Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 332 - MAINECARE ELIGIBILITY MANUAL
Part 5.5 - CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) - CUB CARE
Current through 2024-38, September 18, 2024
SECTION 1: DEFINITIONS
FEDERALLY FACILITATED MARKETPLACE: The federally facilitated marketplace (FFM) is a website established and operated by the US federal government to facilitate the purchase of health insurance in accordance with the Patient Protection and Affordable Care Act.
MYMAINECONNECTION: MyMaineConnection is a website administered by the Office for Family Independence in which residents of the State of Maine can apply online for medical coverage (www.maine.gov/mymaineconnection).
SECTION 2: SCOPE
The Children's Health Insurance Program (CHIP) is authorized under Title XXI of the Social Security Act. Cub Care is the name of the CHIP program in Maine. It is available to individuals who are under the age of 19 who are ineligible for Medicaid and who meet certain other requirements as identified in this section. Coverage became available as of 8/1/98.
The Department has the right to collect from other available insurance or from settlement(s) for accidents or injuries whenever the Medical ID was used.
SECTION 3: BASIC ELIGIBILITY REQUIREMENTS
To be eligible for Cub Care, individuals must meet the basic eligibility requirements for getting full Medicaid coverage as identified in Part 2 regarding residency and citizenship and Social Security numbers. There is no requirement to refer the non-custodial parent without health insurance to the Division of Support Enforcement and Recovery (DSER).
A. Children Excluded from Coverage
A public institution is one in which the facility is under the administrative control of the state or federal government. Examples are Riverview Psychiatric Center, Dorothea Dix Psychiatric Center, the Maine State Prison, or Mountain View Youth Development Center
A child who is residing in an inpatient psychiatric facility is not eligible for Cub Care. An inpatient psychiatric facility includes Riverview Psychiatric Center, Dorothea Dix Psychiatric Center, Acadia and Spring Harbor. If a child is an inpatient in a psychiatric unit of a general medical hospital, the child is potentially eligible for Cub Care.
This exclusion applies regardless of whether the coverage is provided through an adult who resides with the child or through an adult living in another household.
B. Children with a Three Month Waiting Period
With certain exceptions noted below, there is a three month waiting period before a child can be covered by Cub Care if that child is dropped from health insurance provided through an employer.
For example, if the insurance ends January 10th, Cub Care cannot start until May.
There is no three month waiting period if any of the following exists:
For example, if the monthly cost of the child's coverage is $100 and the family pays $65.00, the family is considered to be paying 50% or more of the cost of the child's coverage.
Family income is defined as the total gross non-excluded income of: the child, the child's siblings and step-siblings under age 21 with whom they reside, the adult dropping the coverage and their spouse with whom whey reside.
Income includes both earned and unearned income.
Good cause exists when the individual can substantiate that the coverage was dropped for a reason other than to be covered by Cub Care. Some examples are: The adult lost coverage for the child because of a change in employment, termination of coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), or termination for a reason not in the control of the employee.
Reminder: There is no three month waiting period if a child is dropped from an individual health insurance plan (not provided through an employer).
SECTION 4: APPLICATION PROCESS
The date of application is the date the signed application form is received in or by any OFI regional office My Maine Connection or the Federally Facilitated Marketplace. My Maine Connection or the Federally Facilitated Marketplace will forward the application to OFI. Applications must be processed within forty-five days of their receipt by the Department. If the applicant is not sent a notice of the eligibility decision within forty-five days, temporary coverage will be authorized as identified in Part 2.
All signed applications will be acknowledged in writing. A written decision of eligibility will be sent to the applicant.
An application is valid for authorizing coverage starting the month the application is received.
Verification of information needed to determine eligibility must be requested initially from the individual. If information is requested from other sources (with the exception of public records) the individual must be informed. If collateral contacts are necessary and the individual does not give consent, denial or termination must occur.
When a decision cannot be made due to inconclusive or conflicting information, the individual will be notified what questions remain and what needs to be resolved. If the Department cannot determine that eligibility exists after contacting the individual or collateral contacts, assistance will be denied or terminated.
