10-144 C.M.R. ch. 707, § 2.0 - Eligibility for Services

2.1.General.

If a woman does not meet the criteria below, she is offered written information regarding MaineCare, "free care" and sliding-fee clinics available in the county in which she lives.

To the extent that funding is available from Federal, State and other sources, in order to determine eligibility for MBCHP, an applicant must be:

A woman age 35 through 64 (or older than age 64 if the woman does not have Medicare Part B coverage);

Women age 35-39 must further meet the following criteria:

Rule in Effect since 4/25/07

Recently had an abnormal Pap test result and the health care provider has recommended further testing; and/or

Have not had a Pap test in five (5) or more years.

A resident of Maine or a New Hampshire resident whose primary residence is located less than15 miles from the Maine border;

Financially eligible, and;

Uninsured or underinsured.

2.2.Residency.

Women residing in Maine with the intention of making Maine their permanent or principal home are eligible for the program.

A woman who is visiting in Maine, or residing in the state temporarily, is not considered a Maine resident for the purpose of these Rules.

There is no length of residency requirement.

Proof of citizenship is not required.

New Hampshire residents who live less than15 miles from the Maine border are eligible for the program. MBCHP has a Memorandum of Agreement with the state of New Hampshire, which allows women who live in New Hampshire or Maine to choose to enroll in either state.

2.3. Financial Eligibility.

Definition

MBCHP will use an applicant's "Countable Income" at the time of application to determine financial eligibility. Self-declaration of income may be accepted; however, MBCHP reserves the right to require official documentation to prove the amount, timing and/or source of the self-reported income.

"Countable Income" means:

Earned and/or unearned income for the calendar year. Examples include, but are not limited to, wages, unemployment, alimony, worker's compensation, Social Security, etc.

Included are the incomes of the applicant, spouse, and dependent children under the age of 21. Earned income of dependent children who are under the age of 21, are full-time or part-time students, or receiving SSI payments will be disregarded.

Income is calculated before taxes and/or payroll deductions

In the case of self-employment, the previous year's federal and state income tax returns will be used, and countable income is the reported income after allowable self-employment related expenses are deducted, but before other tax deductions are taken out. If the person did not file a tax return then other suitable documentation may be required to establish eligibility.

In the case of self-employment with significant reduction in income from the previous year, statements from quarterly income tax report, or other suitable documentation, may be required to determine actual countable income.

MBCHP will determine a client financially eligible when the applicant's self-declared countable income is less than or equal to 250% of the Federal Poverty Level (FPL) for the applicant's family size. The "Poverty Guidelines-Federal" is issued annually by the U. S. Department of Health and Human Services. Each year's FPL is available on the Internet at http://aspe.hhs.gov/poverty. An individual can also obtain a copy of the current FPL by contacting MBCHP; by calling 1-800-350-5180, Press 1; TTY 1-800-438-5514; or in writing to the Maine Breast and Cervical Health Program.

2.4. Insurance Status.

MBCHP will determine a client to be uninsured if the women does not have health insurance coverage

Women who have MaineCare or Medicare Part B are not eligible.

MBCHP will determine a client to be underinsured if the woman has health insurance with unreasonably high co-payments, deductibles, or co-insurance, or the insurance does not cover MBCHP Covered Services.

Women who have health insurance, but the plan has co-payments, deductibles or co-insurance amounts that are financial barriers to receiving MBCHP covered services, are eligible. Co-payments, deductibles or co-insurance will be considered a "Financial Barrier" if the applicants':

Countable income is less than 100% FPL, and the applicant reports co-payments, deductibles or co-insurance greater than $50;

Countable income is greater than 100% FPL and less than 150% FPL, and the applicant reports co-payments, deductibles or co-insurance greater than $100;

Countable income is greater than 150% FPL and less than 200% FPL, and the applicant reports co-payments, deductibles or co-insurance greater than $250;

Countable income is greater than 200% FPL and less than or equal to 250% FPL, and the applicant reports co-payments, deductibles or co-insurance greater than $500.

Notes

10-144 C.M.R. ch. 707, § 2.0