MaineCare (Maine Medicaid) Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In Maine, Medicaid is called MaineCare. This article focuses on Maine Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.

 

Maine Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Maine Medicaid, which is called MaineCare, will cover the cost of long-term care in a nursing home for financially limited Maine seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

  • Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
  • Skilled nursing care
  • Physician’s visits
  • Prescription medication
  • Medication management
  • Mental health counseling
  • Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Maine Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $40/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Maine Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

  A Nursing Home Alternative – Maine Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through Maine’s Money Follows the Person program (MFP). This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. In Maine, Money Follows the Program is called Homeward Bound.

 

Home and Community Based Services (HCBS) Waivers

Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help financially limited Maine seniors who require a Nursing Facility Level of Care remain living in the community instead of residing in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Maine residents who live in their own home or the home of a loved one. While MaineCare’s HCBS Waivers may cover long-term care benefits in those settings, it will not pay for room and board costs.

The HCBS Waiver relevant to Maine seniors is the Medicaid Waiver for Elderly and Adults with Disabilities.

Medicaid Waiver for Elderly and Adults with Physical Disabilities
Maine’s Medicaid Waiver for Elderly and Adults with Physical Disabilities is intended to delay nursing home placement for Maine seniors who require a Nursing Facility Level of Care but live in their own home or the home of a loved one. Program participants can not live in an adult foster care home or an assisted living facility. A registered nurse will conduct an in-person functional assessment using the Medical Eligibility Determination tool to see if applicants for this Waiver meet the level of care requirement. An applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) is taken into consideration during this assessment.

Benefits of the Medicaid Waiver for Elderly and Adults with Physical Disabilities include in-home nursing services, home modifications, meal delivery, transportation and personal care assistance with the Activities of Daily Living. Benefits are made available through a personalized care plan that is created to fit each individual’s needs and circumstances. The state can supply a licensed caregiver to provide benefits, or the program participant can self-direct their care and hire caregivers of their choice. This includes friends and family members, but spouses and legal guardians can not be hired as caregivers for this program.

Unlike Nursing Home Medicaid, most HCBS Waivers are not an entitlement. Instead, each program has a limited number of enrollment spots, and once those spots are full, additional applicants are placed on a waitlist. The Medicaid Waiver for Elderly and Adults with Physical Disabilities had 2,331 enrollment spots per year as of 2023.

 

Aged, Blind, and Disabled Medicaid

Maine’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to financially limited Maine residents who are aged (65 and over), blind or disabled. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially limited people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the beneficiary’s region.

MaineCare ABD Medicaid beneficiaries who show a functional need for long-term care benefits can receive some of those benefits benefits through the Consumer Directed Attendant Services program.

Consumer Directed Attendant Services
Qualified MaineCare ABD Medicaid beneficiaries can receive long-term care support through the state’s Consumer Directed Attendant Services (CDAS) program. To be eligible, program participants must must need help with at least two of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), and they must live in their own home or the home of a loved one.

CDAS program participants can receive up to 28 hours/week of personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, laundry and money management). As the program name suggests, CDAS beneficiaries can self-direct their care by hiring caregivers of their choice to deliver these services. This includes friends and family members (such as adult children), but spouses and legal guardians can not be hired as caregivers through CDAS. Program participants also receive up to 18 hours/year of care coordination and up to 14.25 hours/year of training on how to manage their own care and caregiver.

Like MaineCare ABD Medicaid itself, the CDAS program is an entitlement. This means that all eligible applicants are guaranteed by law to receive benefits.

Program of All-Inclusive Care for the Elderly (PACE)
PACE covers medical, social service and long-term care needs with one comprehensive plan and delivery system for ABD Medicaid recipients, including Medicare benefits for those who are “dual eligible.” PACE also administers vision and dental care, and PACE day centers provide adult day care, meals, social activities and regular health checkups. PACE program participants are required to need a Nursing Facility Level of Care, but they must live in their home or somewhere else in the community. Although Maine does not have a PACE program of its own as of Jan. 1, 2024, there are eight programs in nearby Massachusetts. While seniors can not use PACE programs (or receive any kind of Medicaid benefits) in other states, or transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in a new state without any waiting period if they relocate. To learn more about PACE, click here.

