There are free and low-cost health coverage options that ensure kids under age 21 can get the routine check-ups, immunizations, and care they need to stay healthy.
Types of Health Coverage for Children
MaineCare provides free or low-cost health insurance, other health benefits, and assistance to kids under age 21 who meet income guidelines or disability criteria.
Children’s Health Insurance Premium (CHIP) or Cub Care
A child under age 19, who is over the income level for free MaineCare, may qualify for CHIP and pay a low-cost premium for health coverage.
Children under age 19, with serious health conditions who are over the income level for free MaineCare, may get MaineCare coverage through the Katie Beckett program. Children enrolled in Katie Beckett pay a low-cost premium for health coverage.
Health Insurance Purchase Option (HIPO)
If a child under age 19 loses MaineCare coverage because family income goes up, you can buy MaineCare coverage for up to 18 months or until your child turns 19, whichever comes first. For more information, call the Office of Family Independence at 1-855-797-4357. Ask about the “Full Cost Purchase Option for Children Under 19 Years of Age.”
After your baby is born, call the Office for Family Independence as soon as possible to add your baby MaineCare. If you do not add your baby to MaineCare right away, you may get a bill from the hospital. If you had full MaineCare coverage when your baby was born, the baby can have MaineCare coverage until their first birthday even if your income changes.
How to Apply
Learn about your options for applying online, by mail, and in person. Applications for MaineCare are processed by DHHS’s Office for Family Independence.
Coverage and Services
Early, Periodic, Screening, Diagnosis, and Treatment (EPSDT) Program
Children who are under age 21 who have MaineCare are part of the EPSDT program. EPSDT is designed to assure children receive early detection and treatment in order to address health problems as soon as possible. EPSDT provides regular screening for conditions and preventive care to help to catch and treat disease or ill health early, when it is easier to treat. The EPSDT program focuses on care for the physical, oral, and mental or behavioral health of children. All children are eligible for well-child exams and screenings.
What are some examples of preventive services that are covered by MaineCare?
- Well-child exams, also called “healthy visits”
- Well-child dental exams
- Lead screenings
- Immunizations, also called vaccines or shots
Well-Child Exams are covered by MaineCare. Your child’s health care provider will check to see if your child is healthy, and give vaccines and tests if needed. Children can also get optional treatment services. Optional treatment services are medically necessary services or equipment that may be needed to prevent illness or injury to a child. For more detail, see the Well-Child Visit Pamphlet (PDF).
MaineCare covers preventive dental care for children. Your child’s teeth and gums are checked to make sure they are healthy. Your child should go to the dentist for well-child visits starting by age one or younger.
What are some examples of dental services that are covered for children?
- Teeth cleanings and routine checkups, twice a year
- X-rays and fillings
- Fluoride treatments
- Other care the dentist says is necessary
Health Homes for Chronic Conditions
If your child has chronic health conditions, they may be eligible to participate in a Health Home, Behavioral Health Home, or Opioid Health Home. Health Homes work with your child’s PCP to manage their chronic health conditions. See the Primary Care and Your Health webpage for more Health Home information.
MaineCare for Students
There are three ways MaineCare covers medical services when a member is at school:
- MaineCare’s School-Based Services Program
This program covers medically necessary services listed in the member’s Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) when provided by a school-based provider.
Examples of school-based services include, but are not limited to:
- Children's Behavioral Health Day Treatment (Section 65)
- Speech therapy
- Physical therapy
- Occupational therapy
- Nursing services
- Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations (Section 28)
- Specialized transportation
MaineCare will pay for any medically necessary services that are not listed in the IEP or IFSP, or are in addition to services listed.
- School Health Clinics
There are some school districts that run school health clinics. School health clinics are different from one school district to another. They can provide a range of services from preventive care to acute care. When students who are MaineCare members get services through these clinics, MaineCare will pay for the medically necessary services that are not listed in the IEP or IFSP. Please contact your school health clinic for a list of services that may be offered in your district.
- Provider Discretion
There are MaineCare providers who use space in a school to provide medical services to students when the service is not listed in the IEP or IFSP. The student may get services at the school instead of the provider’s office and these services are not considered school-based service because the referral was not made based on services listed in the IEP or IFSP.
See the MaineCare Member Handbook (PDF) for more detail about MaineCare services provided in a school setting. For all questions regarding school-based services, please contact MaineCare’s State Medicaid Educational Liaison by email or call (207) 624-4094.