MaineCare Announces Post-Incarcerated Incentive Payment Pilot 

Dec 15, 2023

MaineCare is piloting an incentive payment that encourages providers to connect with individuals being released from incarceration within two calendar days of their release.

MaineCare is utilizing funding received from the American Rescue Plan Act of 2021, under Section 9817, to implement this pilot. We know that many individuals leaving incarceration need community-based services such as primary care services, mental health care, and/or substance use treatment. These members are at high risk of overdose and disconnection from care. The goal of this incentive is to improve care transitions in this crucial timeframe by rewarding providers who can connect with members upon release from incarceration and establish relationships that will lead to continuity of community-based services. MaineCare will track incentive payment-related claims through December 2024. MaineCare will reimburse eligible services for this incentive payment quarterly, beginning in March 2024 and continuing through March 2025.  

MaineCare will inform future efforts by outreaching providers to better understand how they are identifying and connecting with members upon release from incarceration. MaineCare will also engage MaineCare members, carceral staff, and community-partners as this work progresses. 

How can providers qualify for this incentive payment? 

Most community-based providers are eligible to receive reimbursement if the service provided meets the incentive requirements. Quarterly, providers who delivered services that meet the below criteria will be reimbursed an additional $236.77 per eligible claim when they: 

• Provide an eligible service to a MaineCare member within two calendar days of the member’s release from prison or jail,   
  • AND
• Submit a claim to MaineCare for an eligible service.* 

What are the eligible services? 

Most community-based services provided within 2 days of release from incarceration are eligible. Service examples include, but are not limited to: 

• Primary Care Services 
• Dental Services 
• Substance Use Disorder (SUD) Services 
• Mental Health Services 
• Social Worker/Case Management Services 

*Please Note: For eligible services that are reimbursed through non-claims payments (e.g. Behavioral Health Home providers), there will be a process established to report these eligible services provided to Members following release from incarceration. Additionally, this incentive payment does not supersede or negate current rules or regulations regarding processes for receiving services for certain populations, for example: Prioritization of hospital discharges, any regulated priority populations, or contractual requirements. All appropriate rules/regulations must still be adhered to for the services provided.

Certain services provided are not eligible for this payment.  

Which services are not eligible? 

 The following services are not eligible for the incentive payments: 

• Ambulance services 
• Pharmacy services 
• Institutional services (inpatient hospital, ICF-IDD, nursing facilities) 
• School-based services 
• Non-Emergency Transportation  
• Contact Information

For questions regarding the incentive payment pilot initiative, including eligible services, please contact: HH-BHH-Services.DHHS@maine.gov