 

Eligibility Criteria For Maine Medicaid Long Term Care Programs

To be eligible for MaineCare (Maine Medicaid), a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

 Just For You: The easiest way to find the most current MaineCare eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

 

Maine Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Maine residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through MaineCare (Maine Medicaid). For a single applicant in 2024, the asset limit is $10,000, which means they must have $10,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Maine Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Maine Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $40/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through MaineCare is $15,000 combined if they are sharing a room, and it’s $10,000 per spouse if they are living in separate facilities, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $10,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for MaineCare Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Maine has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through MaineCare is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. To measure level of care need for Medicaid purposes, Maine uses Medical Eligibility Determination tool. A registered nurse will conduct an in-person assessment using this tool, which takes into account an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as their cognitive abilities.

 

Maine Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Maine residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in Maine is $10,000, which means they must have $10,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in Maine for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Maine is a combined $20,000, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $10,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for MaineCare HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Maine has a Look-Back Period of five years. This means the state will look back into the previous five years of the HCBS Waivers applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through MaineCare (Maine Medicaid) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. A registered nurse will conduct an in-person functional assessment using the Medical Eligibility Determination tool to see if Maine HCBS Waiver applicants do require a Nursing Facility Level of Care. An applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), and their cognitive abilities, are taken into consideration during this assessment.

 

Maine Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Maine residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $10,000, which means they must have $10,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a single applicant is $1,255/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants in 2024, the asset limit for MaineCare ABD Medicaid is a combined $15,000, and the income limit is a combined $1,704/month. This applies to married couples with both spouses applying or with just one spouse applying.

  Plan Ahead: There are alternative pathways to eligibility for Maine ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While MaineCare has a Look-Back Period of five years for Nursing Home Medicaid and HCBS Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid or HCBS Waivers, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirement for receiving basic healthcare coverage through ABD Medicaid in Maine is being age 65 or over, blind or disabled. For ABD Medicaid beneficiaries who need long-term care services and supports, MaineCare will administer a functional assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) to determine the kind of long-term care benefits the state will cover.

 

How Maine Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

  • If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $750,000 (as of 2023) then the home is exempt.
  • If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
  • If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $750,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Maine Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States (and the District of Columbia) are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Maine and how you can protect your home from it, click here.

 

Applying For Maine Medicaid Long Term Care Programs

The first step in applying for MaineCare (Maine Medicaid) Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for MaineCare when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the MaineCare applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Maine residents can apply for MaineCare online at My Maine Connection. They can also apply in person at their local Department of Health and Human Services’ Office for Family Independence. Or they can download an application, complete it and mail it to their local Office for Family Independence.

For step-by-step guides to applying for each of the 3 types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

  Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

 

Choosing a Maine Medicaid Nursing Home

After being approved for nursing home coverage through MaineCare (Maine Medicaid), you or your loved one has to choose which Medicaid-accepting nursing home best fits your circumstances. Even though MaineCare nursing home coverage is an entitlement, not all nursing homes accept Medicaid, and those that do might not have any available space. Finding a nursing home that meets all your needs can be difficult, especially if you’re looking in a specific locale.

Maine has roughly 90 nursing homes that accept Medicaid. There are about a dozen in Greater Portland, and nearly 25 along the coast from Kennebunk to Freeport. The choices narrow as you move further north. There are six nursing homes in the Lewiston/Auburn area, and there are 10 facilities within 25 miles of Bangor. Moving Downeast limits the options even further as there are only five nursing homes along the coast from Damriscotta to Belfast.

Residents in some Maine communities regularly cross the state border for personal or business reasons, including healthcare. Medicaid coverage, however, can not cross state lines. So, a MaineCare beneficiary would not be covered for a nursing home in Portsmouth or Rochester, New Hampshire, even if a facility in one of those cities is convenient or well-suited for the Maine resident.

 TOOLS: To find and compare nursing homes, Maine residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country.

When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can be a great source of information. You can also contact your local Area Agency on Aging to find out more information about nursing homes in the state.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? Does it provide transportation? Who are the staff doctors? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data shows that nursing homes in Maine were notably better than the norm when it came to health inspections. Maine nursing homes averaged 18.5 health deficiencies from 2019-2022, while the national average in that same time frame was 25.7.