MaineCare and Long Term Care

Health care and long term care services can be very expensive. Many people need help paying for these services. Planning ahead for this gives you the chance to make good decisions about what you want and how you will pay for it.

This chapter will talk about:

MaineCare;
Common questions that arise when you are getting help from MaineCare;
Getting help paying for your long term care;
What to do if you have been denied MaineCare or are experiencing a reduction in services;
Your long term care options in Maine;
Your rights as a resident and where to go for help if you have a complaint about your long term care; and,
What to do if your nursing home is trying to make you leave the facility.

MaineCare (Medicaid)

In Maine, Medicaid is called MaineCare. Medicaid is a health insurance program that provides insurance to people who have limited income and assets. Medicaid is run by the federal and state governments.

Eligibility for MaineCare is based on age and income. Sometimes you have to be medically eligible as well. To find out if you qualify for MaineCare, call your local Area Agency on Aging at 1-877-353-3771. You might qualify for MaineCare even if you have Medicare coverage.

Applying for MaineCare

Call your local Area Agency on Aging at 1-877-353-3771 to get help applying for MaineCare. A specialist will help you fill out the forms or can help you apply for MaineCare online. If it is hard for you to leave your house, someone might be able to come to your home to help you apply for MaineCare.

You can also call or visit your local Department of Health and Human Services office and ask to talk to an eligibility specialist. To find the closest DHHS office, visit the DHHS website by clicking here. [1]

Common Questions About MaineCare

This section will answer some common questions about MaineCare.

What does MaineCare cover?

MaineCare covers more health services than Medicare. Generally, MaineCare covers the costs of going to the hospital, going to see your doctor, getting medical supplies, or receiving long term care in your own home, assisted living facility, or skilled nursing facility.

The amount of your MaineCare benefit is based on your income, age, medical needs, and family situation. To find out more about MaineCare benefits, call your local Area Agency on Aging at 1-877-353-3771.

What if I can't get MaineCare because I have too much money or property?

If you are not eligible for MaineCare because you have too much money or property, you might be able to reduce your assets to become eligible. This is very risky. There are confusing laws that say how you have to do this. If you make a mistake, you might not be able to get MaineCare even after yhou meet the asset requirements.

You should talk to an attorney before doing anything to reduce your assets. The attorney needs to be very familiar with the MaineCare rules. Call the Legal Services for the Elderly Helpline at 1-800-750-5353 to talk to an attorney for free.

Will I lose my home if I get MaineCare?

Many people think that if you get MaineCare then the State will take your house away. This is not exactly true. Read on to learn more.

Can the State take my home if I get MaineCare?

NO! The law does not allow the State to just take your home. What people are really talking about are rights the State has after you die, called "Estate Recovery". The law says the State can try to collect money it paid for your health care. But, it only applies to care you received after age 55.

Here’s an example of how it works:

MaineCare has paid all Edna’s nursing home bills. When she dies, the State has the right to collect the money it spent on her nursing home care from her estate. This is called “Estate Recovery.” When Edna dies, she only owns her house and a few pieces of family jewelry. Attorneys call this her “estate.” Edna’s estate is so small that the house may need to be sold to pay the State. The amount left after Estate Recovery will go to her son and daughter, her “heirs.”

Does this mean that if I use any MaineCare programs, the State must be repaid?

NO! Your estate will not be touched if you use either of these MaineCare programs:

Medicare Buy-In Benefits or Medicare Savings Programs that help pay for Medicare premiums and other Medicare costs.
The Low Cost Drug Program for the Elderly and Disabled.

Does the State always have the right to collect the money it spent on my health care?

NO! Before the State can collect any money, it must first go to court and prove it is owed money. If it is able to prove this, it can start the Estate Recovery process. But, the State will not start collecting from your estate until:

Your husband or wife (or registered domestic partner) has died;
Your minor child has died; or,
Your adult child who is blind or disabled has died.

What if I have a Will?

A Will does not protect you against Estate Recovery. The State must be paid before the people you name in your Will get anything. If you are on MaineCare for a long time, there may be nothing left in your estate after the State gets paid.

