• Read more about A Final Update to MaineCare Unwinding

December 12, 2024

Maine's Medicaid program (MaineCare) successfully concluded a process known as the "unwinding" of the continuous Medicaid eligibility requirement. Following the end of the COVID-19 Public Health Emergency in 2023, updates to federal rules meant that every MaineCare member needed to have their coverage reviewed to ensure they could remain eligible. This process began in May 2023, and eligibility redeterminations were completed by October 31, 2024, with nearly 80% of Maine people successfully renewing their MaineCare coverage.

• Read more about Notice of MaineCare Reimbursement Methodology Change, COLA, Chapter 101, MaineCare Benefits Manual

• Read more about Notice of MaineCare Reimbursement Methodology Change, Maine Service Provider Tax, Chapter 101, MaineCare Benefits Manual

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual

Dec 12, 2024

Today, the Maine Department of Health and Human Services (DHHS) released an update on the conclusion of MaineCare (Medicaid) eligibility reviews after the COVID-19 Public Health Emergency, known as "unwinding." At the conclusion of the 15-month unwinding period (from May 2023 through October 2024), the Department's efforts have resulted in over 345,000 MaineCare members successfully renewing and retaining coverage.

• Read more about Maine DHHS provides final update on MaineCare "unwinding"

• Read more about MaineCare Proposed Rule #310 - Part 2, Section 9 Update

10-144 C.M.R. Chapter 332; MaineCare Eligibility Manual – Part 2

Part 2, Section 9 Update

• Read more about Provider Responsibility for Managing Users in My HealthPAS Trading Partner Accounts (TPA)

It is important for your TPA administrator to actively manage your user accounts for the Health PAS Online Portal. To manage users, log into the administrator TPA and click on “Account Maintenance” and then “Manage Users”. Edit existing, deactivated or reactivated users by clicking on the row of the user you would like to manage. The Administrator of the account and users with a security role of “R7-User Management” are allowed to use these features. 

• Read more about Attention Pharmacy Providers Under Title 5

Pharmacy providers whose pharmacy license is under a Title 5 review may use your Title 5 notice to extend your enrollment with MaineCare in MIHMS by six months, and for every six months thereafter, until the Title 5 review is resolved.

• Read more about Providers of Section 17 Services - Telehealth Clarification

Effective January 1, 2025, the Department exercises enforcement discretion permitting providers to utilize telehealth for Section 17 services in line with the following guidance. 

• Read more about Prior Authorization (PA) Requests for Dentures

PA requests for complete dentures must include ALL of the following:

• The MaineCare Removeable Prosthodontics PA Form, found on the Health PAS Online Portal
• A treatment plan, completed by providers within their scope of service
• A radiographic or photographic image(s)

We will defer PA requests that do not include appropriate documentation and send a letter to the provider. 

• Read more about Application Fee for 2025 Reminder, CR 128480

Effective January 1, 2025, in accordance with the Centers for Medicare & Medicaid Services (CMS) application fee requirements, MaineCare’s provider enrollment application fee will increase to $730 per enrollment application. This increase will apply to new, reactivating, or revalidating providers, or when adding new service locations to an existing enrollment. You can pay the application fee by credit or debit card at the time of application submission.