Written by a parent, not a doctor. Nothing here is medical advice.

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Maine program

Health insurance for your child (MaineCare)

MaineCare is health insurance for children and young adults under 21. It can sit behind work insurance.

What it is

MaineCare is health insurance for children and young adults under 21. It can sit behind work insurance.

MaineCare can cover a child with or without work insurance. Eligibility uses current monthly income, so a change in pay can matter. Maine decides who belongs in your child’s household and which income counts.

Eligibility rules
  • You must live in Maine and meet the coverage rules. Current income-based child and young-adult MaineCare includes ages 19 and 20. CHIP and Katie Beckett have separate under-19 limits.
  • The 2026 monthly limits are $4,057 for one person, $5,501 for two, $6,944 for three and $8,388 for four.
  • The base limit is 300% of poverty. Maine publishes 305% after its five-percentage-point allowance when income exceeds the base.
  • This category has no asset test. A yearly income divided by 12 is only an estimate of current monthly income.
  • Children under 21 can receive the same scope of coverage regardless of immigration status.
How two plans can work together
  • Your work insurer is billed first. For covered care from a MaineCare-enrolled hospital or clinic, you generally do not owe the work plan’s deductible, copay or coinsurance, even when MaineCare pays $0. The hospital must check the service and both plans’ rules.
  • Full MaineCare also opens a separate review for help with a qualifying private premium through PHIP.
What needs checking
  • The hospital and pharmacy need both insurance cards. Your cancer team’s participation and each plan’s treatment rules matter.
  • Keeping work insurance can preserve access, but you still pay its premium unless separate help is approved.
What you get
  • No monthly premium for your child’s coverage.
  • Hospital care, chemotherapy, medicines, dental care and vision care.
  • Rides to covered appointments, with home nursing reviewed separately.
  • Eligible earlier bills can be covered.
What the help includes
  • Services must meet MaineCare coverage requirements. Nursing at home requires a separate assessment and approval.
  • Eligible bills can reach back three months before the application month through 2026. For children, the period becomes two months on January 1, 2027.
If you decide to apply
  1. Ask the hospital financial counselor to help you complete the MaineCare application at My Maine Connection.
  2. Have identity documents, a Maine address, current pay information and insurance cards ready. Include earlier medical bills.

Office for Family Independence: 1-855-797-4357 · Official page ↗

After you ask
  • OFI must decide within 45 days. If it has not, Maine gives temporary coverage from day 46 as long as you have supplied what it asked for.
  • An eligible child under 19 generally keeps MaineCare for 12 months despite income changes, subject to limited exceptions. This guarantee does not automatically extend to ages 19 and 20. OFI confirms the continuous-coverage period for your child.
  • An income denial can lead to separate reviews of Katie Beckett and the Medically Needy Deductible. The first requires disability and care assessments; the second requires a qualifying category and medical-bill calculation. Neither route is approved by the income screen alone.
  • A qualified hospital can assess temporary hospital presumptive eligibility. It starts on the hospital’s decision date. The period ends on the later applicable date: the last day of the following month, or the final eligibility decision when a full application was submitted by that month’s end.
  • If MaineCare reduces or stops an existing authorized service, the notice may set an earlier deadline to keep it during appeal. The continuation request must reach the proper office before the intended action date and meet the other conditions.
  • You have 60 days from a notice to appeal, and a decision usually comes within 90 days; urgent service appeals are decided in three working days.
Good to know

Your work plan is billed first. For covered care, a MaineCare-enrolled hospital or clinic generally cannot collect the remaining private-plan patient charges; service and billing rules still apply.

Other details
  • For example, assume the work plan allows $6,000, applies a $3,000 deductible and pays $3,000. There is no other private cost sharing in this example. If MaineCare allows $2,000, its additional payment is $0. For covered, properly authorized care from an enrolled clinic, the family still owes $0. Noncovered care or a valid advance private-pay agreement has different rules.
  • A generic signature or a preventable billing denial does not by itself establish valid private pay. If you already paid, the billing counselor can review an adjustment or refund; MaineCare does not necessarily reimburse you directly.

Federal background: Medicaid · Medicaid as second insurance.

Official sources
Ask your social worker

“What are the benefits and drawbacks of MaineCare for my child, including using it with work insurance? If it makes sense to apply, could you help us?”