Is there anything I can do to protect my house from Estate Recovery? It’s all I own.

There may be some steps you can take now to protect your house from Estate Recovery. Call the Legal Services for the Elderly Helpline at 1-800-750-5353 to talk with an attorney for free.

Remember:

The State CANNOT try to collect any money it pays for your health care while you are alive.
The State CANNOT take (or put a lien) on your house while you are alive.
You have the right to do what you want with your property. You can sell your house. The State has NO rights to your property when you are alive.
Estate Recovery applies only to MaineCare benefits you get after age 55. The State CANNOT collect money it paid for your health care before age 55.

Estate Recovery is complicated. These are just the basics. There may be other ways the Estate Recovery rules affect you that are not covered here. Call the Legal Services for the Elderly Helpline at 1-800-750-5353 to learn more.

Resources

Area Agency on Aging
To get help applying for MaineCare, or if you have questions about your MaineCare benefits, call your local Area Agency on Aging at: 1-877-353-8771

Legal Services for the Elderly
If you are a Maine resident who is 60 or older and you are worried about Estate Recovery, call the Legal Services for the Elderly Helpline at 1-800-750-5353 to talk to an attorney for free.

Maine Equal Justice Partners
The Maine Equal Justice Partners created a comprehensive “Guide to MaineCare.” Get the Guide by clicking here. [2]

Department of Health and Human Services, Office of MaineCare Services
If you have questions about MaineCare, call the Office of MaineCare Services at: (207)287-2674 OR TTY: 711

You can apply for MaineCare online by visiting the “My Maine Connection” website. Visit the My Maine Connection website by clicking here [3].

To find out what your MaineCare benefits are, check out the MaineCare Member Handbook by clicking here. [4]

Getting Help Paying for Your Long Term Care

You might be worried about how you’ll pay for costly long term nursing care, if you need it. You might think you have to be poor or spend all your money first. Or, that you have to sell your house. That’s not true. Here’s the real story.

Doesn’t Medicare pay for long term nursing care?

No, not really. It only pays for up to 100 days and only if you need a very high level of care and have spent some time in the hospital ﬁrst.

If you need longer term nursing care and can’t pay for it, MaineCare pays.

How does MaineCare decide when they’ll pay?

MaineCare decides when to pay for long term nursing care based on 3 rules.

Rule 1: Whether you have a “medical need”

Having a medical need means you need help with personal care such as walking, eating, getting into bed and bathing. If you call the State, MaineCare will send a nurse to decide if you have a medical need for MaineCare.

Rule 2: Whether you have a “ﬁnancial need”

Having a financial need means that your total monthly income is less than the cost of nursing care for a month. And you don’t have enough savings to pay for your care. See more details below about how much cash and property you are still allowed to keep.

Rule 3: Whether you have given away any of your property or assets within the past ﬁve years

When you apply for help with nursing costs, MaineCare looks at your ﬁnancial records to determine if you have made any “disqualifying transfers.” MaineCare will look back five years, and if you had given any money or property away in those five years, MaineCare will determine an ineligibility period based on the average cost of care in a nursing home. The penalty would begin on the date of the transfer.

The rules are complex and they change often. It is not a good idea to give property away and then apply for MaineCare without consulting an attorney. Before you give away any of your property, call the Legal Services for the Elderly Helpline at 1-800-750-5353.

If I apply for MaineCare, can I keep any savings or property?

Yes! How much you can keep depends on whether you’re single or married. Here are the basic limits:

Single: You can keep up to $8000 of savings (such as in CDs, savings accounts, etc.) plus $2000 of any other property.

Married: You can keep up to $12,000 of savings and property. Your spouse who doesn’t need nursing care can keep enough of your combined property and income to allow a modest lifestyle.

There are many exceptions to the income and property limits.

*Note that you can also keep your house and a car, whatever their values.

Should I buy long term care insurance?

