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Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Sections 45 and 46, Psychiatric Hospital Services
The MaineCare Advisory Committee (MAC) is a federally mandated committee to ensure that MaineCare is an effective and efficient program informed by the diverse experiences of beneficiaries, their caretakers, and other interested parties.
Notice of Agency Rulemaking Proposal
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND RULE TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual (“MBM”), Chapter I, Section 7, Children’s Behavioral Health Services Global Rule
TYPE OF RULE: Routine Technical
PROPOSAL FILING NUMBER:
As part of the Department of Justice Children’s Behavioral Health Services Settlement Agreement, all BHH Coordinators and Children’s Targeted Case Managers are required to complete the Wraparound Planning Principles (WPP) Training. Please complete this training by January 31, 2026.
WPP form the foundation of high-quality care coordination for children and families—ensuring that services are family-driven, collaborative, culturally responsive, and grounded in each child’s strengths and needs.
The required training consists of three online modules:
The Office of MaineCare Services made significant reductions in enrollment case processing time in the last two years. Below is a table beginning with the high wait for case inventory backlog from November 2023, with percentage decreases since then. The table shows the average turnaround time (TAT) for the month identified, and case inventory is the number of cases. TAT is the processing time for Gainwell. It is total time minus any Need More Information (NMI) or suspended time. This is the best metric for assessing processing time.
This message replaces the former messages sent on November 17, 2025, and November 18, 2025.
Effective January 1, 2026, the Department will add preferred and non-preferred drugs to the Biosimilar PDL.
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Biosimilar Preferred Drug List 2026 Effective January 1, 2026 |
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Bevacizumab and Biosimilars |
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Preferred Drugs |
HIV prevention, treatment, harm reduction, and resource navigation are the topics of a four-part webinar series facilitated by MaineCare’s HIV team. Presentation slides and recordings are available in the HIV Program section of the OMS Provider Resource page. There are also other HIV resources on that page, including an HIV Resource List.
Effective January 1, 2026, orthodontic codes D8010, D8020, D8030 and D8040 will be added to the Secondary Claim Billing Process for Orthodontic services.
Updated Orthodontia Secondary Billing Reminder
Notice of Agency Rulemaking Proposal
AGENCY: Department of Health and Human Services, MaineCare Services, Division of Policy
CHAPTER NUMBER AND RULE TITLE: 10-144 C.M.R., Chapter 101, MaineCare Benefits Manual, Ch. II, Section 92, Behavioral Health Home Services Ch. III, Section 92, Principles of Reimbursement for Behavioral Health Home Services
TYPE OF RULE: Routine Technical
PROPOSAL FILING NUMBER:
Data show encouraging progress in mental health and reduced substance use among Maine students
AUGUSTA-- The Maine Department of Health and Human Services' (DHHS) Maine Center for Disease Control and Prevention (Maine CDC) and the Maine Department of Education (Maine DOE) announced today the release of the 2025 Maine Integrated Youth Health Survey (MIYHS) data, showing positive trends in mental health and reduced substance use among Maine students.