10-144 C.M.R. ch. 334, § 2 - APPLICATION PROCESS

An application is the request for Maine Rx Plus coverage made by signing the Agency's application form for Maine Rx Plus or MaineCare. The individual or anyone acting on the individual's behalf may sign the application form. The applicant may choose anyone to help in completing the form.

The date of application is the date the signed and dated application form is received in any regional office of the Department.

All signed applications will be acknowledged in writing. A written decision of eligibility will be sent to the applicant.

Coverage starts the first day of the month of application or the first day of the month an individual meets program requirements, whichever is later.

A reapplication is any signed application form received after the Adverse Action Notice Period. This includes review forms returned after that period.

All applicants or re-applicants will be given information in writing, or verbally if appropriate, about the following:

I. services covered under Maine Rx Plus;

II. the individual's rights, including hearings; and

III. responsibilities of recipients, including reporting changes.

Section 2.1: Assets

There are no asset criteria.

Section 2.2. Income

Non-excluded gross monthly income is countable for Maine Rx.

If the individual meets the rule for a Family - Related assistance unit, the Family - Related rules are used to determine what is countable income and whose income to count. See Part 3 and 17.

If the individual meets the rules for the Non - Categorical or SSI - Related assistance unit the SSI - Related rules are used to determine what is countable income and whose income to count. See Parts 6 and 17.

If the individual meets the rules of more than one assistance unit, the rules that are most advantageous to the individual are used.

Non-excluded gross monthly income must be equal to or less than 350% of the Federal Poverty Level (See Chart 6) for the assistance unit.

If income exceeds this amount coverage may be available if the assistance unit meets a spend down requirement as determined by the Office of MaineCare Services. The criteria are set forth in 10-144 CMR 104 §3.

Income exclusions used in Family - Related and SSI - Related Medicaid are used for Maine Rx Plus. When income is fully or partially excluded by one of the groups and not the other, the rule that is most beneficial to the individual is used.

Notes

10-144 C.M.R. ch. 334, § 2