Your Health Insurance: Understanding Medicaid (Mainecare)

Medicaid was authorized by title XIX of the Social Security Act and was signed into law in 1965 along

Bridget Thornton is MLA’s health insurance Navigator. MLA photo

with Medicare. All states, the District of Columbia, and the U.S. territories have Medicaid programs designed to provide health coverage for low-income people. Although the federal government establishes certain parameters for each state to follow, each state administers their Medicaid program differently, resulting in variations in Medicaid coverage across the country. Beginning in 2014, the Affordable Care Act (ACA) provided states the authority to expand eligibility to individuals under 65 in families with incomes below 133 percent of the Federal Poverty Level ($32,718 a year for a family of four in 2018) and standardized the rules for determining eligibility and providing benefits through Medicaid, Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.
CHIP was signed into law in 1997 and provides federal matching funds to states to provide health coverage to children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage. All states have expanded children’s coverage significantly through their CHIP programs, with nearly every state providing coverage for children up to at least 200 percent of the Federal Poverty Level ($49,200 a year for a family of four in 2018).
Many states refer to their Medicaid programs as something other than Medicaid. In Maine, we refer to our Medicaid program as Mainecare. As mentioned before, the ACA provided states the authority to expand eligibility for Medicaid. Currently Maine has not expanded Medicaid despite passage of a citizens referendum supporting expandedeven though the citizens voted to expand coverage in November, 2017. In that referendum it was stated that expanded Medicaid coverage would beginning on July 2, 2018. Expansion is currently being held up by the LePage administration and is under review by the state’s Supreme Court. Maine Equal Justice Partners, a local state advocacy group, is suing the administration for not meeting the deadlines put forth in the referendum.
Without expansion, the only groups of people eligible for Mainecare are children, parents and caretakers of kids 18 and under, pregnant women, people who have aged out of the foster care system and are under age 26, young adults aged 19 and 20, adults with disabilities, and adults 65 or older. If you fall into one of these categories, you also must be within the income limits to get coverage, which varies by category. The income guidelines are based on the federal poverty level and your household size, much like the Health Insurance Marketplace tax credit eligibility. Since there are a number of categories and income guidelines, this can make determining your eligibility difficult and confusing. If you think you might be eligible for Mainecare or would like to discuss this as a potential option, the MLA has trained Navigators on staff who can help. Contact the MLA at 207-967-4555 or email bridget@mainelobstermen.org.

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