C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-65, subsec. 144-101-II-65.11
Co-payment exemptions and dispute resolution are described in Chapter I, Section 1 of the MaineCare Benefits Manual.
Services furnished to members under twenty-one (21) years of age are exempted from co-payments.
Co-payment does not apply to tobacco cessation treatment services.
A co-payment will be charged to each MaineCare member twenty-one (21) and older for services. The amount of the co-payment shall not exceed $2.00 per day, per service or $2.00 per week for Opioid Treatment Program Services with Methadone for services provided according to the following schedule.
MaineCare Payment for Services | Member Co-payment |
$10.00 or less | $.50 |
$10.01 - $25.00 | $1.00 |
$25.01 or more | $2.00 |
The member shall be responsible for co-payments up to twenty dollars ($20) per month per service whether the co-payment has been paid or not. After the twenty-dollar ($20) cap has been reached, the member shall not be required to make additional co-payments and the provider shall receive full MaineCare reimbursement for covered services.
The provider shall not deny services to a MaineCare member on account of the member's inability to pay a co-payment. Providers must rely upon the member's representation that he or she does not have the money available to pay the co-payment. However, the individual's inability to pay does not eliminate his or her liability for the co-payment.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-65, subsec. 144-101-II-65.11