Of the 61,935 MaineCare members due for renewal during that period, 24,769 were determined to be eligible to renew and retain their MaineCare coverage. Just over 3,000 individuals were found to be ineligible and were disenrolled from MaineCare and referred to, while over 32,000 MaineCare members will have their eligibility reassessed later this year (described further below).

In order to best serve the MaineCare population, DHHS is implementing a process called “passive renewal” or “ex parte" starting with members due for renewal in August. This process allows the Department to check other data sources, such as the Federal Data Services Hub for employment records, to determine a member’s eligibility and, if they are found to be eligible, automatically renew their MaineCare coverage without requiring the member to manually complete and return a renewal form.

To ensure that those whose renewal deadline has passed also benefit from the new passive renewal process, DHHS is maintaining coverage for members who do not return their renewal paperwork in May, June, or July. These members will have their eligibility reviewed using the passive renewal system in the coming months and will be automatically renewed if they are eligible. As such, no MaineCare members have yet been disenrolled for the “procedural” reason of not returning their recertification form.

DHHS has implemented a robust cross-departmental outreach effort to make sure MaineCare members know the steps to take to avoid unnecessarily losing coverage, including:

  • Directly communicating with members by postal mail, text, outbound phone calls, and email;
  • Running a public information campaign, including traditional and digital media outreach;
  • Supporting partnerships with community-based organizations to reach people on the ground;
  • Adding temporary call center staffing resources to support increased call volumes and provide assistance to MaineCare members;
  • Streamlining transitions of coverage to, Maine’s Health Insurance Marketplace, for MaineCare members no longer eligible for MaineCare, including implementation of an extended Special Enrollment Period for people transitioning from MaineCare; and
  • Encouraging employers to let their workers who may be on MaineCare know about their own health plan offerings.

Data on the number of individuals who lose MaineCare coverage but enroll in Marketplace coverage will be available in the coming months. National estimates indicate that the vast majority of individuals who lose Medicaid have or will be eligible to receive other coverage through employer-based insurance or federal or state-based Marketplaces like in Maine.

MaineCare members who have not yet gone through the redetermination process can take two important steps to stay covered:

  • Update their current contact information with MaineCare, including address, email and phone number. Members can call 1-855-797-4357, and press option 1 to update contact information through an automated system, or visit Stay Connected to Stay Covered!
  • Be on the lookout for an envelope with a blue block on it, which contains the MaineCare renewal notice: If it’s blue, it’s time to renew! Members who signed up for e-noticing on My Maine Connection will receive their notice electronically, and will not receive the envelope. Whether a member receives their renewal form by mail or e-notice, they will need to complete and return it by the deadline.  Members who are determined to be eligible through the passive renewal process will receive a notice that their coverage has been renewed for 12 months and will not be required to fill out a renewal form.

To view Maine’s unwinding data report, please visit the MaineCare Renewals Data Dashboard.