10-144-333 Me. Code R. § 1

Current through 2024-51, December 18, 2024

Section 144-333-1 - COVERED INDIVIDUALS

I.Age

Individuals must be age 62 or older or age 19 through age 61 and meet the disability criteria for SSI (Supplemental Security Income under Title XVI of the Social Security Act). See 10-144, C.M.R. Ch. 332, Part 6, Section 5.1.

II.Residence

Individuals must meet Medicaid criteria for residence (See 10-144, C.M.R. Ch. 332, Part 2, Section 4).

III.Citizenship

Individuals must meet Medicaid criteria for citizenship, except they do not need to provide documentation of citizenship or identity (See 10-144, C.M.R. Ch. 3 32, Part 2, Section 3).

Certain individuals who do not meet the Medicaid citizenship requirements may be eligible for DEL. They are:

A.Undocumented noncitizen - noncitizens who do not have documentation of their citizenship status from the U.S. Citizenship and Immigration Services.

B.Ineligible noncitizen - noncitizens legally admitted on a temporary basis. The following are examples of individuals who are ineligible noncitizens:

1. Foreign government representatives on official business and their families and employees;

2. Visitors for business or pleasure, including exchange visitors;

3. Noncitizens in travel status while traveling directly through the United States;

4. Crewmen on shore leave;

5. Treaty traders and investors and their families;

6. Foreign students;

7. International organization personnel and their families and servants;

8. Temporary workers, including agricultural contract workers;

9. Members of foreign press, radio, film or other information media and their families; or

10. Parolee in the U. S. under Section 212 (d)(5) for less than one year unless they are granted "temporary parolee status."

The following individuals are not eligible for DEL. They are considered to be residents of a public institution.

I. Inmates of the state prison, juvenile corrections facilities, local or county jails.

II. Individuals admitted to reside in a public (or private) medical institution classified as an IMD (Institution for Mental Disease) for over thirty days: Spring Harbor, Acadia, Riverview Psychiatric Center, Dorothea Dix Psychiatric Center.

Section 1.1DEL and Medicare Part D

An individual who meets all criteria in this Chapter will have their benefit affected by the following conditions:

I. Individuals who are enrolled in Medicaid or HIV Limited Benefit are not eligible for DEL unless they are also eligible for Medicare Part D.

II. Individuals who apply for DEL and who are eligible for Medicare Part D must take action to enroll in Medicare Part D and a Prescription Drug Plan at the next available opportunity to do so.

III. Individuals who are enrolled in DEL and subsequently become eligible for Medicare Part D must enroll in Medicare Part D and a Prescription Drug Plan at the first available opportunity to do so.

If the individual does not comply with II. or III. above they are ineligible for DEL until they comply.

There is good cause for not enrolling in Medicare Part D and a Prescription Drug Plan if:

I. The individual is denied enrollment by Medicare or by a Medicare Prescription Drug Plan due to circumstances beyond their control.

II. The individual has prescription drug coverage which is determined by the insurer to be creditable coverage. Creditable coverage means that the coverage on average is at least as good as the standard Medicare Prescription drug plan.

10-144 C.M.R. ch. 333, § 1