DHHS → node
Effective January 1, 2026, the Department will add preferred and non-preferred drugs to the Biosimilar PDL.
Preferred drugs added:
Change from preferred to non-preferred drug:
Per federal requirements, MaineCare is the payor of last resort, with only limited exceptions. The Office of MaineCare Services continuously refines policies and claims processing procedures to ensure that primary insurance coverage is leveraged, whenever possible. This includes reviewing Medicare and commercial coverage policies for service coverage changes in all areas, including, but not limited to, behavioral health, durable medical equipment, and physician services.
Effective immediately, Acentra Health made the following update to call center operations:
On November 14, 2025, the Office of MaineCare Services held the Annual Draft Rate Determination Schedule Consultation with the TAP which was open to the public.
Paper Ras
Within the next several weeks, the Office of MaineCare Services (OMS) will eliminate the mailing of all paper RAs to providers. This is a cost-saving initiative for the department. We encourage those receiving paper RAs to reference the electronic PDF versions posted on the Health PAS Online Portal. Advantages of using the PDF version include easier member and claim searching and access to previous RAs.
For the PERM RY 2027 cycle, which covers claims for the current state fiscal year, PERM auditors will not be conducting the Medical Review portion of the audit. As a result, the PERM auditors will not outreach providers to collect claims documentation as they usually do. This does not change the documentation requirements as listed in the MaineCare Benefits Manual, but it does mean that this PERM audit will not require provider participation. For the next PERM cycle, covering claims from July 1, 2028, to June 30, 2029, we anticipate that Centers for Medicare and Medicaid Services (CMS) will
On November 10, 2025, MaineCare with our vendor Milliman kicked off a rate determination process for a new MDFT service with interested parties. At this meeting, we introduced the project team and reviewed project goals, work plans, an initial timeline, and a survey.
Nov 11, 2025
The Office of Behavioral Health (OBH) is committed to supporting a complete and coordinated behavioral health continuum of care. Children’s Behavioral Health Services (CBHS), within OBH, is working to expand services that help children with behavioral health disabilities get the right support at the right time and in the right place. When children can receive care at home and in their communities, they stay connected to the people and places that matter most. Being surrounded by family, friends, and familiar routines helps children heal, grow, and thrive.
The State of Maine submitted an application for funding through the RHTP to support the health of rural communities through innovation and collaboration. The application was shaped by feedback from health providers, MaineCare members, partners, and others across the state.
10-144 C.M.R. Chapter 323; Maine General Assistance (GA) Manual, Sections III, XII, and XIII
GA Rule #27 – P.L. 2025, Chapters 2 Part SS, 149, and 449