Maybe, but it’s not for everyone. It works best for middle class people who have savings above the limits allowed by MaineCare. Many people can’t afford it or don’t need it. So before you decide, learn more about it. Call your local Area Agency on Aging at 1-877-353-3771 to talk about your options for paying for long term care.

Resources

Area Agency on Aging
Your local Area Agency on Aging can help you figure out what your options are for paying for long term care. Call your local Area Agency on Aging at 1-877-353-3771.

Legal Services for the Elderly
If you are a Maine resident who is 60 or older and you have a MaineCare eligibility problem, call the Legal Services for the Elderly Helpline at 1-800-750-5353 to talk to an attorney for free.

Consumers for Affordable Health Care
The advocates at Consumers for Affordable Health Care can help you figure out your health insurance options. Call their Helpline at 1-800-965-7476 to talk to an advocate, or visit their website by clicking here. [5]

Pine Tree Legal Assistance
To learn more about free hospital care, visit the PTLA website on the topic by clicking here. [6]

MaineCare Denials and Appeals

If you have been denied MaineCare, or if your services have been reduced, you have the right to appeal. You might want to have an attorney help you with this process. Call the Legal Services for the Elderly Helpline at 1-800-750-5353 to speak to an attorney for free.

Here are a few examples of why the State might reduce or deny your MaineCare coverage:

Your in-home service hours have been reduced or eliminated following an assessment by a nurse assessor;
Your in-home service hours have been cut off due to an inability to pay your monthly bill or “cost-of-care”;
The state will no longer pay for your care in a nursing home or assisted living facility; or,
You are being moved from a nursing facility to a different type of a facility (such as an assisted living facility or a residential care facility) following an assessment by a nurse assessor.

Resources

Legal Services for the Elderly
If you are a Maine resident who is 60 or older and you have been denied MaineCare or received a reduction in your services, call the Legal Services for the Elderly Helpline at: 1-800-750-5353 to talk to an attorney for free.

Area Agency on Aging
If you have any questions about Medicare or MaineCare, call your local Area Agency on Aging at 1-877-353-3771.

Senior Long Term Care Housing Options

This section will give you information about the different long term care housing options that are available in Maine. Call your local Area Agency on Aging at 1-877-353-3771 to learn about your options.

Staying in your home. Some seniors choose to stay in their home as they age. This is sometimes called “aging in place.” Some seniors rely on family to provide care, whereas others hire a home health agency to help. There are a number of community services available that can help with other things like meal preparation and transportation.

Medicare covers certain short-term home health care. MaineCare might also be an option if you are able to get it.
Independent living housing. The most common types of Independent living programs are senior residences and assisted living facilities. Independent living housing is typically offered in a room or apartment rental. You might have a roommate. Usually these programs offer help with things like bathing, getting dressed or cooking.
Depending on the program, you might be able to get health care from people who work at the facility.

You might be able to get help paying for your Independent living housing.
Nursing homes. Nursing homes offer housing for seniors who need a great amount of help. Some nursing home residents are there for a short period of time while they recover from an illness or disability. Other nursing home residents live at the nursing home. At a nursing home, you have access to 24-hour medical attention. The nursing home will have a doctor on staff and most also hire nurses, physical therapists, speech therapists and occupational therapists on staff.

There are many very good nursing home options available in Maine. You might be able to get help paying for your nursing home. Your local Agency on Aging can help you find the right one for you and can help with any fears that you might have about moving into a nursing home. If you are researching a specific nursing home, the Long Term Care Ombudsman Program (LTCOP) can help you understand state inspection reports, and can give advice on what to look for when you are visiting a nursing home. Call the LTCOP at 1-800-499-0229.
Continuing care retirement communities (CCRC).Retirement communities offer a wide range of services depending upon the resident’s needs. This means that you won’t need to move as your needs increase.

Retirement communities are very expensive. Most require you to pay a large up-front fee and sign a lengthy contract. In addition to the up-front fee, you will also have to pay rent and monthly fees. If you do choose a CCRC, you might want to get an attorney to help you review the contract.Call the Legal Services for the Elderly Helpline at 1-800-750-5353 to talk to an attorney for free.

