10-144-332 Me. Code R. § 9-5

Current through 2024-51, December 18, 2024

Section 144-332-9-5 - COVID-19 TESTING FOR UNINSURED INDIVIDUALS

The Families First Coronavirus Response Act (FFCRA) H. R. 6201, 116 Cong. (2019-2020), P. L. No. 116-127 (3/18/2020), 134 STAT 178 et seq. specified in Division F, Section 6004(a)(3) that State Medicaid programs were authorized to create an optional coverage group to ensure services related to testing and diagnosis of COVID-19 are available in response to the pandemic, pursuant to Section 1902(a)(10)(A) (ii)(XXIII) of the Social Security Act, 42 U. S. C. 1396a(a)(10) as amended. This is a limited coverage benefit that is effective March 18, 2020 and ends on the last day of the month within which the federal public health emergency (PHE) ends unless otherwise directed by CMS. Coverage under this group is available to individuals who are without health insurance, or whose health insurance coverage does not meet the requirements for minimum essential coverage.

On April 28, 2020 the Governor's Executive Order 48, FY19/20 suspended and modified the relevant provisions of the Maine Administrative Procedure Act in order for these rule changes to:

(1)remain in effect until the later of the end of the Federal Proclamation of Emergency or the end of CMS's approval of the MaineCare program changes, even if that period exceeds ninety days; and

(2)automatically repeal upon termination of the Federal Proclamation of Emergency or the end of CMS's approval of the MaineCare program changes (whichever is later), without further rulemaking by the Department.

In the event of a conflict between this emergency rule and any other MaineCare rule, the terms of this rule supersede other rules and shall apply.

Section 5. 1: Basic Eligibility Requirements

Basic Non-Financial eligibility requirements for getting full MaineCare coverage, identified in Part 2 apply to this coverage group. This includes the rules on residency, citizenship, social security numbers, and assignment of rights to medical payments and support rights, as well as applying for other benefits.

In order to receive benefits under this category, an individual must not be:

A. Eligible to receive coverage under a mandatory Medicaid eligibility group.

B. Enrolled in Medicaid health care coverage, except that individuals who are enrolled in a limited benefit Medicaid eligibility group will not be considered to be enrolled in health coverage as a result of such enrollment and therefore may meet the definition of uninsured individual. Limited coverage groups include individuals infected with tuberculosis, individuals eligible for the Limited Family Planning Benefit, and individuals eligible as Medically Needy.

C. Enrolled in another health care program funded by the federal government, including CHIP, Basic Health Program, Medicare, TRICARE and Veterans Administration, and federal employee plans.

D. Enrolled in a group health plan or health insurance coverage offered by a health insurance issuer (as defined in section 2791 of the Public Health Service Act), including: a qualified health plan through the federally facilitated marketplace, employer-sponsored health insurance, retiree health plans and COBRA continuation coverage.

Section 5. 2: Assets

There is no asset test for this coverage group.

Section 5. 3: Income

There is no income limit for this coverage group.

10-144 C.M.R. ch. 332, § 9-5