Recoupment of Claim Payments for Non-Covered Services Processed Under the COVID-19 Uninsured Benefit After the End of the Federal Public Health Emergency (PHE)

As explained in the January 17, 2024, e-message, MaineCare’s COVID-19 Uninsured Benefit was available for uninsured individuals through the end of the federal PHE, which ended May 11, 2023. MaineCare will not pay for services for this population for dates of service after May 11, 2023.  

Covered Services & Benefits

MaineCare pays for medically necessary services based on your coverage group, which is determined by your income, household size, age, medical needs, and if you need help with Activities of Daily Living. Each coverage group has different covered services and benefits, and there are limits or special rules for most covered services.

This page provides information about:

Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Section 97, Private Non-Medical Institution (PNMI), Appendix C, Residential Care Facilities

Notice of MaineCare Reimbursement Methodology Change

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

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Section 97, Private Non-Medical Institution (PNMI), Appendix C, Residential Care Facilities (RCFs)

Code & Service Category List: HCBS Providers of Clinical, Therapy, Care Coordination, Supportive Skills Building, Assistive Technology & Personal Care Services

As part of the rate determination process the Department initiated earlier this summer for sections 12, 18, 19, 20, 21, 29, 40, 96, & 102, our vendor Public Consulting Group performed a code analysis to identify all services that will be included in this determination. 

Dental Services

Provider Dental Forums

July 30, 2024 Dental Provider Forum  

Topics covered: 

  • Services covered and underutilized   
  • Claims and billing updates   
  • Who to contact and when 
  • Early and Periodic Screening, Diagnosis, and Treatment services (EPSDT) resources now available     
  • Addressing challenges and barriers to accessing dental services  

Forum materials: 

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