Resources

Area Agency on Aging
Your local Area Agency on Aging will help you find out what options are available in your area. You can also get information on how to pay for your long term care. Call your local Area Agency on Aging at 1-877-353-3771 to learn about your options.

Maine Office of Aging and Disability Services (OADS)
To learn more about your long term care options, call the Office of Aging and Disability Services at 1-800-262-2232.

Medicare.gov
The official Medicare website has information about nursing homes in your area. To check out statistics about local nursing homes, check out “Nursing Home Compare” by clicking here. [7]

Call 1-800-MEDICARE to speak to a representative about options in your area.

Maine Long Term Care Ombudsman Program (LTCOP)
The LTCOP protects the rights of the residents of nursing homes and independent living facilities. They receive and investigate complaints about facilities. If you are researching a specific nursing home, the LTCOP can help you understand state inspection reports and can give you advice on what to look for when you are visiting a nursing home. Call 1-800-499-0229 or (207) 621-1079 and ask for help choosing a nursing home.

Resident Rights: What They Are and How to Enforce Them

When you live in a nursing home or independent living facility, the law gives you special protections. Under the law, you have the right to be treated a certain way. The law also says that you have the right to stay in the facility unless the facility discharges you by following very specific rules. If the facility doesn’t follow these rules, you have the right to appeal. Your rights and how to enforce them are explained in this section.

If you received a “Discharge Notice” or if the facility is threatening to kick you out, see the section “Can The Nursing Home Make Me Leave?” below.

Nursing home resident’s rights

The Federal Nursing Home Reform Act says that you have certain rights when you are a nursing home resident. According to Medicare.gov, residents generally have the following rights:

Respect: You have the right to be treated with dignity and respect.
Services and Fees: You must be informed in writing about services and fees before you enter the nursing home.
Money: You have the right to manage your own money or to choose someone else you trust to do this for you.
Privacy: You have the right to privacy, and to keep and use your personal belongings and property as long as it doesn't interfere with the rights, health, or safety of others.
Medical Care: You have the right to be informed about your medical condition, medications, and to see you own doctor. You also have the right to refuse medications and treatments.

For more information, visit the website of the Maine Long Term Care Ombudsman Program by clicking here [8].

Or, see the Guide to Choosing a Nursing Home publication on the official Medicare website. You can get the Guide by clicking here. [9]

I don’t like how I am being treated by the staff. What can I do?

If you are unhappy with how you are being treated by your nursing home or independent living facility staff, there are things you can do. If possible, try talking to the administrators at the facility first. If the problem is not fixed, you can call the Long Term Care Ombudsman Program (LTCOP) at 1-800-499-0229 or (207) 621-1079. The LTCOP will investigate. Their services are free and confidential.

If you believe that your rights are being violated, you should speak to an attorney. Call the Legal Services for the Elderly Helpline at 1-800-750-5353 to speak to an attorney for free.

Resources

Legal Services for the Elderly
If you are a Maine resident who is 60 or older and you believe your resident’s rights are being violated, call the Legal Services for the Elderly Helpline at 1-800-750-5353 to talk to an attorney for free.

The Maine Long Term Care Ombudsman Program (LTCOP)
To make a confidential complaint about a nursing home or assisted living facility, call 1-800-499-0229 or (207) 621-1079. For more information about how the Long Term care Ombudsman Program can help, visit their website by clicking here [10].

Can The Nursing Home Make Me Leave?

If you live in a nursing facility, your right to stay there is protected. This means that the nursing facility can’t make you leave without doing certain things first. But, nursing facilities don’t always follow the rules.

If you have been given a letter that says you are no longer welcome to live there, or is one of the staff has told you that you are going to be kicked out, you have the right to callenge this. This letter is sometimes called a “Discharge Notice”.

You have to act fast! You only have five days to challenge the discharge.

If you are in danger of being kicked out of your nursing facility, Legal Services for the Elderly might be able to help you. Call the Legal Services for the Elderly Helpline at 1-800-750-5353 right away to speak to an attorney for free.