Why I’m asking: I want to understand what MaineCare would cover and how it could reduce treatment bills.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File at mymaineconnection.gov, give this month's income for the tax household, and name the months that already have bills.

Your social worker

The oncology social worker or hospital financial counsellor helps you file and holds the account while the application is pending.

The care team

Nothing for ordinary child MaineCare. Medical records are needed only for the Katie Beckett category.

Who decides
The Office for Family Independence decides on income. The Department of Health and Human Services runs the coverage.
Ask your social worker
“Can you help me file the MaineCare application today, ask for the three months before it, and put a hold on the bills while it is pending?”

How to apply

First step: Apply at mymaineconnection.gov or call 1-855-797-4357 this week.

  1. Apply at mymaineconnection.gov this week, or call 1-855-797-4357.
  2. List every month with bills so the three-month look-back covers the admission.
  3. Tell the hospital billing office that a MaineCare application is in, so the account is held.

Official application / program page ↗

Where it starts: Apply at mymaineconnection.gov or call 1-855-797-4357. Ask the hospital financial counsellor to help you file the same week.

What to gather

  • The child's birth certificate or identity document and Social Security number
  • A Maine address
  • This month's pay for each parent in the tax household
  • Insurance cards, if any
  • Hospital bills from the three months before you apply

How long: An ordinary decision is due within 45 days. Day-46 temporary coverage has cooperation and reasonable-opportunity exceptions; the caseworker checks the actual delay.

What a yes looks like

A notice identifies the category and coverage dates. Eligible children under 19 generally have 12-month continuous coverage, subject to limited exceptions.

What a no looks like, and the next move

Read whether the no was about income, a document or a category. If it was income, ask for Katie Beckett by name and appeal by the date on the notice.

Watch out

  • Do not cancel the work plan to apply. MaineCare pays last and sits behind it.
  • Ask for the three months before the application month by name. That window becomes two months on January 1, 2027.
  • If the answer is no on income, ask about Katie Beckett in the same breath: it leaves your income out.

Dates that change this

2027-01-01: Coverage reaches back up to three months before the application month now. From January 1, 2027 that becomes two months for children.

2026-01-01: Maine's own day for adopting each year's poverty guidelines was not published, so the 2026 table is dated by year only. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full MaineCare with no premium. The published monthly line is $8,388 for four people, $6,944 for three, $5,501 for two and $4,057 for one.

  • $4,057/month — Household of 1, published monthly line
  • $5,501/month — Household of 2, published monthly line
  • $6,944/month — Household of 3, published monthly line
  • $8,388/month — Household of 4, published monthly line
  • $9,832/month — Household of 5, Medicaid Ombudsman chart cell, not a state table
  • $11,275/month — Household of 6, Medicaid Ombudsman chart cell, not a state table

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Everything medically necessary for a child under 21, through VitalCare for Kids · Home nursing and personal care when approved · Rides to appointments, and dental and vision care

Legal protection: Generally 12 months of coverage for eligible children under 19 despite income changes, subject to limited exceptions. · Ordinary decision within 45 days; day-46 temporary coverage has cooperation and reasonable-opportunity exceptions.

What it costs the family: No premium. No savings test.

The eligibility facts, as published

Age
under 21 for the current ordinary child/young-adult income group; separate age rules govern CHIP and Katie Beckett
Age max exclusive
21
Income
MAGI household income at or under 300% of the poverty level, with a five-percentage-point allowance subtracted when income is over that standard; the state publishes the result as 305%
Assets
no asset test for any group using MAGI rules
Insurance status condition
none: MaineCare is always the last payer, so private insurance does not block it
Residency
Maine
Continuous eligibility
Generally 12 months for an eligible child under 19, subject to limited exceptions; this does not automatically extend to ages 19 and 20.
Retroactive months
3 now; 2 from January 1, 2027
Processing standard
Ordinary decision within 45 days; temporary coverage from day 46 subject to cooperation and reasonable-opportunity exceptions.

Decisions this site cannot make: Office for Family Independence income determination

Expect friction on: Checking that the oncology team bills MaineCare

The trap: Work insurance is billed first. For MaineCare-covered, properly authorized care from an enrolled clinic, payment-in-full rules generally protect the family from private cost sharing even when MaineCare pays $0. Noncovered care and valid advance private-pay arrangements have separate rules.

Where I read this

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