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Other Medical Assistance Programs Coverage Group Benefit FPL 1 2 3 4 Each Additional Person Qualifications and Special Rules Special Benefit Waiver (SBW) Limited Benefit 250% $3,325 $4,509 A MaineCare benefit for people living with HIV/AIDS who are not eligible in another coverage group. Must comply with treatment plan. A monthly premium may be required (see chart below). No asset test. Family Planning Limited Benefit 214% $2,847 $3,859 $4,871 $5,885 $1,012 Provides limited family planning services for individuals of any age not otherwise eligible for MaineCare. Only the income of the applicant is counted. No asset test. Breast and Cervical Cancer Limited Benefit 250% $3,325 $4,509 $5,692 $6,875 $1,184 For information visit: Maine CDC Breast and Cervical Health Program or call 1-800-350-5180 Emergency Services for Immigrants Limited Benefit Varies This coverage is a limited benefit to stabilize an emergency condition for immigrants who are ineligible for federal Medicaid benefits due to their immigration status or have no documents to verify their immigration status. Applicants must meet all eligibility factors for a MaineCare program, excluding U.S. citizenship and Social Security Number requirements. Income limits and asset tests (if applicable) vary per program. Drugs for the Elderly and Disabled (DEL) Prescription Drug Benefit 185% $2,461 $3,337 A discount drug program for individuals who are aged 62 and older or have a disability and are not eligible for MaineCare. No asset test. Maine Rx Plus Prescription Drug Benefit 350% $4,655 $6,312 $7,969 $9,625 $1,657 A discount prescription drug program for individuals who are over income for MaineCare. No asset test. Medically Needy Deductible Full MaineCare Benefit Varies Deductibles are available for some individuals who meet all the conditions to qualify, except their monthly income is more than the monthly limit. To qualify for MaineCare, the person must spend down their monthly income to the MaineCare income standard. When the deductible is met, coverage will be granted for the remainder of a limit time period (usually 6 months or less). * Up to $8,000 of savings for an individual, $12,000 for a couple may be excluded. Any amount over the excluded amount is counted toward the asset limit.