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• Maine submitted its sixth amendment on June 29, 2005. This amendment adds DirigoChoice, a managed care entity, as a service delivery option for the state’s title XXI program.

Children Covered Under the Program

• The State reported that 30,947children were ever enrolled in CHIP in Federal fiscal year (FFY) 2008.

Administration

• Maine’s Department of Health and Human Services (DHHS) oversees the administration of the MaineCare program. The MaineCare program contains both title XIX and title XXI programs and both are administered in the same manner. Three Bureaus within DHHS share functional responsibility for the title XXI program: the Office of MaineCare Services (OMS) has primary responsibility for administration and oversight; the Office of Integrated Access and Support (OIAS) determines eligibility; and the Maine Center For Disease Control (Maine CDC) oversees the EPSDT, HSI, and immunization programs and conducts outreach and education activities.

Health Care Delivery System

• MaineCare primary care case management initiative is operational in all 16 counties. MaineCare children covered under title XXI funding access services through primary care case management.

• MaineCare members may voluntarily enroll in DirigoChoice, a managed care entity, if they work for a DirigoChoice eligible business that offers the DirigoChoice plan to its employees and they meet the requirements of an eligible employee. MaineCare members who are dependents of DirigoChoice members may also enroll in DirigoChoice.

• MaineCare members not participating in primary care case management or the DirigoChoice initiative can access services through the fee-for-service system.

Benefit Package

• The current Medicaid health benefit package is provided for both the Medicaid expansion and the separate child health program.